Micro water jet technology for gentle debridement

Micro water jet technology for gentle debridement

by in Publications February 27, 2018

Application for decubitus category IV ~ Sebastian Kruschwitz

Chronic wounds cause a great deal of suffering and severely restrict the quality of life of affected patients. Treatment is often difficult. An important problem here is often the presence of bacterial colonization in the form of biofilms on the wounds. This is because bacteria embedded in a biofilm have a high tolerance to otherwise highly effective and proven wound disinfectants. It is therefore all the more important to remove the biofilm - preferably gently and without damaging the tissue. Micro water jet technology can ensure very gentle yet highly effective debridement and a well-prepared wound bed (see box).

In addition to treating the root causes, a clean wound bed is a basic prerequisite for the complex wound healing processes to proceed undisturbed. The international consensus document1 describes the strategic approach to wound hygiene in four steps1:
Step 1: Irrigation and cleansing,
2nd step: debridement,
Step 3: Treatment of the wound edge and surrounding area,
Step 4: The wound dressing.

When a wound has difficulty healing, the interruption of the healing process is largely due to the presence of a persistent biofilm (tough, thin layer of mucus or matrix with various microorganisms embedded in it) within the wound. Although other patient-related factors can also delay healing, it is increasingly recognized that the majority of chronic wounds contain biofilm, which is a major barrier to healing. Biofilm as an enabler of critical colonization increases the risk of infection in any tissue. There is an increased risk of biofilm formation in chronic wounds due to underlying diseases such as diabetes mellitus, chronic venous insufficiency (CVI) or peripheral arterial disease (PAD). Increased microbial virulence, antibiotic resistance and/or immunodeficiency or immunosuppression in patients further multiplies the risk of biofilm formation. However, care-related factors can also be responsible for impaired wound healing, as can be seen in the following case report.


A bedridden 61-year-old female patient suffered from a grade IV decubitus ulcer which, according to best practice wound treatment, could no longer be treated purely on an outpatient basis but required hospitalization for surgical treatment. This patient had the following diagnoses:

- Waking coma with right common ductal hemorrhage, with
- Ventricular hemorrhage with arteriovenous malformation (AVM)
- Diabetes mellitus type 2
- Severe dysphagia
- Arterial hypertension
- Hypercholesterolemia
- Care-relevant components: Urinary and fecal incontinence Severe cognitive dysfunction.

In summary, the following aggravating care-relevant factors and factors influencing wound healing were identified in the patient:

- age
- weakened immune status
- cachexia
- consuming underlying disease
- Cognitive impairment
- Completely immobile
- Urinary and fecal incontinence
- Causal therapy:
- a repositioning system in bed
- Mobilization in a wheelchair (with AD cushion).

The patient was admitted to a hospital in Berlin for surgical debridement of the pressure ulcer, as several necroses and avital tissue had formed at the wound bed.

Successful use of a focused micro water jet

However, the wound bed was still clearly covered even after surgical debridement (Fig. 1). We used the so-called micro water jet technology (debritom+, Medaxis) to clean the wound bed as gently as possible and to remove the remaining or re-emerging tough biofilm. A controlled, multi-center study has already demonstrated the advantages of debridement using micro waterjet technology compared to standard surgical debridement.2 The gentle removal of infected, damaged or dead tissue with the debritom also produced excellent healing results in our application. After using the debritome, significantly fewer deposits are visible on the wound bed (Fig. 2).

The wound was treated a total of 4 times with the debritome. After each treatment, it could already be seen that the wound bed could be cleaned significantly more and the wound healing processes progressed further (Fig. 2-6).

The wound was treated with an alginate as a wound filler. A superabsorbent was used as a cover for this length of time,

until the granulation tissue completely filled the wound. PU foam was then used at a later stage. The dressing change intervals were three days. Overall, the wound took up to 10 months to heal, although this was also due to the reduced general condition and the other factors described above that inhibited healing.



Sebastian Kruschwitz, Head of Wound Management, Wound Care Therapist ICW, Nursing Specialist for Outpatient Ventilation, Deputy Case Manager, ZBI Group, Franz-Jacob-Straße 4D, 10369 Berlin
1 International Consensus Document: Defying hard-toheal wounds with an early antibiofilm intervention strategy: wound hygiene. JWC 2020; 29(3): S2-S26
2 Armstrong DG, Zelen C: Multicenter, Randomized Controlled Clinical Investigation Evaluating a Unique Micro Water Jet Technology Device Versus Standard Débridement in the Treatment of Diabetic Foot. Diabetes 2022; 71(Supp_1). DOI: 10.2337/db22-30-LB

You can find the full report here:
Study Sebastian Kruschwitz