Water Microjet as a Gentler Method of Debridement

Introduction

Chronic wounds represent a significant and often overlooked burden for individuals, families, and society. A wound becomes chronic if the healing process does not lead to anatomical and functional integrity within approximately 3 months. Chronic wounds of various etiologies affect a large portion of the global population, with a prevalence of 2.2 per 1000 inhabitants. The treatment of chronic wounds also represents an economic burden. For example, in the United Kingdom, the annual cost of caring for patients with chronic wounds is estimated at 6 billion pounds.

Traditional Methods of Debridement

Debridement is an essential part of chronic wound care. Its goal is to remove necrotic tissue and foreign materials from the wound bed and create a healthy wound base, its edges, and surrounding skin, thereby supporting and accelerating healing. Several methods of debridement exist in clinical practice, including autolytic, enzymatic, mechanical, surgical (sharp), and biological. Autolytic, enzymatic, and surgical methods are considered selective techniques, while mechanical methods are considered non-selective. Selective methods primarily target the removal of necrotic tissue, whereas non-selective methods remove both necrotic and viable tissue. However, clinical experience shows that even selective methods can remove or damage healthy tissue.

For many years, the most commonly used method has been mechanical debridement. It has been shown to improve wound healing, with the main advantages being low treatment costs and rapid removal of dead tissue. However, the problem is that residual non-viable tissue can remain in the wound in microscopic amounts, potentially slowing down the healing process. Conversely, extensive excision can damage healthy tissue or deeper structures, such as blood vessels, nerves, tendons, or even bones, leading to delayed healing. It is also important to recognize that mechanical debridement can be painful, which can lead to fear in patients, reduced comfort, psychological distress, and ultimately poorer cooperation.

Autolytic or enzymatic debridement, while more selective and less burdensome for patients, significantly prolongs the time required for complete removal of dead tissue. This necessitates more applications and greater cooperation, which can be challenging or even impossible given the condition of some patients.

New Alternatives

Progress in the field of new wound care methods continues. A promising trend and alternative to traditional debridement methods is the use of water microjet technology in promoting wound healing. This technique involves the use of sterile fluid that is expelled from a nozzle at a chosen intensity and precisely directed at the wound surface. The ultra-fine, strong water jet ensures homogeneous mechanical cleaning of the wound bed while simultaneously stimulating it. It induces microbleeding in the wound, which can stimulate regenerative and healing processes while preserving healthy tissue without scarring. The painfulness of the procedure can be regulated by the intensity of the jet. In some patients, local anesthetics may be required.

In 2018, a retrospective study was conducted in two Swiss wound healing centers, evaluating the results of treating chronic wounds of various etiologies using water jet debridement. The study included 90 patients (46 men and 44 women) with an average age of 68.5 years (range 17-93 years) and 95 different wounds. All patients except one could be treated on an outpatient basis, and local anesthesia was minimally used. Upon discharge from the chronic wound care center, 58 wounds were completely closed, with closure occurring on average after 59 days of treatment (8.4 weeks). Debridement was completed on average after 39 days (5.6 weeks) with an average wound size of 6.1 cm². Compared to traditional debridement methods, a reduction in healing time of approximately 30% was observed. Safety was high, with no adverse effects recorded during treatment with this method.

Swiss experts are now conducting a study comparing water jet debridement to scalpel or curette debridement in terms of wound dimensions (length, width, depth, area, and volume) over 6 weeks of treatment.

Conclusion

Chronic wounds represent a significant burden for individuals and society, particularly the healthcare and social systems. It is therefore necessary to seek effective treatment strategies that lead to better outcomes and reduced healthcare costs. The new debridement method using water microjet technology appears to be a safe, effective, precise, and time-efficient modern approach that promises improved care.

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Sources:
1. Reber M., Nussbaumer P. Effective debridement with micro water jet technology (MWT): a retrospective clinical application observation of 90 patients with acute and chronic wounds. Wound Med 2018; 20: 35−42, doi: 10.1016/j.wndm.2018.01.001.
2. Probst S. E. Healthy tissue preservation during wound debridement by using Debritom+ Micro Water Jet technology − a pilot study. School of Health Sciences Geneve, 2023. Available at: https://ichgcp.net/clinical-trials-registry/NCT04514783
3. Medaxis debritom+: micro water jet technology for gentle debridement. Milani Design & Consulting AG, 2019. Available at: www.youtube.com/watch?v=6fuD3s_aIVE