A prospective randomised controlled trial was undertaken to compare conventional tangential burn wound debridement against the use of Versajet™ hydrosurgery in the treatment of partial thickness paediatric burns. Seventy-five children under the age of 16 were recruited for the study from the Burns Unit at The Children’s Hospital at Westmead, Sydney out of which 61 patients were found to be eligible. The outcomes looked at were stratified into immediate, short-term and long-term differences between each surgical method. Randomisation of patients was computer generated and accessed only after enrolment. The operating surgeons were not blinded to the study, however, all other staff involved in the care of the child were. Facial burns and patients with delayed presentation were excluded. After surgery, the adequacy of debridement was assessed histologically by taking 2mm punch biopsies pre and post debridement. Thirty-one patients underwent conventional debridement and 30 using hydrosurgery. However, after further exclusion due to inadequate debridement and also technical issues with the histological process, 22 who underwent conventional debridement and 19 who underwent hydrosurgery were assessed. More viable tissue was found to be lost in the conventional group (325µm compared to 35µm of tissue) and the difference was found to be significant. There were no significant differences found in the secondary outcomes between the two groups of graft take, postoperative wound infections, duration of surgery or time to healing. There was also no difference between the groups when assessing scarring using the Vancouver Scar Scale at three and six months post-graft take. The findings suggest that hydrosurgery may be a more precise method of burn wound debridement ensuring maximal dermal preservation. Despite this finding, there was no significant difference between hypertrophic scarring at three and six months post-burn. As dermal preservation may be a factor in reducing hypertrophic scarring, longer term follow-up of these patients should be considered.

Prospective, randomised controlled trial comparing Versajet™ hydrosurgery and conventional debridement of partial thickness paediatric burns.
Hyland E, D’Cruz R, Menon S, et al.

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Zeeshan Sheikh

NHS Lothian, UK

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