Hydro-surgical debridement tools: worth the investment?

Horses often sustain traumatic wounds, commonly associated with tissue loss, necrosis and heavy contamination [1]. Whenever possible, primary closure is preferred over healing by second intention. Primary closure reduces the risk of further wound contamination and infection and, if successful, healing is faster with a superior cosmetic and functional outcome [2]. Second-intention healing, of distal limb wounds in particular, is at high risk of complications such as chronic inflammation, the development of exuberant granulation tissue, poor wound contraction and slow epithelialization [3]. Effective debridement is the essential first stage in reducing the risk of wound infection, considered to be a important cause of dehiscence and impaired healing overall [4]. Traditional wound debridement involves sterile saline irrigation and sharp resection. However, this is time-consuming, laborious, and inefficient. With sharp debridement, there is always a risk of removing viable tissue or leaving necrotic tissue in the wound, especially when the margin between the two is ill defined.

A more effective hydrosurgical device (VersajetTM) was launched in 1997 and is routinely used in the human field to manage burns [5–7] and a variety of other acute and chronic wounds [8, 9]. The system has now been adopted by many equine hospitals, and has proven to be cost effective since the handles can be reused. It consists of a foot-pedal-activated power console, a handpiece connected to a sterile saline supply and a waste tube that can be connected to a receptacle (Figure 1). A high-pressure stream of sterile saline jets across the operating window of the handpiece and, while cutting, creates a localised suction (Venturi) effect (Figure 2). [...]