Coblation Therapy in the Management of Chronic Wounds

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, https://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.Video.: Supplemental Digital Content 1 demonstrates use of the Coblation device, https://links.lww.com/PRS/C121.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.Fig. 1.: Summary of the main advantages of each of these techniques. (Above) Arthrocare; (center) Versajet hydrosurgery system; and (below) MIST therapy device.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 SurgeryWound Healing and Burns UnitsLapeyronie University HospitalMontpellier, France Benoit Chaput, M.D.Department of Plastic and Reconstructive SurgeryRangueil University HospitalToulouse, France Luc Téot, M.D., Ph.D.Julian Vitse, M.D.Department of Plastic and Reconstructive SurgeryWound Healing and Burns UnitsLapeyronie University HospitalMontpellier, France Antoine De Runz, M.D.Department of Maxillofacial,Plastic, Reconstructive, and Cosmetic SurgeryNancy University HospitalNancy, France Christian Herlin, M.D., Ph.D.