• Catherine M Legemate, KwaKelly A AKAABurn Centre, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands.Department of Traumasurgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands., Harold Goei, Anouk Pijpe, Esther Middelkoop, van ZuijlenPaul P MPPMDepartment of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Movement Sciences, Vrije Univeristeit Amsterdam, 1081 HV Amsterdam, The Netherlands.Burn Centre, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands., BeerthuizenGerard I J MGIJMBurn Centre, Martini Hospital, 9728 NT Groningen, The Netherlands., Marianne K Nieuwenhuis, van BaarMargriet EMEDepartment of Public Health, Erasmus MC, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands.Association of Dutch Burn Centres, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands., Cornelis H van der Vlies, and HyCon Study Group.
• Burn Centre, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands.
• Br J Surg. 2022 Mar 15; 109 (4): 332339332-339.

BackgroundTangential excision of burned tissue followed by skin grafting is the cornerstone of burn surgery. Hydrosurgery has become popular for tangential excision, with the hypothesis that enhanced preservation of vital dermal tissue reduces scarring. The aim of this trial was to compare scar quality after hydrosurgical versus conventional debridement before split-skin grafting.MethodsA double-blind randomized within-patient multicentre controlled trial was conducted in patients with burns that required split-skin grafting. One wound area was randomized to hydrosurgical debridement and the other to Weck knife debridement. The primary outcome was scar quality at 12 months, assessed with the observer part of the Patient and Observer Scar Assessment Scale (POSAS). Secondary outcomes included complications, scar quality, colour, pliability, and histological dermal preservation.ResultsSome 137 patients were randomized. At 12 months, scars of the hydrosurgical debrided wounds had a lower POSAS observer total item score (mean 2.42 (95 per cent c.i. 2.26 to 2.59) versus 2.54 (95 per cent c.i. 2.36 to 2.72; P = 0.023)) and overall opinion score (mean 3.08 (95 per cent c.i. 2.88 to 3.28) versus 3.30 (95 per cent c.i. 3.09-3.51); P = 0.006). Patient-reported scar quality and pliability measurements were significantly better for the hydrosurgically debrided wounds. Complication rates did not differ between both treatments. Histologically, significantly more dermis was preserved with hydrosurgery (P < 0.001).ConclusionOne year after surgery scar quality and pliability was better for hydrosurgically debrided burns, probably owing to enhanced histological preservation of dermis.Registration NumberTrial NL6085 (NTR6232 (http://www.trialregister.nl)).© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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