Cura por vacío (VAC), a propósito de un caso en Atención Primaria / Vacuum assisted closure (VAC), about a case in primary care

El síndrome compartimental agudo requiere de la descompresión quirúrgica, mediante fasciotomía, esta técnica debe ser urgente y será clave para evitar la instauración de graves secuelas. El posterior abordaje de estas heridas de difícil y lenta cicatrización suponen un reto para los profesionales de la salud y un problema para la salud pública debido a los altos costes y elevada morbilidad. La terapia de presión negativa (TPN) o cura por vacío (VAC, "vacuum assisted closure") es un tratamiento no invasivo que consigue la curación de las heridas favoreciendo la vascularización, la aparición del tejido de granulación y eliminación del exceso de exudado[AU]

Acute compartment syndrome requires surgical decompression by fasciotomy, this technique must be urgent and will be key to avoid the establishment of serious sequels. The subsequent approach to these wounds, which are difficult and slow to heal, is a challenge for health professionals and a problem for public health due to high costs and high morbidity. Negative pressure therapy (NPWT) or vacuum assisted closure (VAC) is a non-invasive treatment that achieves wound healing by promoting vascularization, the appearance of granulation tissue and elimination of excess exudate[AU]

A síndrome compartimental aguda requer descompressão cirúrgica, por fasciotomia, esta técnica deve ser urgente e será fundamental para evitar o estabelecimento de sequelas graves. O tratamento subsequente destas feridas difíceis e de cicatrização lenta é um desafio para os profissionais de saúde e um problema desaúde pública devido aos elevados custos e à elevada morbilidade. A terapia por pressão negativa (NPWT) ou o encerramento assistido por vácuo (VAC) é um tratamento não invasivo que permite a cicatrização de feridas através da promoção da vascularização, do aparecimento de tecido de granulação e da remoção do excesso de exsudado[AU]

Implementación artesanal del sistema VAC en pacientes con Gangrena de Fournier: serie de casos

La fascitis necrosante es una infección de los tejidos blandos profundos que provoca la destrucción progresiva de la fascia muscular y subcutánea. Una de sus presentaciones es la Gangrena de Fournier (GF) para el cual el diagnóstico debe de ser preciso y asociado a desbridamiento quirúrgico precoz y antibioticoterapia de amplio espectro. Si existe retraso del manejo, la repercusión en el pronóstico es negativa. Entre las opciones actuales para el tratamiento destaca una técnica para mejorar la limpieza y granulación del área cruenta mediante el uso del dispositivo tecnológico y el sistema de cierre asistido por vacío (VAC). Describimos el manejo y la técnica de la terapia VAC implementado artesanalmente en una serie de casos de pacientes masculinos con diagnóstico de GF, en respuesta a los escasos recursos económicos de los pacientes que generalmente son afectados en nuestro medio; proponiendo una opción más económica, segura y replicable para nuestro entorno.

Necrotizing fasciitis is a deep soft tissue infection that causes progressive destruction of the muscle fascia and subcutaneous . One of its presentations is Fournier's Gangrene (FG) for which the diagnosis must be accurate and associated with early surgical debridement and broad-spectrum antibiotic therapy. If management is delayed, the impact on prognosis is negative. Current treatment options include a technique to improve cleaning and granulation of the cruciate area using a technological device and the vacuum assisted closure system (VAC). We describe a handmade technique of VAC therapy implemented in a series of cases of male patients diagnosed with FG, in response to the scarce economic resources of patients who are generally affected in our environment; proposing a more economical, safe and replicable option for our environment.

A case on novel treatment protocol for difficult to treat foot myiasis

Foot myiasis is a rare condition, with only a few reported cases and no treatment consensus. We proposeda conservative and unique treatment approach with VAC dressing method. The patient administered in the hospital with presentation of deep tissue injury from a sharp stone, from 3 months back which was maggot infested. The patient had approached local physicians before been admitted in our facility. The wound was severe with maggot infestation. The patient was non diabetic with no other comorbid conditions. We had the aim of infection free wound with faster rate of healing, which was fulfilled by the noveltreatment protocol using vacuum-assisted closure (VAC®) dressing method. Culture sensitivity tests ruled out infection and maggot infestation. The wound was closed surgically after healthy uninfected granulation tissue confirmed with culture sensitivity report. No recurrence of maggot or any other infection were found. The protocol performed was safe and effective in critical case of myiasis.

