Treatment of deep partial thickness and indeterminate depth facial burn wounds with water-jet debridement and a biosynthetic dressing

Abstract

Background: Debriding deep thermal injury to face and neck can be particularly challenging with cold knife techniques. Timely healing, a precondition for minimal scarring, is dependant upon optimal wound bed preparation.

Objective: A new water-jet surgical tool (Versajet) (Smith & Nephew, Hull, UK) has been designed for wound debridement. Ex vivo histologic analysis of depth of debridement on human skin confirmed that predictable and controlled depth of debridement could be obtained by adjusting apparatus settings.

Methods & materials: We prospectively studied the versatility of this instrument for the treatment of deep and indeterminate depth face and neck burns. Wounds were then covered with either a biosynthetic (Biobrane) (Bertek Pharmaceuticals Inc) or cultured biosynthetic dressing (TransCyte).

Results: Patient follow-up demonstrated no adverse effects. Placement of biosynthetic dressings was compatible with water-jet debridement. Median healing time for wounds covered with biosynthetic dressings was 14 days, and 12 days for those which received the cultured biosynthetic dressing.

Conclusion: We have found the water-jet system to be a versatile instrument for surgical burn debridement with particular advantage in addressing the challenging and delicate contoured regions found in the face and neck. Accurate control of debridement depth facilitates wound bed preparation for simultaneous treatment with growth promoting biosynthetic dressings.