Waterjet in Bacterial Clearance of Diabetic Lower Extremity Contaminated Wounds: A Retrospective Cohort Study

Abstract

The waterjet debridement is now a standard practice in contaminated or infected diabetic lower extremity wounds. The bacterial clearance of the waterjet debridement remains an important parameter that should be predicted in this application. This study aimed to investigate the waterjet in reducing the diabetic lower extremity wound contaminants. A retrospective cohort study was conducted. Patients' etiology and pathogen diagnosis were established as diabetic lower extremity contaminated wound. The high-power waterjet (Versajet™, Smith-Nephew) was used in the treatment group and conventional surgical methods were used in the control group. The bacteriological swab samples were collected before and after the debridement. The results of bacterial culture were analyzed. A total of 74 patients were included in our study, 40 patients in the treatment group and 34 in the control group. Patient characteristics were well matched. The preoperative bacteriological swab samples of the 2 groups showed no significant difference between each other with a P value of .1022. The culture result of postoperative bacteriological swab samples in the treatment group was significantly lower than control with a P value of .0099. The odds of bacterial clearance were greater in the treatment group than in the control group (odds ratio, 5.139; 95% confidence interval, 1.386-18.41). As demonstrated by this retrospective research, waterjet debridement reduced the bacterial load in the diabetic lower extremity contaminated wounds.

Keywords

foot infection wound debridement diabetic foot foot ulcer diabetic lower extremity contaminated wound

Get full access to this article

View all access options for this article.

References

Papatheodorou

Papanas

Banach

Papazoglou

Edmonds

. Complications of diabetes 2016. J Diabetes Res. 2016;2016(1):6989453.

Pitocco

Spanu

Di Leo

, et al. Diabetic foot infections: a comprehensive overview. Eur Rev Med Pharmaco. 2019;23(2 Suppl):26-37.

Prompers

Huijberts

Apelqvist

, et al. High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the eurodiale study. Diabetologia. 2007;50(1):18-25.

Holman

Young

Jeffcoate

. Variation in the recorded incidence of amputation of the lower limb in england. Diabetologia. 2012;55(7):1919-1925.

Ince

Kendrick

Game

Jeffcoate

. The association between baseline characteristics and the outcome of foot lesions in a UK population with diabetes. Diabet Med. 2007;24(9):977-981.

Driver

Wrobel

Armstrong

. Foot ulcers in the diabetic patient, prevention and treatment. Vasc Health Risk Manag. 2007;3(1):65-76.

Granick

Tran

Alvarez

. Latest advances in wound debridement techniques. Surg Technol Int. 2020;36(5):37-40.

Schoeb

Klodmann

Schlager

Müller

Miernik

Bahls

. Robotic waterjet wound debridement—workflow adaption for clinical application and systematic evaluation of a novel technology. PLOS ONE. 2018;13(9):e204315.

Pascone

Papa

Ranieri

. Use of a novel hydrosurgery device in surgical debridement of difficult-to-heal wounds. Wounds. 2008;20(5):139-146.

10.

Granick

Posnett

Jacoby

Noruthun

Ganchi

Datiashvili

. Efficacy and cost—effectiveness of a high—powered parallel waterjet for wound debridement. Wound Repair Regen. 2006;14(4):394-397.

11.

Gurunluoglu

. Experiences with waterjet hydrosurgery system in wound debridement. World J Emerg Surg. 2007;2(1):10.

12.

Lavery

Armstrong

Wunderlich

Mohler

Wendel

Lipsky

. Risk factors for foot infections in individuals with diabetes. Diabetes Care. 2006;29(6):1288-1293.

13.

Pickwell

Siersma

Kars

Holstein

Schaper

. Diabetic foot disease: impact of ulcer location on ulcer healing. Diabetes Metab Res Rev. 2013;29(5):377-383.

14.

Monteiro-Soares

Russell

Boyko

, et al. Guidelines on the classification of diabetic foot ulcers (IWGDF 2019). Diabetes Metab Res Rev. 2020;36(Suppl 1):e3273.

15.

Ferrer-Sola

Sureda-Vidal

Altimiras-Roset

, et al. Hydrosurgery as a safe and efficient debridement method in a clinical wound unit. J Wound Care. 2017;26(10):593-599.

16.

Ndosi

Wright-Hughes

Brown

, et al. Prognosis of the infected diabetic foot ulcer: a 12-month prospective observational study. Diabet Med. 2018;35(1):78-88.

17.

Euser

Zoccali

Jager

Dekker

. Cohort studies: prospective versus retrospective. Nephron Clin Pract. 2009;113(3):c214-c217.

18.

Grimes

Schulz

. Cohort studies: marching towards outcomes. Lancet. 2002;359(9303):341-345.

19.

Lipsky

Tabak

Johannes

Hyde

Weigelt

. Skin and soft tissue infections in hospitalised patients with diabetes: culture isolates and risk factors associated with mortality, length of stay and cost. Diabetologia. 2010;53(5):914-923.

20.

Singer

Tassiopoulos

Kirsner

. Evaluation and management of lower-extremity ulcers. N Engl J Med. 2017;377(16):1559-1567.

21.

Ghotaslou

Memar

Alizadeh

. Classification, microbiology and treatment of diabetic foot infections. J Wound Care. 2018;27(7):434-441.

22.

Andrews

Houdek

Kiemele

. Wound management of chronic diabetic foot ulcers: from the basics to regenerative medicine. Prosthet Orthot Int. 2015;39(1):29-39.

23.

Hicks

Selvarajah

Mathioudakis

, et al. Burden of infected diabetic foot ulcers on hospital admissions and costs. Ann Vasc Surg. 2016;33(5):149-158.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.01 MB

26.58 MB