Trial of Versajet Compared With Conventional Treatment in Acute and Chronic Wounds

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Smith & Nephew Wound Management Inc
ClinicalTrials.gov Identifier:
NCT01050673
First received: January 13, 2010
Last updated: September 7, 2012
Last verified: September 2012
  Purpose

It is increasingly recognised that the debridement of devitalised, bacterially contaminated or senescent tissue is an essential component of the effective treatment of delayed healing wounds.

Whilst surgical debridement procedures have conventionally been performed with scalpels and other sharp instrumentation, alternative techniques such as the VERSAJET Hydrosurgery System are becoming more widespread.

To increase the adoption of this new technology, it is essential that clinical improvements are assessed alongside the potential impact on the costs of debridement and the net financial impact on the hospital.

It is hypothesised that a decrease in the time to achieve stable wound closure will not only lead to a patient benefit, but also a potential reduction in the cost of treatment due to e.g. repeat procedures, longer hospital stay, infection etc. The purpose of this study is to investigate the difference in time to closure of wounds surgically excised with VERSAJET Hydrosurgery System and those surgically excised using conventional operating room techniques.


Condition Intervention Phase
Surgical Wound Dehiscence
Device: VERSAJET
Procedure: Scalpel or blade
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Study to Investigate the Time to Closure of Delayed Healing Dehisced Incisions, Delayed Healing Traumatic Wounds or Chronic Cutaneous Defects Surgically Excised With VERSAJET Compared Conventional Operating Room Techniques

Further study details as provided by Smith & Nephew Wound Management Inc:

Primary Outcome Measures:
  • Difference in Time to Closure Between Wounds Surgically Excised With VERSAJET™ Hydrosurgery System and Those Surgically Excised Using Conventional Operating Room Techniques. [ Time Frame: 28 days plus 6 week follow-up ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Time of Actual Excision Procedure [ Time Frame: 28 days ] [ Designated as safety issue: No ]
  • Cost Per Operative Procedure [ Time Frame: 28 days ] [ Designated as safety issue: No ]
  • Cost of Reference Wound-related Surgical Procedures to Achieve Closure [ Time Frame: 28 days ] [ Designated as safety issue: No ]
  • Quantitative Bacteriology From Standardised Tissue Biopsies Pre- /Post- 1st Excision & Pre-closure [ Time Frame: 28 days ] [ Designated as safety issue: No ]
  • Percentage of Patients Achieving Stable Closure Within Study Period [ Time Frame: 28 days ] [ Designated as safety issue: No ]
  • Length of Hospital Stay (1st Excision to Discharge (Days)) [ Time Frame: 28 days ] [ Designated as safety issue: No ]
  • Number of Patient's With Wound-related Readmissions [ Time Frame: 28 days and 6 week follow up ] [ Designated as safety issue: Yes ]
  • Number of Patient's With Serious Adverse Events and Relationship to Device [ Time Frame: 28 days ] [ Designated as safety issue: Yes ]

Enrollment: 40
Study Start Date: November 2007
Study Completion Date: September 2011
Primary Completion Date: June 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: VERSAJET
Excision with VERSAJET™ Hydrosurgery System
Device: VERSAJET
Hydro-surgery debridement
Active Comparator: Conventional Therapy
Conventional operating room excision will consist of sharp instrumentation and electrocautery techniques, with the use of pulse lavage at the investigator's discretion. The type of sharp instrumentation, together with the brand of pulse lavage will be recorded.
Procedure: Scalpel or blade
Conventional Surgical Debridement

Detailed Description:

It is increasingly recognised that the debridement of devitalised, bacterially contaminated or senescent tissue is an essential component of the effective treatment of delayed healing wounds. Whilst passive autolytic or enzymatic debridement procedures have their place, where patients are unable to tolerate any surgical procedure, the judicious use of surgical debridement to rapidly remove necrotic, contaminated tissue and slough has been shown to offer many advantages in returning a wound to a healing trajectory.

