Abstract and Introduction
Abstract
Objective The authors present the novel use of a new generation surgical ablative tool known as the WoundWand.
Methods A 66-year-old woman presented with 18% deep-dermal and full-thickness burns affecting the left side of her body including the total left upper limb, abdomen, and left thigh following lighting a cigarette in bed while on home oxygen therapy. She underwent tangential excision of burn using the WoundWand with immediate reconstruction using split skin grafts and topical negative pressure therapy.
Results We found that we were able to easily tangentially excise the hard eschar from delicate areas such as the hand and fingers using the WoundWand.
Discussion The authors conclude that the novel use of this device particularly in delicate areas such as dorsum of fingers and hand has some advantages over preexisting methods. Further clinical study may add to the surgical armamentarium of the burns surgeon.
Introduction
There are many surgical tools at the Burns surgeon's disposal. Traditional methods include Watson, Goulian, and Silver knives particularly for use in tangential excision.[1] Recent advances in technology have given rise to the more hemostasic monopolar cutting and coagulation diathermy systems as well as bipolar diathermy, which are better suited to tangential excision or where minimizing blood loss is imperative.[2–5] Further technological advances have given rise to the advent of other tools such as the harmonic scalpel which has been widely used in surgery, initially in urological surgery[6] and now widely used in a variety of (plastic) surgical disciplines including aesthetic surgery for rhytidectomy, skin oncology surgery for block dissections, and head and neck surgery for tumor extirpation.[7–10]
Monopolar cautery is extremely effective, but it may cause significant collateral tissue damage.[11] Thermal damage can have deleterious effects on wound healing, safety, and clinical outcomes in general;[12] this is particularly crucial in burns surgery. Due to these factors, carbon dioxide lasers and radiofrequency devices are gaining favor; this is also due to the lesser thermal collateral damage.[13] There are several published studies which support the use of these devices in routine daily surgical practice.[14,15] Each method has its advantages and disadvantages as well as an appreciable learning curve which the surgeon will have to negotiate.
Pivotal to burns and plastic surgery is the concept of innovation and application of new tools and techniques to a variety of clinical problems. This drive to perform an operation safer, faster, or with fewer complications prompts a surgeon to continue to trial new devices. While devices such as Versajet are being used in the field of burn care, it is known that Versajet is less effective at directly removing the thick hard eschar of full-thickness burns.[16–18] The authors present the use of such a new-generation surgical ablative tool known as the WoundWand (ArthroCare Corporation, Austin, Texas) to discuss both advantages and disadvantages, as well as its potential application in burns surgery.
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