Uso de VAC en neonatos / Use of VAC in neonates

El objetivo de este trabajo es normatizar el uso de la terapia de presión negativa de heridas complejas en neonatos. La iniciativa surge a partir de la negativa de nuestros proveedores locales de proporcionarnos el material del sistema VAC (cicatrización asistida por vacío), por temor a las posibles complicaciones por su uso en neonatos y escasa bibliografía al respecto. Se presentan 2 casos tratados en neonatos entre 2018 y 2021, y se acompaña de revisión bibliográfica encontrada, de diferente etiología. Con las conclusiones obtenidas, se pretende establecer al VAC como una herramienta terapéutica eficaz en neonatos, de igual manera que se aplica, en toda herida compleja que lo requiera, sin importar la edad del paciente

The goal of this work is to standardize the use of negative pressure therapy for complex wounds in newborns. The initiative arises from the refusal of our local suppliers to provide us with the VAC (vacuum-assisted healing) system material, for fear of possible complications from its use in newborns and little literature about it. There are 2 cases treated in neonates between 2018 and 2021, and it is accompanied by found bibliographic review of different etiology. With the conclusions obtained, it is intended to establish the VAC as an effective therapeutic tool in neonates, just as it is applied, in any complex wound that requires it, regardless of the age of the patient

A Comparative Study between Indigenous Low Cost Negative Pressure Wound Therapy with Added Local Oxygen versus Conventional Negative Pressure Wound Therapy

@#Introduction: The incidence of compound fractures and severe soft tissue loss has increased manifolds due to high speed traffics. Negative Pressure Wound Therapy (NPWT) is a treatment modality for managing soft tissue aspect of such injuries. It reduces the need of flap coverage. However, many patients from developing countries cannot afford a conventional NPWT. We developed an indigenous low cost NPWT for our patients and supplemented it with Topical Pressurised Oxygen Therapy (TPOT). We conducted this study to compare its treatment outcome with the use of conventional NPWT. Materials and Methods: The study was conducted from 2018 to 2020 at a tertiary care teaching hospital. A total of 86 patients were treated with NPWT and their results were assessed for various parameters like reduction in wound size, discharge, infection, etc. We included patients with acute traumatic wounds as well as chronic infected wounds, and placed them in three treatment groups to receive either conventional NPWT, Indigenous NPWT and lastly NPWT with supplement TPOT. Results: We observed a significant reduction of wound size, discharge and infection control in all three groups. The efficacy of indigenous NPWT is at par with conventional NPWT. Only six patients who had several comorbidities required flap coverage while in another four patients we could not achieve desired result due to technical limitations. Conclusion: Indigenous NPWT with added TPOT is a very potent and cost effective method to control infection and rapid management of severe trauma seen in orthopaedic practice. It also decreases the dependency on plastic surgeons for management of such wounds.

Our Initial Experience with VAC Suction in the Management of Infected Wounds: A Prospective Study

Introduction: Management of infected wounds is notalways simple and easy. Vacuum-assisted closure (VAC) isa wound healing therapy that utilizes a dressing system thatcontinuously or intermittently applies a negative pressure tothe wound surface. Our aim was to assess the Feasibility andadvantages of simplified version of otherwise costly VAC, orsimple suction drainage in selected cases.Material and methods: This prospective study was conductedin the unit 2nd of department of surgery at SMHS hospital, anassociated hospital GMC Srinagar, over a period of 3 yearsfrom January 2014 to December 2016. During this period, 32patients were subjected to vacuum suction treatment and wereincluded in this study.Results: Wall suction (VAC) was used in 26 patients. MiniVac drain (USG guided) was used in 5 cases. In one patient ofscalp infection conventional large size suction drain was used.The time taken for the wounds to become healthy was 3 to7(average 3.5) days of VAC dressing or suction drainage. Noantibiotics were given during suction drainage in 21 patients.Need for grafting by split skin grafting method was felt in only2 patients. Mild discomfort (abnormal sensation) was reportedin 21 patients. Hospital stay for patients managed by suctiontherapy ranged from12 hours (breast abcess) to 16 days withan average of 7 days. The total cost incurred in the patientsundergoing VAC for a period of 15 days per patient was Rs.800 ($ 12).Conclusion: VAC seems to have revolutionary potential inthe management of the difficult to treat infected wounds asfar as its safety, speed and cost-effectiveness are considered.

