Several approaches have been used over the years in the surgical management of soft tissue necrosis, disease, and infection. Traditionally, patients underwent wide excision with a scalpel or electrocautery, oftentimes sacrificing viable tissue while not always achieving complete excision of the nonviable tissue. This can result in multiple attempts at debridement to achieve a physiologic state conducive for wound healing or preparation for definitive closure subjecting patients to repeat operations and the significant associated cost.

WHAT IS VERSAJET?

Since 2003, however, there has been a shift in the surgical management of these often-complex wounds. The VERSAJET, a high-powered water jet debridement tool, is designed to establish a new standard of patient care and procedural efficiency in surgical wound management. The device is currently marketed by Smith and Nephew Advanced Wound Management Division and is a Food and Drug Administration-approved medical device (see Figure 1).

Figure 1. No caption available.

HOW DOES IT WORK?

Many aspects regarding the patient's physiologic state must be addressed. Direct wound management requires a process of wound bed preparation. The principle behind the debridement tool focuses on achieving a desirable wound surface proficiently while maximizing viable tissue that is spared. This concept is better understood using the "TIME" acronym.

The "TIME" principles are described as a process:

T-tissue that is necrosed or diseased be removed

I-infection and bacterial burden be controlled

M-moisture is to be balanced

E-edge (healing), better described as the point of optimal healing of the wound, should be present.

This scientific approach behind the success of the Versajet's ability is more thoroughly described utilizing the Venturi effect of physics. The high-powered parallel water jet utilizes saline enclosed in a sterile circuit to pass through a small but highly powerful pump (see Figure 2a-d). The saline is directed through high-pressure tubing into a hand piece where it is directed into a 180[degrees] turn and forced through a nozzle 0.005" in diameter. The energized saline emerges in a focused beam of up to 15,000 psi. The stream of saline is collected through an eductor port. Because of the Venturi effect, the wound debris is ablated by the saline and evacuated along with the saline leaving behind a clean wound bed. The beam of saline is directed parallel to the wound surface, allowing the cutting mechanism to be a more precise and highly controlled form of tangential excision. This allows undesired tissue to be excised while preserving healthy underlying and surrounding tissue. (This differs from pulsatile lavage in that the fluid is directed perpendicular to the wound bed potentially driving bacteria and debris further into the wound. In addition, the irrigant spray is not well controlled using the pulsatile lavage.) Multiple power settings are available and displayed on a console for controlled excision around delicate tissue.

Figure 2a-d. No caption available.

Venturi Effect

The design of the Versajet is such that the high-velocity fluidjet passes across the operating window and into the evacuation collector creating a localized vacuum to hold and cut targeted tissue while aspirating debris from the site.

Tissue Excision

Additional design attributes allow the user to finely control excision. Orienting the operating window parallel to the tissue optimizes the Versajet's performance for tissue excision-cutting and evacuation.

Contaminant Removal

Alternatively, orienting the operating window obliquely to the tissue optimizes the VERSAJET's performance for contaminant removal-irrigation and vacuuming.

WHICH PATIENTS ARE APPROPRIATE CANDIDATES FOR THE VERSAJET?

The Versajet is used in many surgical specialties for the debridement of wounds, including in orthopedic, vascular, podiatric, plastic, and general surgery (Figure 3).

Figure 3. No caption available.

HOW WILL MY PATIENTS BENEFIT?

Soft tissue disruption continues to significantly impact and sometimes overwhelm the surgical specialities because of their complexity. The Versajet is new technology that is superior to traditional debridement modalities due to its ability to debride, irrigate, and evacuate debris all in one tool.

Achievement of a healthy wound bed promotes rapid wound healing, requiring fewer operations, thus reducing costs for the patient and hospital, ultimately improving patient outcomes (Figure 4).

Figure 4. No caption available.

CONCLUSION

Versajet is a technologically sophisticated addition to traditional surgical debridement tools intended to enhance and expedite patient healing while minimizing soft tissue loss. In addition, Versajet allows for improvement of clinical, procedural, and economical outcomes reducing patient exposure to procedures and operation room time therefore reducing expenses.

As nursing staff in the perioperative setting, it is essential that we remain patient advocates and explore with our physician team members the advanced technology available with the Versajet. Another important concept is to utilize the technology appropriately through understanding of the product, its intention, and availability while containing costs and optimizing patient outcomes. Our common goal as healthcare providers taking care of surgical patients with soft tissue disruption will be met if we keep these few principles in mind.

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