Coblation Therapy in the Management of Chronic Wounds

Bekara, Farid M.D.; Chaput, Benoit M.D.; Téot, Luc M.D., Ph.D.; Vitse, Julian M.D.; De Runz, Antoine M.D.; Herlin, Christian M.D., Ph.D.

Plastic & Reconstructive Surgery: April 2017 - Volume 139 - Issue 4 - p 1026e–1028e
doi: 10.1097/PRS.0000000000003220
Letters

Department of Plastic and Reconstructive Surgery, Wound Healing and Burns Units, Lapeyronie University Hospital, Montpellier, France

Department of Plastic and Reconstructive Surgery, Rangueil University Hospital, Toulouse, France

Department of Plastic and Reconstructive Surgery, Wound Healing and Burns Units, Lapeyronie University Hospital, Montpellier, France

Department of Maxillofacial, Plastic, Reconstructive, and Cosmetic Surgery, Nancy University Hospital, Nancy, France

Department of Plastic and Reconstructive Surgery, Wound Healing and Burns Units, Lapeyronie University Hospital, Montpellier, France

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s website (www.PRSJournal.com).

Correspondence to Dr. Bekara, Department of Plastic and Reconstructive Surgery, Lapeyronie University Hospital, Avenue du doyen Gaston Giraud, Montpellier, France, farid.bekara@live.fr

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Sir:

We read with great interest the article by Anghel et al. entitled “Current Concepts in Debridement: Science and Strategies.”1 We would like to congratulate the authors for this overview in the management of chronic wounds, which describes the techniques available to us.

Numerous debridement methods exist, such as autolytic, enzymatic, biodebridement, and surgical/sharp. Sharp debridement using a scalpel or curette remains the gold standard. Recent innovations such as hydrosurgery (Versajet; Smith & Nephew, London, United Kingdom), ultrasound (MIST therapy device; Aliqua Biomedical, Langhorne, Pa.), and plasma-mediated bipolar radiofrequency ablation therapy (Coblation; Arthrocare ENT, Austin, Texas) could represent alternatives to conventional débridement in many cases, especially in patients with a chronic nonhealing wound.

Coblation uses bipolar radiofrequency to energize molecules by means of a conductive solution surrounding the active electrode, thus creating a precisely focused plasma field. The glow discharge plasma produces chemically active radical species from the dissociation of water, breaking molecular bonds and causing tissue dissolution. (See Video, Supplemental Digital Content 1, which demonstrates use of the Coblation device, http://links.lww.com/PRS/C121.) The importance of biofilm and bacterial colonization as they relate to impaired wound healing are receiving significant scientific and clinical attention.2 In an in vitro study, Sönnergren et al.3 have shown significant microbicidal effects compared to hydrosurgery or standard debridement. The reduction compared with untreated control was 99.87 to 99.99 percent (p < 0.0001) for all strains (i.e., Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas aeruginosa, Escherichia coli, and Candida albicans). Compared to hydrosurgery, there is no risk of spreading of the aerosolized bacteria4; thus, health personnel are less exposed to air bacterial contamination. Coblation provides a hemostatic effect,5 which is particularly interesting for chronic inflammatory wounds or for patients under anticoagulant therapy.

In our experience,5 this is the most useful device for fibrotic, infected, and hemorrhagic wounds. This instrument has gradually replaced the use of hydrosurgery. It also seems to us to be more accurate and more convenient than hydrosurgery. However, the wear of the filaments limits its use for wounds for which the surface is less than 5 percent of the total body surface area. The extrapolation of our experience concerning hydrosurgery (150 procedures), Coblation (200 procedures), and ultrasound therapy (50 procedures) has allowed us to identify a practical approach, as follows:

– Coblation therapy seems to be particularly useful for dry fibrotic, infected, and bleeding wounds, typically chronic ulcers or small deep burns.

– Hydrosurgery can be used for infected (n = 13), fibrinous (n = 5) wounds and intermediate depth and large burns.

– Ultrasound seems useful for wounds with a low density of fibrin, a low risk of bleeding, and a small infected area (e.g., in diabetic foot ulcer lesions or small leg ulcers that require frequent attention, often performed by a nurse in consultations).

We summarize these indications in Figure 1.

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DISCLOSURE

The authors have no financial interest to declare in relation to the content of this communication. There were no sources of funding.

Farid Bekara, M.D.

Department of Plastic and Reconstructive Surgery

Wound Healing and Burns Units

Lapeyronie University Hospital

Montpellier, France

Benoit Chaput, M.D.

Department of Plastic and Reconstructive Surgery

Rangueil University Hospital

Toulouse, France

Luc Téot, M.D., Ph.D.

Julian Vitse, M.D.

Department of Plastic and Reconstructive Surgery

Wound Healing and Burns Units

Lapeyronie University Hospital

Montpellier, France

Antoine De Runz, M.D.

Department of Maxillofacial,

Plastic, Reconstructive, and Cosmetic Surgery

Nancy University Hospital

Nancy, France

Christian Herlin, M.D., Ph.D.

Department of Plastic and Reconstructive Surgery

Wound Healing and Burns Units

Lapeyronie University Hospital

Montpellier, France

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REFERENCES

1. Anghel EL, DeFazio MV, Barker JC, Janis JE, Attinger CECurrent concepts in debridement: Science and strategies. Plast Reconstr Surg. 2016;138(Suppl):82S–93S.
2. Wolcott RD, Rhoads DD, Bennet WE, et alChronic wounds and the medical biofilm paradigm. J Wound Care 2010;19:45–46, 48–50, 52–53––.
3. Sönnergren HH, Strömbeck L, Aldenborg F, Faergemann JAerosolized spread of bacteria and reduction of bacterial wound contamination with three different methods of surgical wound debridement: A pilot study. J Hosp Infect. 2013;85:112–117.
4. Bowling FL, Stickings DS, Edwards-Jones V, Armstrong DG, Boulton AJHydrodebridement of wounds: Effectiveness in reducing wound bacterial contamination and potential for air bacterial contamination. J Foot Ankle Res. 2009;2:13.
5. Trial C, Brancati A, Marnet O, Téot LCoblation technology for surgical wound debridement: Principle, experimental data, and technical data. Int J Low Extrem Wounds 2012;11:286–292.
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