Deep-second degree burns are deep dermal injuries of the skin. Its healing depends on the deep dermal recovery and the regeneration of the remaining hair follicles, sebaceous glands and sweat glands. Facial blood circulation is abundant, and the number of skin attachments, such as hair follicles, sebaceous glands, and sweat glands, are large. Therefore, the potential for wound repair is great. Occasionally, wounds that appear to be third degree can also heal on their own. The face is uneven and inconvenient to bandage, so traditionally exposed or semiexposed conservative treatment is often used for facial burn wounds. With the improvement of people's living standards, appearance is increasingly valued, especially for facial burns. On the basis of wound repair, the growth of scars and deformities should be reduced as much as possible. Clinical studies have demonstrated that deep second degree wounds exhibit progressive deepening in the early stage; thus, scar hyperplasia will be more severe after conservative treatment. The main reasons are as follows. ① The microcirculation in the early stage of burn is in a hypercoagulable state. The dermal microcirculation, namely, the parabiotic tissue, is static. If not effectively treated, it will transform into necrotic tissue and deepen the wound. ②Increased capillary permeability leads to tissue edema, ischemia and hypoxia. ③The continued existence of wound necrotic tissue increases IL-8 levels in the wound and inflammatory cell infiltration. These factors simultaneously inhibit the release of growth factors and hinder wound repair. In response to the wound necrotic tissue, our department has provided comprehensive treatment of microtrauma dermabrasion of deep second-degree facial burns during the early postburn stage since 2002. These methods can effectively remove necrotic tissues, reduce toxin absorption, and control infection. Thereby, the microenvironment of tissues is improved. Additionally, the morphology and function of parabiotic tissue are restored. Furthermore, burn wounds rich in necrotic tissue are converted into cutting wounds, which changes the healing mode and effectively prevents the progressive deepening of the wounds.
However, in clinical practice, deep second-degree burn wounds typically exhibit uneven bases and irregular edges, especially on the head, neck, fingers, toes, and perineum. The boundary between normal tissue and necrotic tissue is unclear. In addition, multiple drug-resistant bacterial infections and inflammatory mediators are present on the wound. Therefore, traditional scab debridement that relies on roller blades and scalpels exhibits certain limitations, and it is difficult to achieve a minimally invasive and precise debridement goal. Debridement is categorized into shallow debridement (residual necrosis tissues) or deep debridement (damage to some healthy tissues). Both of these types of debridement are not conducive to perfect wound healing. Thus, it is difficult to debride complex wounds completely.
As a new technology, hydrodynamic debridement systems have been widely used in the medical field. Domestic and foreign scholars have used the hydrodynamic debridement system for wound repair for more than a decade. Its efficacy has been gradually affirmed, and its application has been gradually popularized [1–5]. The system works by pumping a high-pressure and high-speed water jet through a small hole at the end of the handpiece, which produces a scalpel-like cutting effect [6] and forms local negative pressure on the wound surface to rapidly remove the necrotic tissue and wound secretions, which include bacteria and inflammatory mediators. Thus, the normal tissues can be protected to the greatest extent, and the debridement can be truly minimally invasive, accurate, flexible and efficient to improve the healing quality of the wound surface [7,8]. Compared with traditional debridement methods, the hydrodynamic debridement system has the following advantages in the processing of deep second-degree facial burn wounds: ①The cutting power is derived from the hydrodynamic energy and does not produce a thermal effect or damage to normal tissues and structures around the wound during the operation; ②The system is convenient to operate and with a low technic threshold, which make it easy to learn; ③It integrates the removal of necrotic tissue and wound lavage with a small working window, clear vision and depth by layer, which can truly achieve minimally invasive and accurate debridement; ④The single debridement thickness of the hydrodynamic debridement system is 50 − 10 µm [9,10], and the traditional debridement method has a single debridement thickness of 700–1700 µm [11,12]. Therefore, the hydrodynamic debridement system can minimize the damage to the normal tissues and structures of the wound surface. Moreover, the operator can clearly grasp the level of debridement and precisely handle the edge of the wound in the operation, thus avoiding the "cliff-type" debridement results of traditional debridement methods; ⑤The hydrodynamic debridement system is especially suitable for the head, face, neck, fingers, toes, perineum and other uneven parts that are difficult to reach by conventional traditional instruments; ⑥The hydrodynamic debridement system exhibits good tissue selectivity, which is conducive to optimizing the wound bed and creating good conditions for wound healing.
Our department has provided traditional scab debridement of deep second-degree facial burns to since 2002[13,14]. Thirty five patients with traditional facial debridement in each period (Table 3: 2010–2012, Table 4:2013–2015) were randomly selected. We found that not only the healing time was significantly reduced by the hydrodynamic debridement system compared with traditional debridement, but also the VSS score was reduced. This finding demonstrates that the hydrodynamic debridement system can improve the healing of deep second-degree facial burns.