Whilst surgical debridement procedures have conventionally been performed with scalpels and other sharp instrumentation, alternative techniques such as the VERSAJET Hydrosurgery System are becoming more widespread.

To increase the adoption of this new technology, it is essential that clinical improvements are assessed alongside the potential impact on the costs of debridement and the net financial impact on the hospital. In fiscal year 2004, there were more than 57,000 discharges under DRG code 217 ('wound debridement and skin graft except hand) in the United States. Mean length of stay (all payers) was 11 days and mean charges were $52,800. In 2005, Medicare funded 15,800 discharges under this code. Average charges for these patients were $56,500 and average reimbursement was $18,2654. In this context it is particularly important that the potential patient benefit and cost impact of new technology is fully assessed.

It is hypothesised that a decrease in the time to achieve stable wound closure will not only lead to a patient benefit, but also a potential reduction in the cost of treatment due to e.g. repeat procedures, longer hospital stay, infection etc. The purpose of this study is to investigate the difference in time to closure of wounds surgically excised with VERSAJET Hydrosurgery System and those surgically excised using conventional operating room techniques.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients aged 18 years and older
  • Male, and female patients (provided they are not pregnant and if of reproductive age are using contraception)
  • Patients with a delayed healing traumatic wound or chronic cutaneous defect of 30 days or more in duration, or a delayed healing dehisced incision that requires excision to remove necrotic or infected tissue
  • Patients who are deemed to require closure by primary intention or definitive cover with an autologous split-thickness skin graft (STSG) or flap
  • Patients who are hospital in-patients, or will be an in-patient for the period of 1st excision to closure
  • Patients deemed suitable for debridement with both VERSAJET Hydrosurgery System and conventional operating room techniques
  • Patients undergoing surgical excision of their reference wound in the operating room (OR)
  • Patients able to understand the evaluation and willing to consent to the evaluation

Exclusion Criteria:

  • Patients who have previously undergone surgical excision of the reference wound by the Principal Investigator in the last 30 days
  • Patients with coagulopathy (including those with haemophilia)
  • Patients with vasculitis, non-reconstructive peripheral vascular disease, pyoderma granulosa, renal failure or lymphoedema
  • Patients with irradiated, burn or ischaemic wounds
  • Patients with a BMI >35
  • Patients deemed to require a staged procedure, with hospital discharge occurring between procedures
  • Patients deemed to require biological dressings / skin substitutes
  • Patients for whom wound healing by secondary intention is deemed necessary
  • Patients who have been treated with systemic immunosuppressants (including corticosteroids), or cytotoxic chemotherapy in the last 30 days, or who are anticipated to require such medications during the course of the study
  • Patients known to have Acquired Immunodeficiency Syndrome (AIDS) or known to be infected with Human Immunodeficiency Virus (HIV)
  • Patients with a known history of poor compliance with medical treatment
  • Patients who have participated in this evaluation previously or who are currently participating in another clinical study
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01050673

Locations
United States, Illinois
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States, 60611
Sponsors and Collaborators
Smith & Nephew Wound Management Inc
Investigators
Principal Investigator: Robert D Galiano, MD Northwestern University Feinberg School of Medicine
  More Information

Publications:
Responsible Party: Smith & Nephew Wound Management Inc
ClinicalTrials.gov Identifier: NCT01050673     History of Changes
Other Study ID Numbers: CE/030/VJT
Study First Received: January 13, 2010
Results First Received: June 12, 2012
Last Updated: September 7, 2012
Health Authority: United States: Institutional Review Board

Keywords provided by Smith & Nephew Wound Management Inc:
VERSAJET hydro-surgical debridement
traumatic wound

Additional relevant MeSH terms:
Surgical Wound Dehiscence
Postoperative Complications
Pathologic Processes

ClinicalTrials.gov processed this record on August 28, 2014