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  

S 2 7

Limitations

The principal limitation of this technology is that 

it may be painful for some patients and for this 

reason it should only be used when an adequate 

pain control can be achieved, such as by use of 

local anesthesia.

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Another issue is that jet lavage has been suspected to 

disseminate bacteria in the environment because of 

the formation of an aerosol during the application. 

This may contribute to the contamination of the 

setting in which the procedure is carried out.

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Although questionable, this objection emphasises 

the importance of an adequate education of the 

staff. The clinicians responsible should not only 

be trained by experienced staff members, but also 

supported by a system that includes periodical 

control of the incidence of nosocomial infections. 

Air contamination can be prevented by using 

adequate cuffs or protection that may effectively 

stop, or a least reduce, the diffusion of the aerosol 

in the environment.

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Costeffectiveness

Costs of jet lavage equipment vary according to the 

different technologies adopted, but are generally 

higher than other solutions, depending mainly on 

the costs of the consumables. On the other hand, the 

advantage of a fast, precise and effective technique 

make jet lavage interesting and widely indicated for 

use in the operation-room setting for complex and 

vast lesions, which can be effectively debrided in 

a single session, with local anaesthesia. Therefore, 

indications are the primary issue with regards to cost 

effectiveness; when used for the correct indications 

jet lavage is claimed to be cost effective, due to a 

reduction in cost of management in the hospital and 

shortened hospital stay in some cases.

ultrasound

Background

The most renowned application of ultrasound (US) 

in medicine is related to the diagnostic-imaging 

field, in which they reached a level of sophistication 

considered the golden standard in many areas of 

medicine and surgery. However, on the therapeutic 

side, many applications of ultrasound in the range of 

the megahertz (MHz) have recently been developed. 

These include surgical cutting and coagulation 

in laparoscopy or, to the specific interest of this 

document, in the debridement of chronic lesions.

Mechanismofaction

US can, depending on the frequency and intensity 

of the mechanical energy transmitted, interfere 

with many different structures, from inert protein 

material to cellular bodies, exerting a range of effects 

that may vary from destruction to dislocation and 

physical modification.

This characteristic makes this technology suitable for 

application in different conditions and in different 

clinical settings; primarily for debriding purposes, but 

eventually also as an adjunct to the reparative phase.

The application of US in the debriding phase 

of the management of various types of chronic 

ulcerations has been difficult until relatively 

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S 2 8