Hydrosurgery for Excision of Partial - Thickness Burn Wounds - Procedure, Advantages, and Disadvantages

Introduction

Wounds are common and may occur due to any trauma or injury on the skin surface. Burn is a type of wound that arises from skin burns. Skin burns can occur from various sources such as electricity or current, mechanical, chemical, etc. It may affect the superficial layer, middle layer, or all the layers of the skin. Based on this, there are three types of skin burns. In addition, based on the causative agents, there is a different classification of burns.

When a burn occurs, removing the dead tissues and reducing the bacterial load is essential, allowing quick healing and providing an appropriate wound bed for skin grafts. Traditionally, sharp knives are used for surgical debridement to remove dead tissues from the wound. However, nowadays, hydrosurgical debridement is preferred over traditional techniques. This method uses a high-pressure jet of water and saline to remove the dead tissues and reduce the bacterial load.

What Is a Burn?

It is a wound caused by different types of energy such as chemical, electrical, thermal, and electromagnetic.

What Are the Types of Burns?

Burns are classified as:

1. Physical Burn - It is caused by physical force or friction.

2. Thermal Burn - It is caused by a heat source that increases the skin temperature resulting in tissue charring or death. For example, hot metals, steam, flame, and hot liquid. There are two types:

   • Dry heat.

   • Wet heat.

3. Electrical Burn - An electrical current causes it. The source of the current can be alternate or direct. There are two types of current sources:

   • High voltage.

   • Low voltage.

4. Radiation Burn - It is caused by prolonged standing exposure to ultraviolet rays or X-rays.

5. Laser Burn - The exposure of a laser beam causes it.

6. Chemical Burn - It is caused by strong acids, detergents, or other solutions that come in contact with the skin and cause damage. The chemicals can be of three types:

   • Acid.

   • Alkali.

   • Others.

What Is the Classification of Burn Wounds?

There are three types of burn wounds:

1. First Degree Burn - It is also called superficial burn. The external layer of skin is burned and occurs as a red, dry, and painful wound - for example, sunburn.

2. Second Degree Burn - It is also called partial thickness burn. The superficial layer (epidermis) and middle layer (dermis) are damaged or burned. The skin becomes red and swollen, and blisters develop on the wound.

3. Third Degree Burn - It is also called full-thickness burn. All the skin layers are damaged and may also involve underlying bones and muscles. The affected area becomes numb due to damage to the nerves. It appears white and charred.

What Is Burn Debridement?

It is the removal of damaged tissues followed by wound dressing. It allows the healing of the burn. There are various debridement techniques, as mentioned below:

1. Surgical Debridement:

• It is the standard gold treatment.

• The foreign bodies and dead tissues, and skin are removed.

• It helps in reducing the bacterial load in the wound.

• It is performed with different surgical knives such as Weck knives or Blair knives.

• It is indicated for partial-thickness and full-thickness burns.

• It aids in wound healing and less scarring.

2. Hydrosurgical Debridement or Hydrosurgery:

• It is a new tool used for wound debridement and is a minimally invasive procedure.

• The water jet and saline with high pressure are used to remove the foreign bodies and dead tissues.

• The jet comes out through a small, narrow nozzle.

• It creates a Venturi effect (decrease in fluid pressure while going through a narrow passage, such as the nozzle of the jet).

• This jet removes the damaged tissue and skin. It is then collected through a suction attached next to the jet.

• The jet is angled at 45 degrees, attached to a console, and handled through a foot pedal.

• The pressure of the jet is adjustable based on the requirement.

What Are the Advantages of Hydrosurgical Debridement?

1. Cost-effective.

2. Decreases the number of debridements.

3. Preserve underlying skin.

4. The tool used in this method is relatively small and quickly reaches hard-to-reach areas.

5. Provides more accurate debridement.

6. Results in fast operating time.

7. Less blood loss.

8. Healing time is fast, generally seven to 11 days.

9. Low rate of infection after the surgery.

What Are the Disadvantages of Hydrosurgical Debridement?

1. The high pressure may cause irregularity in the tissues or skin surface.

2. Requires special equipment.

What Are the Other Methods of Wound Debridement?

1. Autolytic Debridement - It occurs through a natural process in which specific cells and enzymes break down the damaged tissues. It is used only in non-infected wounds. It is generally used as an adjunct to other therapies.

2. Biological Debridement - It is also called larval therapy, in which a sterile larva removes damaged tissues.

3. Enzymatic Debridement - It uses collagenase enzymes to digest the collagen present in the damaged tissues. It is a slow method of debridement.

What Are the Complications of Wound Debridement?

1. High risk of bleeding or blood loss from the wound.

2. Increased pain.

3. Allergic reaction to anesthesia.

What Are the Indications of Hydrosurgical Debridement?

1. To remove the dead tissues.

2. To reduce bacterial load in the wound.

3. To reduce the infection rate.

4. To obtain appropriate samples for culture.

5. To aid in the healing process.

6. To provide a proper wound bed for placing a skin graft or flap.

What Are the Contraindications of Hydrosurgical Debridement?

1. Dry eschar (dead tissues that are shed off from the skin).

2. Absence of infection in the wound.

Why Is Wound Debridement Done?

The main aim of wound debridement is to obtain a clear wound bed for the placement of skin grafts and to fasten the healing process.

Conclusion

Burns are the most crucial and complicated wound that requires immediate care. The cleaning of the burn wound is essential to support the healing process. It is called debridement, in which the dead tissues are removed. There are various techniques available to perform the debridement. Surgical debridement is the gold standard and a traditional method done with sharp knives. Newer techniques include hydrosurgery or hydrosurgical debridement. The newer techniques are more effective and minimally invasive.