CASE REPORT The WoundWand and Its Novel Use in Burn Excision Surgery

METHODS/CASE REPORT

The authors present the case of a 66-year-old retired woman, who presented with 18% flame burns. She sustained the burns after her bed sheets caught fire when she was smoking a cigarette while using home oxygen therapy; for chronic obstructive airways disease. Her medical history included a 60 pack-year history of smoking, liver cirrhosis and concurrent malnutrition.

After detailed assessment, she sustained full-thickness burns to her left thigh, left breast, and left upper limb including her hand, groin, and abdomen (Fig 1). She underwent fascial excision of her burns to these areas. The WoundWand device was used to excise the burns on her arm, hand, and fingers only. On the hand, the paratenon was preserved but burns were deep involving the dorsal skin and subcutaneous tissues (Fig 2). She subsequently underwent meshed skin grafting (1:1 to the hand, 2:1 elsewhere) and had application of topical negative pressure device to all grafted areas, set at 70 mmHg continuous.

Figure 1. The burn eschar on the left forearm and dorsum of the hand.

Figure 2. The WoundWand device and excision of eschar from the dorsum of the left index finger.

A real-time video of the device in use can also be seen at this video link (Video 1. The WoundWand removing eschar from the dorsum of the wrist and left little finger).

[Click Here to view video]

When checked 5 days later, she had 50% graft loss to the thigh. The grafts to her left upper limb, breast, and abdomen were intact. Microbiology swabs confirmed presence of coliforms in the burn wounds at initial surgery. This was compounded by low preoperative albumin levels at 16 to 19 g/dL. Unfortunately, at 10 days postoperatively, she had extensive graft loss to her left breast and abdomen requiring regrafting.

Interestingly, the wounds on the arm and hand healed very well with good graft take which did not require regrafting (Figs 3 and 4). She underwent extensive hand therapy and made a good recovery overall despite needing regrafting to the left breast and thigh, the areas where the excision was “fascial” using cutting diathermy. She was nutritionally optimized using nasogastric enteral feeding, which improved her albumin levels to 26 to 30 g/dL. She is now fully medically rehabilitated and has been discharged. At follow-up 6 weeks postoperatively, her wounds were more than 95% healed with no indication of any wound infection.

Figure 3. The left forearm at 5 days postoperatively.

Figure 4. The left hand dorsum at 5 days postoperatively.

DISCUSSION

The WoundWand device uses hydrodissection and radiofrequency ablation technology in one simple, light handheld, hand-operated tool. The probe that interfaces with the tissue is broad-fronted and is well-suited to removing thick eschar from delicate areas such as the dorsum of the fingers and hand.

The device is easy and simple to operate. However, as with all devices there is a learning curve, however in the hands of an experienced burns surgeon, the senior author performed the burn excision with relative ease. A key learning point is to use the device in a unidirectional manner. It was found that repeat back and forth passage obstructs the device-tissue interface, which congests the suction device and causes inefficiency.

The WoundWand device presents itself as a new surgical tool, which is suitable for the discrete tangential excision of full-thickness eschar from delicate areas such as the hand and fingers.