Efficacy of hydrosurgical excision combined with skin grafting in the treatment of deep partial-thickness and full-thickness burns: A two-year retrospective study |
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| Institution: | 1. Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China;2. The School of Pharmacy, Anhui Medical University, Hefei, Anhui 230032, PR China;1. Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel;2. Kauffmann-Green Skin Engineering Laboratory, The Division of Plastic Surgery and the Intensive Care Burn Unit, Sheba Medical Center, Tel Hashomer, Israel;3. The Division of Plastic & Reconstructive Surgery and The Intensive Care Burn Unit, Sheba Medical Center, Israel;4. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;5. University of Notre Dame Australia, Fremantle, Western Australia, Australia;6. Talpiot Leadership Program, Sheba Medical Center, Tel Hashomer, Israel;7. Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel;8. The Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, Israel;1. University of Western Australia, Burn Injury Research Unit, 35 Stirling Highway, Crawley, Western Australia 6009, Australia;2. Telethon Kids Institute, University of Western Australia, 15 Hospital Ave, Nedlands, Western Australia 6009, Australia;3. Fiona Wood Foundation, 11 Robin Warren Dr, Murdoch, WA 6150, Australia;4. Burn Service of Western Australia, Fiona Stanley Hospital, MNH (B) Main Hospital, Level 4, Burns Unit, 102-118 Murdoch Drive, Murdoch, Western Australia 6150, Australia;5. Burns Unit, Perth Children’s Hospital, 15 Hospital Ave, Nedlands, WA 6009 Australia;1. Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan;2. Department of Emergency and Acute Medicine, Saitama Medical University International Medical Center, Saitama, Japan;3. Division of Traumatology, Research Institute, National Defense Medical college, Saitama, Japan;4. Department of Psychiatry, National Defense Medical College, Saitama, Japan;5. Department of Mathematics, National Defense Medical College, Saitama, Japan;1. Victorian Adult Burn Service, The Alfred, Melbourne, Australia;2. Department of Epidemiology and Preventive Medicine, Monash University, Australia;3. Heath Data Research UK, Swansea University Medical School, Swansea University, United Kingdom;4. Emergency and Trauma Centre, The Alfred, Melbourne, Australia;1. Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Islamic Azad University, Urmia, Iran;2. Department of Medical-Surgical Nursing, Nasibeh School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran;3. Department of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran;4. Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran |
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| Abstract: | IntroductionDeep partial-thickness and full-thickness burn wounds often undergo tangential excision or escharectomy to expose healthy tissue, combined with skin grafting to promote wound healing. However, conventional tangential excision with the humby knife leads to inevitable damage to the dermis while excising burn tissue due to the lack of precision. Indeed, the preservation of dermal tissue is a key factor in determining wound healing and scar quality. The precision and tissue selectivity of the Versajet Hydrosurgical System has been established for excising burn tissue while preserving dermal tissue. In this study, we retrospectively compared the efficacy of "Hydrosurgical excision combined with skin grafting" and "Conventional tangential excision combined with skin grafting" in treating deep partial-thickness and full-thickness burn wounds to demonstrate that hydrosurgery improved the treatment of deep partial-thickness and full-thickness burns.MethodsA total of 86 patients with deep partial-thickness and/or full-thickness burns with a total burn surface area (TBSA) ≤ 25% from July 2018 to July 2020 were included in this study and were divided into experimental (hydrosurgical excision combined with skin grafting, n = 43) and control (conventional tangential excision combined with skin grafting, n = 43) groups. Parameters were analyzed, including the intraoperative blood loss volume per unit area of grafted skin, surgery duration, wound healing time, skin graft survival, and the treatment costs per unit of burned area. Scar assessment was performed at 1 year with the modified Vancouver Scar Scale linked with TBSA (mVSS-TBSA).ResultNo significant difference was found in male to female ratio, age, weight, TBSA, burn depth, skin grafting area (SKA), skin grafting methods, cases treated with carbon dioxide fractional laser or incidence of inhalation injury, and the incidence of hypovolemic shock between two groups(p > 0.05). Compared with the control group, patients treated with hydrosurgical excision combined with skin grafting experienced less intraoperative blood loss volume per unit area of grafted skin (p < 0.05). The mVSS-TBSA of patients that underwent hydrosurgical excision combined with skin grafting was significantly improved in comparison to the control group (p < 0.01). No significant difference was found in surgery duration, wound healing time, skin graft survival and treatment costs per unit of burned area between the two groups (p > 0.05).ConclusionHydrosurgical excision combined with skin grafting reduced intraoperative blood loss volume per unit area of grafted skin, improved scarring 1-year after injury, and did not increase the treatment costs per unit of burned area. This technique provides a novel alternative for managing deep partial-thickness and full-thickness burn wounds. |
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| Keywords: | Hydrosurgical excision Deep partial-thickness and full-thickness burn Intraoperative blood loss volume per unit area of grafted skin Treatment costs per unit of burned area Scar |
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