Dispersion Risk Associated With Surgical Debridement Devices

INTRODUCTION: Surgical instrumentation is now available to facilitate wound debridement. The 2 primary options involve different energy applications, but both have the potential to spray. The Versajet II (Smith & Nephew, London, UK) utilizes a high-powered water jet to disrupt tissue and remove debris by means of the Venturi effect. The SonicVac (Misonix, Farmingdale, NY) is a direct-contact, low-frequency ultrasound debriding device. It delivers a high-energy ultrasound to a wound surface via a fluid medium, causing bubble cavitation, a physical effect of rapid pressure waves causing bubbles to form and implode that releases mechanical energy.

OBJECTIVE: This study is designed to assess spray dispersion under ideal and challenging conditions.

MATERIALS AND METHODS: The 2 aforementioned instruments were tested in a laboratory situation. Bacteria (Escherichia coli [ATCC#54288] or Staphylococcus epidermidis [RP62A]) were seeded onto separate pieces of beef steak. Culture plates were set up in a predesignated position around the specimen; the specimen was then treated for 60 seconds at a power setting of 7 and 70% irrigation (ultrasound device) or 10 (waterjet device). After 60 seconds of debridement, about 4 mm to 5 mm of muscle tissue had been removed by the ultrasound device and 2 mm to 3 mm by the waterjet. In the bony specimen, the bone was more exposed after the treatment. The ultrasound device polished but did not remove the bone.

RESULTS: Both instruments performed well with minimal dispersion in the ideal setting. In beef steak with bone and grizzle, the waterjet created a lawn of bacterial spray in the plate in front of the surgeon. The ultrasound had a small number of contaminants in the same conditions.

CONCLUSIONS: Both instruments can be used safely in the proper conditions, but the surgeon needs to be aware of the limitations and risks of spray dispersion.