Manejo de perforación esofágica tardía, secundario a cirugía de columna cervical anterior / Management of a late esophageal perforation secondary to an anterior cervical spine surgery

Resumen Introducción: La cirugía anterior de columna cervical es un procedimiento de rutina para la fijación de fracturas vertebrales inestables, las indicaciones para estabilización de las vértebras son osteomielitis, tumores espinales y trauma. Objetivo: Informar sobre una de las complicaciones poco frecuentes y potencialmente peligrosas de la fijación de columna cervical por vía anterior. Pacientes y métodos: CASO 1: Paciente del sexo masculino de 41 años de edad que sufrió un accidente automovilístico. La tomografía reportó fractura del arco anterior de C1 y fractura de apófisis espinosa de C5-C6. Fue intervenido quirúrgicamente, y se le colocó osteosíntesis con placa. Un mes después presentó perforación esofágica, por lo que fue reintervenido, se le retiró la osteosíntesis, se le realizó un drenaje y se le colocó sistema VAC. Fue dado de alta por evolucionar adecuadamente. CASO 2: Paciente mujer de 53 años de edad, que inició su padecimiento un mes antes, con dolor cervicodorsal. Se le realizó una resonancia magnética en la que se encontró hernia discal C4-C5, C5-C6; se realizó artroplastia con prótesis en C4-C5. Cinco meses después, presentó migración del implante protésico; fue intervenida para retirar la prótesis, y presentó perforación esofágica. Fue reintervenida, se realizó el lavado de herida quirúrgica y se le colocó sistema VAC. Evolucionó de forma satisfactoria, por lo que egresó por mejoría. Resultados: La perforación cervical posterior a cirugía anterior de columna cervical es una complicación poco frecuente, y es indispensable su reconocimiento y diagnóstico temprano. Conclusiones: La perforación esofágica posterior a la fijación anterior de columna cervical es una complicación muy rara, con una incidencia de 0.25%, cuya mortalidad es elevada de no ser diagnosticada de manera temprana.

Abstract Introduction: The anterior cervical spine surgery is a routine procedure for the fixation of unstable vertebral fractures; the indications for stabilization of the vertebrae are osteomyelitis, spinal tumors and trauma. Objective: To inform about one of the rare and potentially dangerous complications of the cervical spine fixation by anterior approach. Patients and methods: CASE 1: A 41 year-old male patient who had a car accident. The tomography shows a fracture of the anterior arch of C1 and a spinous process fracture of C5-C6. He underwent surgery, and osteosynthesis with plate fixation was placed. A month later he presented esophageal perforation, and underwent surgery again. Osteosynthesis was removed, drainage was performed and a VAC system was placed. He was discharged by adequate evolution. CASE 2: A 53 year-old female patient, began her condition a month earlier with cervicodorsal pain. A magnetic resonance was performed finding disc herniation C4-C5, C5-C6. An arthroplasty with prosthesis in C4-C5 was performed. Five months later, she presented migration of the prosthetic implant and underwent surgery again to remove the prosthesis, presenting esophageal perforation. The surgical wound was washed and a VAC system was placed with satisfactory evolution. Results: A cervical perforation after an anterior cervical spine surgery is a rare complication; an early diagnosis is crucial.

