Expert consensus on the application of the hydrosurgery system in wound debridement (2026 edition)
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摘要: 水动力手术系统作为一种新型外科清创工具,在促进创面愈合、创面床准备等方面体现出重要价值。与传统外科清创相比,水动力手术系统具有组织选择性高、安全性高和清创精准度高等优点,因此在创面治疗中的应用日趋增多,但如何合理使用该系统、正确掌握其操作要点,以及准确把握其适应证与禁忌证或相对禁忌证,尚缺乏统一认识。因此,中国医师协会创面修复专业委员会组织国内烧创伤和创面修复领域知名专家学者,基于循证医学证据,结合国内外研究进展与临床实践经验,制订《水动力手术系统在创面清创中应用的专家共识（2026版）》,为水动力手术系统的临床应用提供参考。Abstract: As a novel surgical debridement device, the hydrosurgery system has significant clinical value in facilitating wound healing and optimizing wound bed preparation. Compared with conventional surgical debridement, the hydrosurgery system possesses prominent advantages, including high tissue selectivity, favorable safety profile, and precise debridement performance, which has contributed to its expanded application in wound management. However, there is a lack of consensus regarding the rational application, key operational essentials, as well as accurate identification of indications and contraindications or relative contraindications for this system. Accordingly, the Wound Repair Professional Committee of Chinese Medical Doctor Association assembled renowned experts in the fields of burn, trauma, and wound repair in China. Based on evidence-based medical evidence, combined with domestic and international research advances and clinical practice experience, the committee formulated the Expert consensus on the application of the hydrosurgery system in wound debridement (2026 edition) to provide references for the clinical use of the hydrosurgery system.
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Key words:
- Surgical procedures, operative /
- Burns /
- Debridement /
- Wound treatment /
- Hydrosurgery system /
- Expert consensus
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参考文献
(47) [1] DuteilleF,PerrotP.Management of 2nd-degree facial burns using the Versajet® hydrosurgery system and xenograft: a prospective evaluation of 20 cases[J].Burns,2012,38(5):724-729.DOI: 10.1016/j.burns.2011.12.008. [2] MatsumuraH,NozakiM,WatanabeK,et al.The estimation of tissue loss during tangential hydrosurgical debridement[J].Ann Plast Surg,2012,69(5):521-525.DOI: 10.1097/SAP.0b013e31826d2961. [3] FraccalvieriM, SerraR, RukaE, et al. Surgical debridement with VERSAJET: an analysis of bacteria load of the wound bed pre- and post-treatment and skin graft taken. A preliminary pilot study [J]. Int Wound J, 2011, 8(2): 155-161. DOI: 10.1111/j.1742-481X.2010.00762.x. [4] MostiG,IabichellaML,PicerniP,et al.The debridement of hard to heal leg ulcers by means of a new device based on Fluidjet technology[J].Int Wound J,2005,2(4):307-314.DOI: 10.1111/j.1742-4801.2005.00147.x. [5] BekaraF,VitseJ,FluieraruS,et al.New techniques for wound management: a systematic review of their role in the management of chronic wounds[J].Arch Plast Surg,2018,45(2):102-110.DOI: 10.5999/aps.2016.02019. [6] 赵建磊,赵婧琦,刘唱,等.水动力清创治疗烧伤的效果:随机对照试验的系统评价[J].上海交通大学学报(医学版),2025,45(5):10.DOI: 10.3969/j.issn.1674-8115.2025.05.010. [7] CubisonTC,PapeSA,JefferySL.Dermal preservation using the Versajet hydrosurgery system for debridement of paediatric burns[J].Burns,2006,32(6):714-720.DOI: 10.1016/j.burns.2006.01.023. [8] OrgillDP.Excision and skin grafting of thermal burns[J].N Engl J Med,2009,360(9):893-901.DOI: 10.1056/NEJMct0804451. [9] OngYS,SamuelM,SongC.Meta-analysis of early excision of burns[J].Burns,2006,32(2):145-150.DOI: 10.1016/j.burns.2005.09.005. [10] LegemateCM,KwaK,GoeiH,et al.Hydrosurgical and conventional debridement of burns: randomized clinical trial[J].Br J Surg,2022,109(4):332-339.DOI: 10.1093/bjs/znab470. [11] GranickM, BoykinJ, GamelliR, et al. Toward a common language: surgical wound bed preparation and debridement [J]. Wound