Mosti Giovanni, Iabichella Maria Letizia, Picerni Pietro, Magliaro Antonio, Mattaliano Vincenzo
Reparto di Angiologia e Cardiologia, Clinica Barbantini, Via Del Calcio 2, 55100 Lucca, Italy.
Int Wound J. 2005 Dec;2(4):307-14. doi: 10.1111/j.1742-4801.2005.00147.x.
Debridement plays an essential role in the wound-bed preparation of necrotic and sloughy ulcers, being a mandatory step to achieve a well-debrided bed, proceeding towards healing. This study reports our experience with Versajet [Versajet Hydrosurgery System (Smith & Nephew, Hull, UK)], a new device for the debridement of exudating ulcers, based on Fluidjet technology, which excises and aspirates the unwanted tissue by using the Venturi effect. In a 10-month time period, a total of 68 patients, out of a setting of 167 patients, hospitalised as affected by chronic, hard-to-heal leg ulcers, stuck in the inflammatory phase, were treated with Versajet. Based on ulcer characteristics and clinical conditions, the remaining 99 patients underwent traditional debridement with moist dressings (controls). In the majority of Versajet-treated cases (46), an adequately debrided wound bed was achieved with one operative procedure; two and three procedures were required in 17 and 5 patients, respectively. Almost all the procedures were performed in the ward at the patient's bedside. This procedure is quick (mean time per treatment is about 5 minutes); when compared with a traditional treatment with moist dressings, Versajet considerably shortens the in-hospital stay and promotes a quicker healing process. When used by an experienced surgeon, Versajet allows a selective debridement, as it makes it possible to remove only the tissue centred in the working end and spare the healthy tissue. Debriding with Versajet is highly effective in reducing the bacterial load of the ulcer bed. The pain caused by Versajet is well tolerated, especially when set for gentle debridement. If multiple treatments are required, the combined use with moist dressings is synergistic, as the dressings soften the necrotic tissue, thus facilitating the following Versajet debridement. The results indicate that Versajet offers more precision than standard mechanical debridement and, at high settings, offers an alternative to surgical debridement.
清创术在坏死性和腐肉性溃疡的伤口床准备中起着至关重要的作用，是实现清创良好的伤口床并促进愈合的必要步骤。本研究报告了我们使用Versajet[Versajet水刀手术系统（英国赫尔的施乐辉公司）]的经验，这是一种基于流体喷射技术的用于清创渗出性溃疡的新设备，它利用文丘里效应切除并吸出不需要的组织。在10个月的时间里，在167例因慢性、难愈合的腿部溃疡而住院且处于炎症期的患者中，共有68例患者接受了Versajet治疗。根据溃疡特征和临床情况，其余99例患者采用湿敷料进行传统清创（对照组）。在大多数接受Versajet治疗的病例（46例）中，一次手术操作就实现了充分清创的伤口床；分别有17例和5例患者需要进行两次和三次手术操作。几乎所有手术都是在病房患者床边进行的。这个操作很快（每次治疗平均时间约为5分钟）；与传统的湿敷料治疗相比，Versajet大大缩短了住院时间，并促进了更快的愈合过程。当由经验丰富的外科医生使用时，Versajet可以进行选择性清创，因为它能够仅切除工作端中心的组织，而保留健康组织。使用Versajet进行清创在降低溃疡床细菌载量方面非常有效。Versajet引起的疼痛耐受性良好，尤其是在设置为轻柔清创时。如果需要多次治疗，与湿敷料联合使用具有协同作用，因为敷料可软化坏死组织，从而便于后续的Versajet清创。结果表明，Versajet比标准机械清创更精确，在高设置下可替代手术清创。