Tumor neuroectodérmico recidivante. A propósito de un caso y revisión bibliográfica / Recurrent neuroectodermal tumor. A case report and literatura review

Resumen ANTECEDENTES: La relación entre cáncer y embarazo supone 0.07% de las complicaciones gestacionales. Cuando estas situaciones coinciden el tratamiento del tumor se dificulta. El tumor neuroectodérmico primitivo es una neoplasia relacionada con el sarcoma de Ewing y su incidencia es excepcional durante el embarazo. CASO CLÍNICO: Paciente de 34 años, con 36.3 semanas de embarazo, que ingresó a la unidad hospitalaria por dolor abdominal irradiado al miembro inferior derecho. A la exploración física se palpó una tumoración de gran dimensión en la fosa iliaca derecha. La ecografía abdominal objetivó una imagen compatible con un mioma. La resonancia magnética reportó una masa de 16 x 13 x 17 cm, retroperitoneal, paravertebral, coincidente con tumor neuroectodérmico, sarcoma y tumor neurogénico. La paciente tuvo parto eutócico, sin administración de analgesia epidural, del que nació una niña de 2950 g, con Apgar 8-9. Se efectuó una biopsia por aspiración con aguja gruesa, que reportó un tumor neuroectodérmico primitivo. El tratamiento consistió en quimioterapia con protocolo VAC (vincristina, dactinomicina y ciclofosfamida [14 ciclos]) y adriamicina (6 a 8 ciclos de inducción). Actualmente padece dolor neuropático en la pierna derecha y permanece en rehabilitación, con tratamiento médico. CONCLUSIONES: Los tumores neuroectodérmicos primitivos son neoplasias excepcionales durante el embarazo. Se requieren estudios complementarios para conocer la relación exacta entre este tipo de tumores y el embarazo, y de esta forma establecer el protocolo de tratamiento adecuado.

Abstract BACKGROUND: The relationship between cancer and pregnancy accounts for 0.07% of gestational complications. This aspect makes treatment difficult and has a negative impact on pregnant patients. The primitive neuroectodermal tumor is a neoplasm related to Ewing's sarcoma and its incidence is exceptional during pregnancy. CLINICAL CASE: A 34-year-old patient, 36.3 weeks pregnant, who was admitted to the hospital unit due to abdominal pain radiating to the right lower limb. Physical examination revealed a large tumor in the right iliac fossa. The abdominal ultrasound showed an image compatible with a myoma. Magnetic resonance imaging revealed a mass of 16 x 13 x 17 cm, retroperitoneal, paravertebral, coinciding with neuroectodermal tumor, sarcoma and neurogenic tumor. The patient had eutocic delivery, without administration of epidural analgesia, from which a girl of 2950 g was born, and Apgar 8/9. An aspiration biopsy was performed with a thick needle, which reported a primitive neuroectodermal tumor. The treatment consisted of chemotherapy with VAC protocol (vincristine, dactinomycin and cyclophosphamide [14 cycles]) and adriamycin (6 to 8 induction cycles). He currently suffers from neuropathic pain in the right leg and remains in rehabilitation, with medical treatment. CONCLUSIONS: Primitive neuroectodermal tumors are exceptional neoplasms during pregnancy. Complementary studies are required to know the exact relationship between this type of tumors and pregnancy, and in this way establish the appropriate treatment strategy.

Application potential of bacterial flagellin in treatment of autoimmune rheumatic diseases with Treg epitope peptides / 中华微生物学和免疫学杂志

Immunization with regulatory T cell ( Treg ) epitope peptides to activate and induce Tregs, by which to suppress pathological autoimmune responses and reconstitute a new homeostasis, is a promising therapeutic regimen for autoimmune rheumatic diseases. However, it is usually hard to induce po-tent peptide-specific immune responses in vivo with small molecular peptides. Bacterial flagellin is one of the agonists triggering innate immune responses. When used as carrier, it shows strong adjuvant activity to its conjugated antigens. In some particular situations, bacterial flagellin can also activate and induce Tregs. Thus if Treg epitope peptides are covalently conjugated to a bacterial flagellin, the conjugates should be able to effectively enhance the Treg-based immune responses via flagellin itself and the adjuvanticity of flagellin to Treg epitope peptides, and thereby enhance the immunotherapeutic effects on autoimmune rheumatic diseases.

