Introduction: Diabetic foot wounds are serious complications of diabetes mellitus. Surgical debridement is a very important part of the management of diabetic wounds. Sharp debridement using the scalpel is normally performed. Versajet II hydrosurgery system is an alternative technique for debridement. To our knowledge, this is the first study conducted to evaluate the use of hydrosurgery debridement for diabetic foot wounds.Materials and Methods: This pilot study included 15 consecutive patients with diabetic foot wounds who were admitted to the National University Hospital (NUH) and were managed by the Diabetic Foot Team from June 2012 to December 2012. All wounds underwent hydrosurgery debridement. Patients' demographic details, clinical details on wound assessments, and outcome were recorded and analysed. Results: The Versajet II hydrosurgery system was found to show some advantages over standard surgical scalpel debridement. It allowed adequate debridement whilst preserving more viable tissue to promote rapid healing. It could be manoeuvred over complex wound terrain. The time required for debridement was short — an average of 9.5 minutes. Good wound healing was achieved in all 15 cases. Only 1 Versajet debridement was required in 13 cases and 2 required an extra debridement. Twelve wounds were healed by split thickness skin grafting (STSG) and 3 wounds by secondary healing. Two of the STSG were infected but they were subsequently healed by dressings via secondary healing. Conclusion: Although good wound healing was achieved in all 15 cases, further study that uses a larger cohort and a randomised controlled trial is required to fully evaluate the effectiveness, or otherwise, of the Versajet II hydrosurgery system for the debridement of diabetic foot wounds.
The prevalence of diabetes mellitus in Singapore is increasing. It was at its highest of 11.3% in the latest National Health Survey 2010 compared to 8.2% in 2004. Diabetic foot wounds are serious complications of diabetes mellitus and can lead to limb loss if left untreated. Diabetics have a 10% to 25% lifetime risks of developing foot ulcers. Neuropathy, poor circulation and injury contribute to the formation of diabetic foot ulcers and 85% of lower extremity amputations are preceded by diabetic foot ulcers. Nather et al found the incidence of major amputations (above and below knee) to be 27.2% for diabetics with foot complications.
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