Wound management is a substantial clinical and economic issue. Difficult wounds significantly affect the socioeconomic costs, and the progressive increase in population lifespan further accounts for the impact on health care spending.^1–3 Today, clinicians share with patients a legitimate demand to limit the consequences of prolonged and/or important morbidity due to complex wounds, whether they are chronic or acute. This raises a compelling need to optimize wound care and requires simple, rapid, and safe treatment for all wound types. Exploitation of the insights coming from research is fundamental to the development and implementation of standard care procedures that may optimize the wound healing potential.

The research into wound healing has laid the path for the evolution of some principles of wound care, especially in relation to the wound bed preparation (WBP). Wound bed preparation is an essential process in accelerating endogenous healing or facilitating the effectiveness of other therapeutic measures. Wound bed preparation considers the removal of local barriers to healing through the T.I.M.E. principles (Tissue management; Infection or Inflammation control; Moisture balance; Epithelization) by optimizing debridement, reduction of bioburden, and exudate management, as integral parts of preparing the wound bed.^4,5

According to WBP, removal of necrotic burden by debridement is a key step in wound management. Devitalized tissue may hinder the assessment of the wound depth or the conditions of the perilesional tissue; necrotic burden can be a breeding ground for bacteria and prevents healing, and concealed dead spaces may harbor bacteria that further contribute to tissue damage.^4,6 Therefore, an efficient wound bed debridement technique that can decrease wound contamination and remove cell debris thereby limits tissue destruction, and is a mandatory step to advance the healing process. Surgical (or sharp) debridement is the most efficient way to remove debris and necrotic tissue. Conventional sharp techniques are mostly performed in difficult and traumatic wounds and are multi-step procedures where initial debridement to remove necrotic or non-vital tissue is followed by a pulsed saline lavage of the wound area that is followed by further debridement of any unconcealed dead tissue. The length of this procedure may be complicated by splashing of irrigant and droplet aerosolization that may occur during the irrigation phase, with resulting limitations on the visibility and potential hazard risks for the operators. Moreover, surgical debridement requires some degree of skill to avoid aggravating the wound, as well as the hospitalization and follow-up of the patient, and is not indicated for patients with bleeding disorders.⁴

Waterjet (or fluidjet) dissection has been practiced in surgery for many years due to its ease of use, hemostatic quality, and rapid technique, which leads to less complications.^7–9 The Versajet^™ Hydrosurgery System (Smith & Nephew, Hull, UK) is a hydrosurgical device based on fluidjet technology that uses the Venturi effect and creates a high-pressure water jet stream that is capable of cutting tissue, while the debris is aspirated into a suction receptacle. Due to its advantages of in terms of precision, speed, and safety, this system is believed to be useful in the excision of difficult wounds.^6,10–17

The authors report on the use of this hydrosurgery system in patients presenting with a variety of difficult chronic and acute lesions of different etiologies.