Jwc ewma final indd

J O U R N A L  O F WO U N D  C A R E   Vo l   2 2 .  N o   1 .  E W M A   D o c u M E N t   2 0 1 3

Technicalsolutions

T

his section will describe and discuss some 

of the most widely-used technologies 

among the different available options, 

such as hydrosurgery, negative pressure wound 

therapy (NPWT) and ultrasound.

Among these, some options, such as hydrosurgery 

and ultrasound, act via a direct debriding action 

on the wound and may be defined as direct 

debridement technologies (DDT). Others, such as 

low-frequency ultrasound and NPWT, act indirectly, 

activating elements and conditions in the wound 

that subsequently promote debridement. These may 

be defined indirect debridement technologies (IDT).

Directdebridement

technologies

Jet lavage/hydrosurgery

Background

The principle of jet lavage debridement 

(hydrosurgery) is basically an evolution of the lavage 

of wounds, used since the ancient times in acute 

wounds and, more recently, in chronic wounds.

Mechanismofaction

It is related to water irrigation, which can 

physically remove foreign bodies, debris and  

any other kind of loose material from the wound. 

The more intense and fast the irrigation, the  

more intense are the energies transferred to  

the tissues and consequently the more extensive 

the debridement.

Many different technologies have been developed 

in this area, and many different devices have been 

produced. Some are gentle, while others are so 

aggressive that they may be considered similar to 

certain surgical tools.

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The gentler options can be used for removal of 

necrotic debris, slough and biofilms and all other 

types of material with a loose structure that have 

a weak consistence and may be removed easily. 

The more powerful options, especially those using 

the so-called Venturi effect, have the capacity to 

precisely debride dense fibrotic tissues and materials, 

and may in some cases be used on bone structures, 

depending on the velocity and intensity of the jet 

stream passing through the instrument tip.

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The precision and the versatility of this kind of 

device are so flexible that they can be applied in 

many different conditions and clinical models, 

from venous leg ulcers to post-surgical diabetic foot 

ulcers, depending on their settings.

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Another interesting aspect of this technology is the 

possibility to combine it with antiseptic solutions. 

This may maximise the antimicrobial activity, which 

is an important part of the debridement procedure. 

When used with the new classes of antiseptics, such 

as super-oxidised solutions or solutions containing 

polyhexanide (PHMB; these both have a neutral 

pH, are not harmful, per se, on the tissue and are 

active against all kinds of infectious material); in 

particular, the hydro surgical devices may act as a 

physical and biological debrider.

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