International Society of Percutaneous Hydrotomy

Definition of Percutaneous Hydrotomy

Percutaneous hydrotomy is a medical intervention which consists in intradermal or subcutaneous injection of a sterile saline solution (NaCl 0.9%)  for the dilution of allopathic active compounds, in line with the market authorisation (MA).  Hydrotomy can be used in combination with or prior to other therapeutic medicinal products in line with their scientifically established pharmacodynamic properties (Vidal). The “hydrotomy cushion” created by the sterile saline constitutes a therapeutic delivery vehicle for the other products, leading to localised regional diffusion helping to treat lesions in a targeted manner. The treatment can be administered discontinuously or continuously in private practice or outpatient services at the hospital using the “tumescent” technique.

MEDICAL TECHNIQUE: LOCOREGIONAL INJECTIONS FOR THERAPEUTIC PURPOSES

Percutaneous route for:

– Extracellular hydration
– Micronutrition (regenerative medicine)
– Therapeutic delivery vehicle.

Equivalent terms:
– Large dilutions
– Surface mesotherapy (subcutaneous infusion)
– Percutaneous hydrotomy

The SIHP is the only organisation authorised to provide training for practitioners in a medical context and declines all responsibility in case of illegal exercise of medicine.

Current status of the nomenclature

Locoregional injections for therapeutic purposes covers three techniques distinguished depending on the depth of injection.
These interventions are covered by the framework of the common classification of medical acts (CCAM) in France, and are therefore validated.

Administered at depth:

Intra-articular infusion of corticosteroids or hyaluronic acid, most often performed by rheumatologists or interventional radiologists.

1. CODE: AHLB011
   WORDING: Therapeutic infusion in the region of a spinal nerve at the rachidian cusp; unguided
2. CODE: AFLB007
   WORDING: Epidural therapeutic injection of a pharmacological agent; unguided
3. CODE: MZLB001
   WORDING: Therapeutic injection of a pharmacological agent into a joint or sinovial bursa of the upper limb; transcutaneous, unguided
4. CODE: NZLB001
   WORDING: Therapeutic injection of a pharmacological agent into a joint or sinovial bursa of the lower limb; transcutaneous, unguided

In general practice, to ensure patient safety the pharmacological agent should not be injected directly into the joint at epidural level or into the sinovial bursa. Indeed, with unguided injections, these routes represent a risk of vascular or nerve breach, or injury to tendons or ligaments. The agent should preferably be instilled around the joint, at a distance from the joint to ensure safe use of the technique in general practice (e.g. when treating cervical vertebrae). 

Percutaneous hydrology does not involve the injection of delayed action corticosteroids (risk of side effects and number of injections limited to 2 to 3 times per year) nor of hyaluronic acid into the joint, rather sterile saline (NaCl 0.9%)  is injected orthogonally to the joint in line with its MA:

1. Extracellular hydration
2. Vehicle for therapeutic take-up
3. Balance ion levels through chloride and sodium input

Administered at mid-depth:

Hypodermoclysis, or the continuous or discontinuous subcutaneous infusion of large quantities of sterile saline and drugs, performed by nurses in private practice, in hospital settings or nursing homes.

1. CODE: AMI9
   WORDING: Infusion treatment lasting up to one hour
2. CODE: AMI14
   WORDING: Infusion treatment lasting more than one hour

Administered superficially:

Mesotherapy or intradermal injection of very low drug doses, most often performed by general practitioners.

1. CODE: ANLB003
   WORDING: Mesotherapy session for analgesia

Percutaneous hydrotomy is a “hybrid” local injection method for use in general medicine within the scope of the procedures listed above. It is listed in the common classification of medical procedures (CCAM) in France, and has been used for several decades.

The “hydrotomy cushion”, depending on its injection volume, constitutes a therapeutic supply vehicle between the deep and superficial planes regulated by the MA for sterile saline (NaCl 0.9%).

In fact, percutaneous hydrotomy differentiates these technical injection procedures based on the following two criteria:

1. The depth of the injection, whether subcutaneous (12 mm) or intradermal (4 mm) and the region targeted: spine, shoulder, knees, fingers, etc.
2. The injection volume, between 5 ml and 500 ml.

Applying the same criteria, the injection varies as follows:

1. Single or multiple injections,
2. Multipoint subcutaneous infusion can be applied for large areas (surface mesotherapy: spine)

In addition, during percutaneous hydrotomy low-dose peripheral local anesthaesia (xylocaine or procaine) is applied for analgesic purposes during infusion of 0.9% NaCl (tumescent technique used in cosmetic procedures): the hydrotomy cushion is thus targeted to the lesion. This technique has been used for several decades by all practitioners, particularly in general practice when placing stitches or extracting foreign bodies.

Hypodermoclysis (CODE: AMI 9 – AMI 14)

Subcutaneous administration of large quantities of physiological solutions. This technique is used to treat large infusion surfaces with drugs and NaCl 0.9% or glucose 5%.

It can be used to supply electrolytes, trace minerals, water-soluble and fat-soluble vitamins, among others.

Therapeutic indications: hydration and nutrition of geriatric and oncology patients, or as part of palliative care.
This technique is commonly used, and has been the subject of numerous scientific publications (see bibliographic references).

Mesotherapy (CODE: ANLB 003)

First developed by Dr Michel Pistor , mesotherapy consists of injecting small quantities of drugs “rarely and in the right place” to limit side effects.
Since 1997, Dr Pistor has encouraged the development of surface mesotherapy or percutaneous hydrotomy as the mesotherapy of the future, as a means to achieve “True cell washing” or “washout”.
Mesotherapy was recognized by the French Academy of Medicine in 1987, by ANAES (French health authority, now part of HAS) in 2001, and by the French National Order of Physicians in 2002. The technique is taught in medical faculties in Paris, Bordeaux, Lyon and Dijon.

Percutaneous hydrotomy uses allopathic conventional medical methods, optimizing their efficacy and safety (depth of injection, products used, large dilutions and small doses), and thanks to their local administration, very clearly reduces the adverse effects of drugs. Percutaneous hydrotomy thus corresponds to a very diluted mesotherapy technique developed over the past decades. It also makes it possible to treat the real causes of the disease at the pharmacological level (hydration, micronutrition, detoxification, regeneration, vaccination).