Burn Centre, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands.
Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Movement Sciences, Vrije Univeristeit Amsterdam, 1081 HV Amsterdam, The Netherlands.
Br J Surg. 2022 Mar 15;109(4):332-339. doi: 10.1093/bjs/znab470.
Tangential excision of burned tissue followed by skin grafting is the cornerstone of burn surgery. Hydrosurgery has become popular for tangential excision, with the hypothesis that enhanced preservation of vital dermal tissue reduces scarring. The aim of this trial was to compare scar quality after hydrosurgical versus conventional debridement before split-skin grafting.
A double-blind randomized within-patient multicentre controlled trial was conducted in patients with burns that required split-skin grafting. One wound area was randomized to hydrosurgical debridement and the other to Weck knife debridement. The primary outcome was scar quality at 12 months, assessed with the observer part of the Patient and Observer Scar Assessment Scale (POSAS). Secondary outcomes included complications, scar quality, colour, pliability, and histological dermal preservation.
Some 137 patients were randomized. At 12 months, scars of the hydrosurgical debrided wounds had a lower POSAS observer total item score (mean 2.42 (95 per cent c.i. 2.26 to 2.59) versus 2.54 (95 per cent c.i. 2.36 to 2.72; P = 0.023)) and overall opinion score (mean 3.08 (95 per cent c.i. 2.88 to 3.28) versus 3.30 (95 per cent c.i. 3.09-3.51); P = 0.006). Patient-reported scar quality and pliability measurements were significantly better for the hydrosurgically debrided wounds. Complication rates did not differ between both treatments. Histologically, significantly more dermis was preserved with hydrosurgery (P < 0.001).
One year after surgery scar quality and pliability was better for hydrosurgically debrided burns, probably owing to enhanced histological preservation of dermis.
Trial NL6085 (NTR6232 (http://www.trialregister.nl)).
切线切除烧伤组织后再进行植皮是烧伤外科的基石。水刀切除术在切线切除术中已变得流行，其假设是增强对重要真皮组织的保留可减少疤痕形成。本试验旨在比较水刀与传统削痂后再行刃厚皮片移植术的疤痕质量。
对需要行刃厚皮片移植术的烧伤患者进行了一项双盲、随机、患者内、多中心对照试验。一个创面区域随机接受水刀清创术，另一个创面区域接受威克刀清创术。主要结局是在 12 个月时采用患者和观察者瘢痕评估量表（POSAS）的观察者部分评估的疤痕质量。次要结局包括并发症、疤痕质量、颜色、柔韧性和组织学真皮保留。
共有 137 例患者被随机分配。在 12 个月时，水刀清创术的创面疤痕的 POSAS 观察者总项目评分较低（平均 2.42（95%置信区间 2.26 至 2.59）与 2.54（95%置信区间 2.36 至 2.72；P=0.023））和整体意见评分（平均 3.08（95%置信区间 2.88 至 3.28）与 3.30（95%置信区间 3.09-3.51；P=0.006）。水刀清创术创面的患者报告疤痕质量和柔韧性测量结果明显更好。两种治疗方法的并发症发生率无差异。组织学上，水刀切除术保留的真皮明显更多（P<0.001）。
手术后 1 年，水刀清创术的烧伤疤痕质量和柔韧性更好，可能是由于真皮的组织学保留增强所致。
NL6085 号试验（NTR6232（http://www.trialregister.nl））。
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