ABSTRACT Burn injuries remain a leading cause of morbidity and mortality worldwide and excisional technique directly influences graft success, healing time, blood loss and long‐term recovery. Conventional tangential excision (CTE) remains the established reference technique for surgical burn wound bed preparation; in contrast, hydrosurgical debridement (HD) employs a high‐velocity saline jet to enable controlled and selective excision of devitalized tissue while preserving viable dermal structures. Given persistent uncertainty regarding comparative outcomes, we conducted a systematic review and meta‐analysis to critically assess the efficacy and safety of HD versus CTE in patients with acute thermal burns. Eight comparative studies comprising 2130 patients were included. HD was associated with significantly faster wound healing (MD −3.77 days; p = 0.002). No statistically significant differences were observed in perioperative haemoglobin change (MD 0.72 g/L; p = 0.89), duration of surgery (MD 5.33 min; p = 0.92) or hospitalisation costs (MD −4864.02 USD; p = 0.64). Safety outcomes were comparable between techniques, with no significant differences in graft loss or wound infection. Meta‐regression identified mean total body surface area as a significant moderator of wound healing ( p = 0.003), suggesting greater benefit of HD in more extensive burns. Overall, HD demonstrated a safety profile equivalent to CTE, with context‐dependent advantages in time to wound healing, supporting its role as a safe alternative in selected clinical scenarios. Further randomised studies with standardised methodologies and long‐term outcome reporting are required to strengthen the evidence base.
Schpchacki et al. (2026) studied this question.