Comparative study in newer techniques for management of diabetic foot

Background: Diabetic foot is the commonest complication of Diabetes Mellitus. It is not totally curable or preventable but with positive approach mortality and morbidity due to diabetic foot can be reduced. Aim and objectives: To find out which type of treatment modality is better in terms of costeffectiveness and number of dressings in patients of diabetic foot, to salvage the limb in diabetic patient with help of various modalities of treatment available to our hospitals, to prevent the recurrence of such lesion by careful follow up, by educating the patient about foot care and prescribing pressure distributing footwear, and rehabilitation of patient once the ulcer has healed. Materials and methods: A total of 60 patients having diabetic foot were included. Clinical assessment was done of all patients after admitting them. History and clinical findings were written as per preformed proforma. All patients were sent to foot wear specialist. All this patients initially underwent debridement or removal of necrotic patch, according to the presenting feature. Depending on the condition of the ulcer (size or slough) they were dressed with newer techniques. Newer techniques used were Vac (Vacuum assisted closure) and Non-Vac (Hydrocolloid, Hydrogel, collagen, Platelet derived growth factor). Results: Majority of diabetic patients were having neuropathic and traumatic type of lesions. 30 patients were dressed with V ac (Vacuum assisted closure) and remaining 30 patients were dressed with Non-V ac. In which 5 patients were dressed with Hydrocolloid, 3 patients were dressed with Hydrogel, 12 patients were dressed with collagen and 10 patients were dressed with platelet derived growth factor. Comparison between V ac and Non-V ac types of dressing in terms of number of dressings, duration of stay, cost effectiveness is done by applying Z-Test. It was significant. Desai A, Panchal A, Parmar H. Comparative study in newer techniques for management of diabetic foot. IAIM, 2016; 3(8): 79-82. Page 80 Conclusion: Newer techniques for dressing- VAC or NON-VAC decreases the morbidity of the patient and also better in terms of cost-effectiveness and duration of stay as compared to conventional dressings.

Manejo clínico quirúrgico de las fistulas enterocutáneas / Surgical - clinical management of enterocutaneous fistula

Introducción: Las fistulas enterocutaneas son una comunicación anormal entre dos superficies epitelizadas anatómicamente compuestas por un orificio de origen (entéricas), trayecto (superficial-labiada) y orificio de descarga (Piel). Lasalida del contenido entérico produce un desequilibrio hidroelectrolitico, desnutrición y deshidratación a nivel sistémico ya nivel local compromete la integridad de los distintos planos dela pared abdominal e impide la cicatrización iniciando un proceso infeccioso que va desde una dermatitis a destrucción parietal condicionando el cierre espontaneo representa unas de lasentidades quirúrgicas de difícil manejo por su elevada morbimortalidad Objectivo: Presentación de un caso clínico y a partir de él unarevisión bibliográfica actualizada del manejo clínico quirúrgico delas fistulas enterocutaneas...

Background: Enterocutaneous fistula is an abnormal communication between two epithelialized surfaces anatomically composed of an orifice of origin (enteric), ride (shallow-lipped)and spout (Skin). The output of enteric content produces a fluidand electrolyte imbalance, malnutrition and dehydrationsystemically and locally compromises the integrity of the variouslayers of the abdominal wall and prevents scarring initiating aninfectious process from dermatitis to parietal destructionconditioning spontaneous closure. Represents a surgical entitiesunwieldy because of its high morbidity and mortalityObjective: Presentation of a clinical case and from it an updatedsurgical clinical management of enterocutaneous fistulas literature review...

A Study of subcutaneous negative pressure closure versus simple closure in laparotomy wound of Ileal perforation.

