| BackgroundResidual wounds are very common in the late stage of the patients with extensive and deep burn.This kind of wounds are difficult to heal,and often delay the treatment procedure.Debridement and autologous skin graft again is the commonly used treatment methods for extensive residual wounds.However,the residual wounds are complicated with uneven bases,irregular edges,severe infection,and the vital tissue usually mix together with the necrotic tissue,which making it rather difficult to be debrided thoroughly.The debridement effect of the traditional method using the conventional sharp surgical instruments,such as scalpel,scissors and tweezers,is difficult to achieve the desired results,because it is hard to remove the necrotic tissue thoroughly,as well as a high postoperative wound infection rate,low survival rate of skin grafts and long wound healing time because of excessive damage of health tissue.Therefore,more advanced debridement instruments and more scientific debridement methods are necessary for the debridement of large residual wound of severe burns.The hydrosurgery system introduced to China recent years is an advanced debridement equipment,which has many advantages comparing with the conventional sharp surgical instruments,clearer surgical vision,more convenient to handle and control,and safer operation.In addition,the hydrosurgery system is hihly selective,which preserving the healhy dermis while remove the necrotic tissue to the maximum extent.The hydrosurgery system has been used for the debridement of early stage burn wounds for more than 10 years,and its effect has been widely accepted.But for the debridement of extensive residual wounds of late treatment stage of patients with severe burn,related studies and reports are seldom.Objective:To evaluate the efficacy of the hydrosurgery system applied in the debridement of extensive residual wounds of patients with severe burn,so as to provide some scientific evidences for surgeons when selecting the appropriate debridement methods for repairing this kind of wounds,and to further improve the debridement effect and success rate of skin grafting,and to shorten the hospitalization.Methods:This is a prospective randomized controlled clinical study.We enrolled the severely burned patients with extensive residual wounds after treatment were admitted into Department of Burn Surgery of Changhai Hospital of the Second Military Medical University from May 2012 to November 2015.The patients were divided randomly into hydrosurgery system debridement group(HD)and traditional debridement group(TD),and their residual wounds were debrided by a hydrosurgery system and conventional surguical instruments respectively.The wounds of patients in the two groups were repaired with stamp-like grafts made from split-thickness autoskin after debridement.Second time of debridement and skin grafting as above was performed if necessary.The time used in debriding 1% TBSA wound in the first surgery,positive rate of bacterial culture of wound exudate on post first surgery day(PFSD)3,survival rate of skin grafts on PFSD7,second debridement rate,and wound healing time of patients in two groups were compared.Data were processed with two independent-sample t test and chi-square test.Results:76 patients meeting the inclusion criteria were enrolled,34 in group HD and 42 in group TD.The preoperative positive rate of bacterial culture of wound exudates of patients of the two groups were both 100%.There were no significant differences in gender,age,total burn area,Ⅲ degree burn area,residual wounds area and the start time of the first debridement of residual wounds of the two groups(P〉0.05).The time used in debriding 1%TBSA wound of patients in the first surgery in group HD was(1.2±0.3)min,which was shorter than that in group TD[(1.9±0.4)min,t=-9.098,P<0.001].On PFSD,positive rate of bacterial culture of wound exudate of patients in group HD was 11.76%(4/34),which was lower than that in group TD [38.10%(16/42),χ2=6.718,P=0.010].On PFSD 7,the survival rate of skin grafts of patients in group HD was(90±8)%,which was higher than that in group TD[(83±15)%,t=2.334,P=0.022].The second debridement rate of patients in group HD was 5.88%(2/34),which was lower than that in group TD[23.81%(10/42),χ2=4.542,P=0.033].The wound healing time of patients in group HD was(10.6±1.5)d,which was shorter than that in group TD[(13.3±2.5)d,t=-5.442,P<0.001].Conclusion:To compare with the traditional debridement method in the debridement of extensive residual wounds of patients with severe burn,the hydrosurgery system could reduce the debridement time,decrease the postoperative wound infection rate,reduce the number of debridements,improve the survival rate of skin grafts and accelerate wound healing.In general,the hydrosurgery system applied in the debridement of extensive residual wounds of patients with severe burn is thorough,highly efficient and beneficial to optimize the wound-bed,which is expected to replace the traditional way as a standard debridement method for this kind of wounds in the future. |
