Hydrosurgical debridement of Grade VI external fixator pin site infection

Background: Pin site infection is a common complication with external fixation, with a reported incidence of 26%-71% in the context of limb reconstruction. The Checketts and Otterburn (C&O) classification is frequently used, with minor infections (C&O I-III) treated with pin site care and enteral antibiotics. Major infections (C&O IV-VI) require removal of the infected pin or fine wire. Surgical debridement is indicated where the infection persists following pin removal (C&O grade VI). The Versajet hydrosurgery system (Smith & Nephew, Memphis, Tennessee) utilizes a saline jet to debride biological tissue. Methods: A retrospective review was conducted on all patients who underwent Versajet hydrosurgery debridement with C&O grade VI pin site infections between January 2011 and January 2021. Data regarding patient demographics, fixator type, indication for the initial surgery, and treatment outcome were recorded. Results: The cohort comprised seven males (87.5%) and one female (12.5%) with a mean age of 41.4 years ± 17.74 (range 16-61). Mean follow-up was 11.8 months ± 6.2 (range 7-25). The mean time in external fixator was 155 days ± 85.19 (range 83-354), and the mean time between fixator removal and Versajet debridement was 46 days ± 33.83 (range 3-116). No perioperative complications were experienced, and all patients (n = 8, 100%) were found to be infection-free at the last clinical review, with healed overlying soft tissue. Conclusion: The Versajet hydrosurgical debridement system is effective in managing C&O grade VI pin site infections. The method is reproducible and provides long-term clearance of infection, allowing subsequent soft tissue healing.