Background: Ileal perforation is a surgical emergency. It has very high morbidity and also mortality. As patients are commonly presented with peritonitis and fecal contamination, wound infection rate is very high. Wound infection is major issue in such condition, where related complications are frequently seen. If wound infection is controlled then many complication related to it could be prevented. And it finally affects the morbidity of patient. Aims & Objective: To compare a role of negative pressure closure versus simple closure of laparotomy wound in ileal perforation. Material and Methods: 60 cases, in period of Nov 2012 to June 2013 at SMIMER hospital, Surat presented with ileal perforation were included in the study. After a surgical treatment of all cases, they were divided in two groups. One group A was closed with Negative pressure closure (By putting subcutaneous Negative Suction Drain) at the time of laparotomy wound closure and other group B with simple closure. And the outcome compared in the form of wound infection, hospital stay, second surgery and morbidity. Total 10 cases were expired within 3 day after surgery, excluded from study (6 from group A and 4 from group B). Results: In study average rate of wound infection (SSI-Surgical Site Infection) was 25% (8/24) in group A and 57.7% (15/26) in group B. Average hospital stay for group A was 12 day and 18 day for group B. Second surgery needed in 4 cases in group A and for 8 cases in group B. Second surgery was in form of secondary suturing of wound or wound dehiscence and burst abdomen repair. Mortality in group A was 6 and in group B was 4 but it was not related to SSI because all death occurred within 3 days after surgery mainly due delay presentation and to poor general condition pre-operatively. Overall morbidity was less with Negative pressure closure in compare to simple closure and it highly affects the morbidity and somehow mortality also. Conclusion: One of the common complications of typhoid is typhoid ulcer and perforation. There is more chance of wound infection in such laparotomy wound because of highly contamination of the peritoneal fluid with fecal material. Such wound constantly leads to serous discharge and bacterial colonization. But negative pressure closure removes that collection and avoids wound infection. And it helps in reducing hospital stay and morbidity.

Modified MVAC as a Second-Line Treatment for Patients with Metastatic Urothelial Carcinoma after Failure of Gemcitabine and Cisplatin Treatment / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: There is no established standard second-line chemotherapy for patients with advanced or metastatic urothelial carcinoma (UC) who failed gemcitabine and cisplatin (GC) chemotherapy. This study was conducted in order to investigate the efficacy and toxicity of modified methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) in patients with metastatic UC previously treated with GC. MATERIALS AND METHODS: We retrospectively analyzed 28 patients who received modified MVAC between November 2004 and November 2012. All patients failed prior, first-line GC chemotherapy. RESULTS: The median age of patients was 64.0 years (range, 33.0 to 77.0 years), and 23 (82.1%) patients had an Eastern Cooperative Oncology Group performance status of 0 or 1. The overall response rate and the disease control rate were 36.0% and 64.0%, respectively. After a median follow-up period of 38 weeks (range, 5 to 182 weeks), median progression free survival was 21.0 weeks (95% confidence interval [CI], 6.3 to 35.7 weeks) and median overall survival was 49.0 weeks (95% CI, 18.8 to 79.3 weeks). Grade 3 or 4 hematological toxicities included neutropenia (n=21, 75.0%) and anemia (n=9, 32.1%). Grade 3 or 4 non-hematological toxicities did not occur and there was no treatment-related death. CONCLUSION: Modified MVAC appears to be a safe and active chemotherapy regimen in patients with stable physical status and adequate renal function after GC treatment.

Vacuum-Assisted Closure (VAC) as a Dressing Method for Skin Graft in Burn Wound Management

PURPOSE: Skin graft is the gold standard surgical treatment in burn wound management. Until now, wet to dry dressing is regarded as the traditionally standard dressing for skin graft. But it needs to be changed daily, burdens the patients and medical caring team and is time consuming. The authors apply VAC to skin graft to secure the skin and compared the outcomes with previous standard dressing technique. METHODS: 38 burn patients who underwent skin graft were included in this study. Patients were selected with their consent for inclusion in an experimental group and a control group. Patients in the experimental group received a VAC appliance after split-thickness skin graft, while those in the control group received wet to dry dressing after the procedure. Time to complete epithelization, rates of skin graft taken areas, satisfaction of patients and medical caring team was evaluated. RESULTS: A shorter time to complete epithelization (12.5 days) was observed in the experimental group than in the control group (14.6 days), and a higher rates of skin graft taken areas (89%) was observed in the experimental group when compared with the control group (84.5%), A higher satisfaction of both the patients and doctors was observed in the experimental group, compared to the control group, with all statistical significance (P<0.05). CONCLUSION: VAC shortens epithelization period and elevate skin graft taken rates. It also makes the patients and doctors the comfortable in burn patients. The VAC is an excellent alternative for securing skin graft.