Table 3
Number | Age | Sex | Cause of burn | Area of injury (face/total TBSA) | Healing time/day | VSS (half a year after injury) |
1 | 44 | female | fire | 3/6 | 16 | 3 |
2 | 44 | male | fire | 3/4.5 | 14 | 3 |
3 | 1 | male | Incense ashes | 2/3.5 | 18 | 2 |
4 | 1 | female | boiling water | 3/4 | 18 | 2 |
5 | 43 | male | electric arc | 2/2 | 15 | 2 |
6 | 1 | female | boiling water | 2/2.5 | 12 | 1 |
7 | 1 | male | boiling water | 1/2 | 14 | 1 |
8 | 44 | male | fire | 2/4 | 12 | 3 |
9 | 23 | male | chemical | 0.5/0.5 | 11 | 3 |
10 | 41 | male | fire | 2/3 | 17 | 2 |
11 | 27 | male | fire | 2/2 | 13 | 3 |
12 | 27 | male | sulfuric acid | 3/4 | 19 | 2 |
13 | 30 | male | fire | 1.5/1.5 | 11 | 2 |
14 | 71 | female | fire | 2/6 | 13 | 2 |
15 | 47 | male | fire | 3/8 | 14 | 3 |
16 | 47 | male | fire | 2/3 | 13 | 2 |
17 | 30 | male | fire | 3/5 | 14 | 2 |
18 | 2 | male | boiling water | 3/7 | 14 | 1 |
19 | 48 | female | fire | 3/10 | 15 | 2 |
20 | 50 | male | chemical | 2/5 | 16 | 2 |
21 | 27 | male | chemical | 2/4 | 14 | 2 |
22 | 33 | female | boiling water | 2/7 | 14 | 1 |
23 | 44 | male | acetic acid | 2/4 | 17 | 1 |
24 | 52 | male | electric arc | 1/4 | 18 | 1 |
25 | 2 | male | boiling water | 3/6 | 14 | 1 |
26 | 2 | female | boiling water | 3/9 | 16 | 1 |
27 | 61 | male | fire | 1/3 | 16 | 2 |
28 | 44 | male | fire | 2/6 | 16 | 2 |
29 | 37 | male | fire | 2/10 | 13 | 3 |
30 | 41 | male | fire | 2/3 | 13 | 2 |
31 | 42 | male | chemical | 1/4 | 13 | 3 |
32 | 24 | male | acetic acid | 1/1 | 13 | 2 |
33 | 55 | female | boiling oil | 2/8 | 15 | 1 |
34 | 47 | male | fire | 1/2 | 15 | 3 |
35 | 37 | female | ammonia | 1/2.5 | 14 | 2 |
Table 4
Number | Age | Sex | Cause of burn | Area of injury (face/total TBSA) | Healing time/day | VSS (half a year after injury) |
1 | 6 | male | fire | 2/2 | 15 | 3 |
2 | 42 | male | fire | 2/2 | 12 | 3 |
3 | 14 | male | fire | 3/4 | 13 | 3 |
4 | 34 | male | chemical | 2/3 | 16 | 2 |
5 | 38 | male | fire | 2/3 | 15 | 2 |
6 | 48 | male | fire | 2/3 | 17 | 3 |
7 | 51 | male | fire | 3/6 | 15 | 2 |
8 | 2 | male | boiling water | 3/5 | 16 | 1 |
9 | 47 | male | fire | 2/2 | 12 | 2 |
10 | 64 | female | fire | 1.5/2.5 | 13 | 3 |
11 | 34 | male | electric arc | 3/3 | 16 | 2 |
12 | 41 | male | chemical | 3/3 | 23 | 3 |
13 | 48 | male | fire | 1.5/1.5 | 12 | 2 |
14 | 36 | male | fire | 3/9 | 12 | 3 |
15 | 4 | male | boiling water | 2/2 | 15 | 1 |
16 | 49 | male | electric arc | 1/2 | 14 | 3 |
17 | 58 | male | fire | 2/5 | 15 | 3 |
18 | 58 | male | fire | 2/3 | 14 | 2 |
19 | 46 | male | fire | 2/5 | 14 | 2 |
20 | 40 | male | fire | 2/5 | 15 | 2 |
21 | 57 | male | fire | 3/5 | 15 | 2 |
22 | 62 | female | fire | 1/2 | 14 | 3 |
23 | 23 | male | chemical | 1/2 | 13 | 2 |
24 | 1 | male | boiling water | 3/10 | 14 | 1 |
25 | 42 | female | electric arc | 1.5/3 | 15 | 2 |
26 | 24 | male | fire | 3/10 | 15 | 2 |
27 | 45 | male | fire | 3/7 | 14 | 2 |
28 | 31 | male | fire | 3/6 | 15 | 3 |
29 | 4 | male | fire | 3/9 | 16 | 2 |
30 | 49 | male | fire | 3/5 | 12 | 2 |
31 | 42 | male | fire | 3/11 | 14 | 1 |
32 | 28 | male | hot oil | 2/3 | 15 | 2 |
33 | 1 | female | boiling water | 3/6 | 13 | 1 |
34 | 28 | female | fire | 1/3 | 14 | 2 |
35 | 31 | male | chemical | 1/1.5 | 13 | 2 |
Table 5
Comparation of different ways of debridement
| Number of patients | Ways of debridement | Healing time | P value | VSS (half a year after injury) | P value |
2016–2018 | 35 | hydrodynamic debridement system | 12.26 ± 2.15 | | 0.86 ± 0.84 | |
2013–2015 | 35 | traditional scab debridement | 14.46 ± 1.99 | < 0.0001 | 2.17 ± 0.66 | < 0.0001 |
2010–2012 | 35 | traditional scab debridement | 14.57 ± 2.00 | < 0.0001 | 2 ± 0.73 | < 0.0001 |
Values are represented as mean ± SD. statistical analysis was performed to compare hydrodynamic debridement system versus traditional scab debridement using the unpaired t test.