Efficacy of hydrodynamic debridement in the treatment of burns: a systematic review of randomized controlled trials

Objective·To compare the effectiveness of hydrodynamic debridement versus conventional debridement in the treatment of burn wounds through a systematic review, focusing on differences in time to complete healing after graft, time to debride a 1% total body surface area (TBSA) wound, hospitalization duration, skin graft survival rate at 7 d post-surgery, secondary debridement rate, and positive rate of bacterial culture of wound exudate at 3 d post-surgery, aiming to select a more effective debridement method for burn wounds requiring debridement.Methods·A systematic literature search was conducted in PubMed, Embase, Web of Science, Cochrane Library, CNKI, SinoMed, China Science and Technology Journal Database,and Wanfang Database, for studies comparing hydrodynamic debridement and conventional debridement in the treatment of burns. The search included articles published in Chinese and English, and the search period was from the inception of the databases to October 1, 2024. The study type was randomized controlled trials (RCTs). After literature search and screening, the included studies was evaluated for quality, and relevant data were extracted. Qualitative variables were presented as relative risk (RR), and quantitative variables as mean difference (MD). Forest plots were created by using RevMan 5.4 software with fixed- or random- effects models. Funnel plots were generated and Egger's test was performed by using Stata 14.0 software.Results·Fifteen high-quality RCTs were included in this study, involving 1 261 patients with burn injuries requiring debridement. The analysis results showed that compared to the conventional debridement group, the hydrodynamic debridement group had significantly shorter time to complete healing after graft (MD=-3.29,95%CI -3.88‒-2.70, P<0.001), shorter time required to debride a 1% TBSA wound (MD=-0.63, 95%CI -0.76‒-0.50, P<0.001), and reduced hospitalization duration (MD=-4.22, 95%CI -6.17‒-2.28, P<0.001). The skin graft survival rate at 7 d post-surgery in the hydrodynamic debridement group (MD=8.62, 95%CI 7.21‒10.04, P<0.001) was significantly higher, while the secondary debridement rate (RR=0.21, 95%CI 0.12‒0.37, P<0.001) and the positive rate of bacterial culture of wound exudate at 3 d post-surgery (RR=0.30, 95%CI 0.17‒0.53, P<0.001) were significantly lower compared with the conventional debridement group. There was no statistically significant difference in the postoperative infections rates between the two groups (RR=1.06, 95%CI 0.66‒1.69, P=0.820).Conclusion·In the treatment of burn wounds, hydrodynamic debridement outperforms traditional debridement. In the management of burn wounds, hydrodynamic debridement outperforms conventional debridement by shortening debridement and hospitalization durations, reducing the need for secondary debridement, decreasing early bacterial colonization, and improving skin graft survival. In terms of postoperative infection risk, no significant difference was observed between the two methods, indicating comparable safety profiles.