Acute Compartment Syndrome of the Thigh Caused by Contusion: 4 Cases Report

Acute compartment syndrome of the thigh, which usually occurs in the anterior compartment, is a rare condition. It can have various causes including femur fractures, vessel injury, pseudoaneurysm of the femoral or popliteal artery, and use of anticoagulant. However, there have been few reports of acute compartment syndrome of the thigh without fracture caused by blunt trauma. We report 4 cases of acute compartment syndrome of the thigh without fracture caused by blunt trauma, in which three patients were treated with fasciotomy and a Vacuum-Assisted wound Closure system and the other one had a delayed diagnosis, and eventually underwent above-knee amputation.

Acceleration of Integra Incorporation in Reconstruction of Burn Scar Contracture with the Vacuum-Assisted Closure(VAC)

PURPOSE: Negative pressure therapy has been used in various conditions to promote wound healing. It has also been used to secure a skin graft by improving microcirculation and improving tight adhesion between the graft and the recipient bed. To reduce post burn scar contracture and improve aesthetical result, many types of dermal substitutes have been invented and used widely. The goal of this study is to evaluate usefulness of the VAC(Kinetic concepts Inc., San Antonio, TX) in improving the take rate and time to incorporation of Integra(R) in reconstruction of burn scar contracture. METHODS: A retrospective study was performed from October, 2006 to December, 2008. The VAC was utilized for 11 patients. The patient's ages ranged from 5 to 27 with an average of 19.7 years. The surface area ranged from 24 to 1,600cm2 with an average of 785cm2. The burn scars were excised deep into normal subcutaneous tissue to achieve complete release of the scar, Integra(R) was sutured in place with skin staple and Steri-strip(R). Then slit incisions were made on silicone sheet only with No.11 blade for effective drainage. The VAC was used as a bolster dressing over Integra(R). Negative-Pressure ranging from 100 to 125mm Hg was applied to black polyurethane foam sponge trimmed to the appropriate wound size. An occlusive seal over the black polyurethane foam sponge was maintained by a combination of the occlusive dressing, OP-site(R). The VAC dressing changes were performed every 3 or 4 days until adequate incorporation was obtained. The neodermis appeared slightly yellow to orange color. When the Integra(R) deemed clinically incorporated, The VAC was removed and take was estimated with visual inspection. Very thin STSG(0.006-0.008 inches) was performed after silicone sheet removal. RESULT: The mean time for clinically assessed incorporation of Integra(R) was 10.00 days(range 9-12). The mean dressing change was 3.5 times until take was obtained. In All patients, Integra(R) had successful incorporation in tissue without serious complications. CONCLUSION: Integra(R) in combination with Vacuum- Assisted Closure(VAC) may be incorporated earlier than conventional dressing method.

Dispositivo de presión negativa en injertos de piel: presentación de un caso / Dispositivo de pressão negativa em enxertos de pele: apresentação de um caso / Negative pressure therapy over skin grafts: a case report

Se presenta el caso de un paciente masculino, de 79 años, con áreas cruentas en miembros inferiores y diversas comorbilidades que hacían de difícil manejo el cubrimiento de las mismas. Se realizaron injertos de piel de espesor parcial optimizando su integración con la terapia VAC®, acelerando este proceso y logrando la cobertura total de las zonas expuestas. Para este artículo se revisó la literatura al respecto y se logró demostrar que esta nueva técnica es efectiva, para el manejo de pacientes diabéticos y con patología cardiovascular...

Case report of a 79 year old male, with multiple soft tissue injuries in both lower limbs and with associated comorbidities like diabetes and heart disease that made difficult their management. We decided to put partial thickness skin grafts, and in the postoperative process we used VAC® therapy to accelerate the graft integration process, obtaining complete healing and coverage of the exposed areas. We made a review of the literature and we can corroborate that this new technique is effective in the management of diabetic and cardiovascular patients...