Repair Regen, 2006, 14Suppl 1: S1-10. DOI: 10.1111/j.1743-6109.2005.00096.x. [12] HylandEJ,D'CruzR,MenonS,et al.Prospective, randomised controlled trial comparing VersajetTM hydrosurgery and conventional debridement of partial thickness paediatric burns[J].Burns,2015,41(4):700-707.DOI: 10.1016/j.burns.2015.02.001. [13] TenenhausM, BhavsarD, RennekampffHO. Treatment of deep partial thickness and indeterminate depth facial burn wounds with water-jet debridement and a biosynthetic dressing[J]. Injury, 2007, 38Suppl 5: S39-45. DOI: 10.1016/j.injury.2007.10.039. [14] RennekampffHO,SchallerHE,WisserD,et al.Debridement of burn wounds with a water jet surgical tool[J].Burns,2006,32(1):64-69.DOI: 10.1016/j.burns.2005.07.010. [15] CaoYL, LiuZC, ChenXL. Efficacy of hydrosurgical excision combined with skin grafting in the treatment of deep partial-thickness and full-thickness burns: a two-year retrospective study[J]. Burns, 2023, 49(5): 1087-1095. DOI: 10.1016/j.burns.2022.07.012. [16] GravanteG,DeloguD,EspositoG,et al.Versajet hydrosurgery versus classic escharectomy for burn débridment: a prospective randomized trial[J].J Burn Care Res,2007,28(5):720-724.DOI: 10.1097/BCR.0B013E318148C9BD. [17] KimbleRM,MottJ,JoethyJ.Versajet hydrosurgery system for the debridement of paediatric burns[J].Burns,2008,34(2):297-298; author reply 299.DOI: 10.1016/j.burns.2007.08.018. [18] KwaK,GoeiH,BreederveldRS,et al.A systematic review on surgical and nonsurgical debridement techniques of burn wounds[J].J Plast Reconstr Aesthet Surg,2019,72(11):1752-1762.DOI: 10.1016/j.bjps.2019.07.006. [19] LegemateCM,GoeiH,GostelieO,et al.Application of hydrosurgery for burn wound debridement: an 8-year cohort analysis[J].Burns,2019,45(1):88-96.DOI: 10.1016/j.burns.2018.08.015. [20] GurunluogluR.Experiences with waterjet hydrosurgery system in wound debridement[J].World J Emerg Surg,2007,2:10.DOI: 10.1186/1749-7922-2-10. [21] VanwijckR,KabaL,BolandS,et al.Immediate skin grafting of sub-acute and chronic wounds debrided by hydrosurgery[J].J Plast Reconstr Aesthet Surg,2010,63(3):544-549.DOI: 10.1016/j.bjps.2008.11.097. [22] Ferrer-SolaM, Sureda-VidalH, Altimiras-RosetJ, et al. Hydrosurgery as a safe and efficient debridement method in a clinical wound unit[J]. J Wound Care, 2017, 26(10): 593-599. DOI: 10.12968/jowc.2017.26.10.593. [23] SchultzGS, BarilloDJ, MozingoDW, et al. Wound bed preparation and a brief history of TIME[J]. Int Wound J, 2004, 1(1): 19-32. DOI: 10.1111/j.1742-481x.2004.00008.x. [24] LiuJ,KoJH,SecretovE,et al.Comparing the hydrosurgery system to conventional debridement techniques for the treatment of delayed healing wounds: a prospective, randomised clinical trial to investigate clinical efficacy and cost-effectiveness[J].Int Wound J,2015,12(4):456-461.DOI: 10.1111/iwj.12137. [25] CaputoWJ,BeggsDJ,DeFedeJL,et al.A prospective randomised controlled clinical trial comparing hydrosurgery debridement with conventional surgical debridement in lower extremity ulcers[J].Int Wound J,2008,5(2):288-294.DOI: 10.1111/j.1742-481X.2007.00490.x. [26] HongCC,NatherA,LeeJK,et al.Hydrosurgery is effective for debridement of diabetic foot wounds[J].Ann Acad Med Singap,2014,43(8):395-399. [27] GranickMS,PosnettJ,JacobyM,et al.Efficacy and cost-effectiveness of a high-powered parallel waterjet for wound debridement[J].Wound Repair Regen,2006,14(4):394-397.DOI: 10.1111/j.1743-6109.2006.00136.x. [28] GriffinB,BairagiA,JonesL,et al.Early non-excisional debridement of paediatric burns under general anaesthesia reduces time to re-epithelialisation and risk of skin graft[J].Sci Rep,2021,11(1):23753.DOI: 10.1038/s41598-021-03141-x. [29] TangXD,QiuL,WangF,et al.Safety and efficacy of waterjet debridement vs. conventional debridement in the treatment of extremely severe burns: a retrospective analysis[J].Burns,2023,49(8):1926-1934.DOI: 10.1016/j.burns.2023.06.004. [30] LigrestiC,BoF.Wound bed preparation of difficult wounds: an evolution of the principles of TIME[J].Int Wound J,2007,4(1):21-29.DOI: 10.1111/j.1742-481X.2006.00280.x. [31] 刘功成,阚朝辉,盛嘉隽,等. 