Vacuums and maggots in orthopaedic surgery

Dear Sir,

In response to the letter by S Thomas and SS Asaad, we must not forget the
essential principle of surgical debridement (1). They correctly state that
both vacuum-assisted closure and biosurgery (use of maggots) are useful
techniques in the treatment of difficult wounds. In addition the recent
literature has shown the use of the Versajet™ Hydrosurgery System as an
effective tool in the debridement of burns and chronic wounds, as we have
also found on our own practice (2).

The danger however with all the above methods is their tendency to
‘medicalise’ wound debridement. It appears that the procedure is being
delegated to wound care nurses who are at times not in the best position
to decide on the most appropriate therapy. Meanwhile surgeons are becoming
increasingly deskilled despite learning the principles of debridement in
basic surgical skills courses. In our specialty, patients referred for
opinion and input with their wound management, have increasingly had
ineffective ‘debridement’.

Adequate and early debridement by a competent surgeon with the help
of a tourniquet on the affected limb still remains the gold standard. Non-
surgical techniques should be considered as adjuncts to surgery and not as
a replacement.

References:

(1) Thomas S, Assad SS. Vaccums and maggots in orthopaedic surgery.
BMJ 2006; 332: 1156. (13 May).

(2) Klein MB, Hunter S, et al. The Versajet water dissector: a new
tool for tangential excision. J Burn Care Rehabil 2005; 26:483-7.

Competing interests:
None declared