水动力清创系统在严重烧伤患者大面积残余创面清创中的应用效果[J]. 中华烧伤杂志,2016,32(9):549-554. DOI: 10.3760/cma.j.issn.1009-2587.2016.09.008. [32] RashaanZM, KrijnenP, AllemaJH, et al. Usability and effectiveness of Suprathel® in partial thickness burns in children [J]. Eur J Trauma Emerg Surg, 2017, 43(4): 549-556. DOI: 10.1007/s00068-016-0708-z. [33] ProhaskaJ, CookC. Skin grafting[M]. Treasure Island (FL): StatPearls Publishing, 2023. [34] BibboC. VERSAJET hydrosurgery technique for the preparation of full thickness skin grafts and the creation of retrograde split thickness skin grafts[J].J Foot Ankle Surg, 2010, 49(4): 404-407. DOI: 10.1053/j.jfas.2010.04.013. [35] ChoiSG,ShinHW,YoonKC.Preparation of harvested skin using the Versajet hydrosurgery system in full-thickness skin grafts[J].Arch Plast Surg,2019,46(6):603-607.DOI: 10.5999/aps.2019.00745. [36] SiemersF,MaussKL,LiodakiE,et al.Accidental inclusions following blast injury in esthetical zones: ablation by a hydrosurgery system[J].Eplasty,2012,12:e33. [37] 章磊,季易,沈卫民.水刀清创系统加反植皮术负压封闭治疗儿童重度污染性皮肤撕脱伤[J].中华小儿外科杂志,2023,44(3):4.DOI: 10.3760/cma.j.cn421158-20211029-00518. [38] VrintsI,Den HondtM,Van BrusselM,et al.Immediate debridement of road rash injuries with Versajet® hydrosurgery: traumatic tattoo prevention?[J].Aesthetic Plast Surg,2014,38(2):467-470.DOI: 10.1007/s00266-014-0290-x. [39] SoongM,SchmidtS.Acute contaminated open forearm fractures treated with VersaJet hydrosurgical débridement[J].J Orthop Trauma,2010,24(7):e66-68.DOI: 10.1097/BOT.0b013e3181ca48f2. [40] ChammasMF, GurunluogluR, CarlsenSN, et al. Surgical debridement of mineral pitch and nonviable penile tissue using water-jet power: a preliminary report [J]. BJU Int, 2009, 103(7): 974-976. DOI: 10.1111/j.1464-410X.2008.08209.x. [41] YuanM,YinM,ZhangL,et al.Selective debridement of burn wounds using hydrosurgery system[J].Int Wound J,2020,17(2):300-309.DOI: 10.1111/iwj.13270. [42] MohammadiAA,Seyed JafariSM,KiasatM,et al.Efficacy of debridement and wound cleansing with 2% hydrogen peroxide on graft take in the chronic-colonized burn wounds; a randomized controlled clinical trial[J].Burns,2013,39(6):1131-1136.DOI: 10.1016/j.burns.2013.01.019. [43] IrkorenS,SivriogluN.A hydrosurgery system (Versajet) with and without hydrogen peroxide solutions for the debridement of subacute and chronic wounds: a comparative study with hydrodebridement[J].Adv Skin Wound Care,2014,27(3):127-131.DOI: 10.1097/01.ASW.0000443898.56886.66. [44] SönnergrenHH,StrömbeckL,AldenborgF,et al.Aerosolized spread of bacteria and reduction of bacterial wound contamination with three different methods of surgical wound debridement: a pilot study[J].J Hosp Infect,2013,85(2):112-117.DOI: 10.1016/j.jhin.2013.05.011. [45] MaragakisLL,CosgroveSE,SongX,et al.An outbreak of multidrug-resistant Acinetobacter baumannii associated with pulsatile lavage wound treatment[J].JAMA,2004,292(24):3006-3011.DOI: 10.1001/jama.292.24.3006. [46] PutzerD,LechnerR,Coraca-HuberD,et al.The extent of environmental and body contamination through aerosols by hydro-surgical debridement in the lumbar spine[J].Arch Orthop Trauma Surg,2017,137(6):743-747.DOI: 10.1007/s00402-017-2668-0. [47] 弓辰,吕开阳,王光毅,等. 水动力清创系统在烧伤创面中的应用[J]. 中华烧伤杂志,2015,31(6):470-472. DOI: 10.3760/cma.j.issn.1009-2587.2015.06.024. -
Table 1. 2011版牛津大学循证医学中心证据等级标准
证据级别 具体描述 1级 基于随机对照试验或单人交叉临床试验的系统性文献回顾,对随机性研究的系统综述 2级 随机对照试验或效果显著的观察性研究 3级 非随机性、对照性队列研究或随访研究 4级 病例系列研究、病例对照研究或历史对照研究 5级 基于机制的推论 
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