Apresenta-se o caso de um paciente masculino, de 79 anos, com áreas cruentas em membros inferiores e diversas comorbilidades que faziam de difícil manejo o cobri mento das mesmas. Se realizaram enxertos de pele da espessura parcial melhorando sua integração com a terapia VAC®, acelerando este processo e conseguindo a cobertura total das zonas expostas. Para este artigo se revisou a literatura ao respeito e se alcanço demonstrar que esta nova técnica é efetiva, para o manejo de pacientes diabéticos e com patologia cardiovascular...

Resolución de una complicación de herida grave de miembro inferior: a propósito de un caso / Resolution of a severe complication of lower limb injury: a propos of a case

Se presenta una sucesión de complicaciones, en el marco terapéutico de una lesión grave de miembro inferior. Se muestra la resolución de cada una de ellas, con la revaloración de la situación en los intervalos entre complicaciones. Diferentes lesiones necesitan diferentes coberturas: estas necesidades deben ser solucionadas de la mejor forma posible, más allá de su complejidad, y esto sólo se puede lograr manejando todas las variantes y técnicas de reconstrucción. Es también muy importante en el diseño del plan no alterar estructuras que podrían ser útiles, como rescate, en caso de no se exitosa la opción implementada. El apoyo durante el plan terapéutico de técnicas complementarias, como la terapia VAC y la cámara hiperbárica, en nuestro paciente fueron fundamentales; creemos que deben ser tenidas en cuenta como una herramienta más para el manejo de esta patología. Una de las características del protocolo de manejo interdisciplinario es el diálogo permanente entre los servicios de Traumatología y Cirugía Plástica y éste es el elemento que permite flexibilizar la terapéutica frente a cada caso particular.

Application of Modified Vacuum Assisted Closure with Silver Materials in Chronic Infected Wound

PURPOSE: Chronic infected wounds sustained over 4 weeks with exposed tendon or bone are difficult challenges to plastic surgeons. Vacuum assisted closure (VAC) device has been well used for the management of chronic wounds diminishing wound edema, reducing bacterial colonization, promoting formation of granulation tissue and local blood flow by negative pressure to wounds. But Commercial ready-made VAC device might have some difficulties to use because of its high expenses and heavy weight. So we modified traditional VAC device with silver dressing materials as topical therapeutic agents for control of superimposed bacterial wound infection such as MRSA, MRSE and peudomonas. METHODS: We designed the modified VAC device using wall suction, 400 cc Hemovac and combined slow release silver dressing materials. We compared 5 consecutive patients' data treated by commercial ready-made VAC device(Group A) with 11 consecutive patients' data treated by modified VAC device combined with silver dressing materials(group B) from September 2004 to June 2007. Granulation tissue growth, wound discharge, wound culture and wound dressing expenses were compared between the two groups. RESULTS: In comparison of results, no statistical differences were identified in reducing rate of wound size between group A and B. Wound discharge was significantly decreased in both groups. Modified VAC device with silver dressing materials showed advantages of convenience, cost effectiveness and bacterial reversion. CONCLUSION: In combination of modified VAC device and silver dressing materials, our results demonstrated the usefulness of managing chronic open wounds superimposed bacterial infection, cost effectiveness compared with traditional VAC device and improvement of patient mobility.

Evaluation of Green Vac-Tube in Clinical Laboratory Tests / 임상검사와정도관리

BACKGROUND: Vacuum tubes are widely used in the clinical laboratory for routine tests. We compared a newly developed Green Vac-Tube (SPM, Gimje, Korea) with Vacutainer (BD, Franklin Lakes, NJ, USA) and Vacuette (Greiner Bio-One, Frickenhausen, Germany) in routine chemistry and hematology tests. METHODS: A total of 101 volunteers, 81 patients and 20 healthy volunteer, were recruited and we had collected blood samples with three kinds of EDTA tubes and those of serum separating tubes. The samples were evaluated for chemistry and hematology tests using TOSHIBA 200FR (Toshiba, Tokyo, Japan) and ADVIA (Siemens, Deerfield, IL, USA) respectively. Their results were statistically analyzed by paired t-test and Bland-Altman plot. RESULTS: Their clinical utilities were examined by CLIA'88 programs. Paired t-test analysis revealed that the results of ALP, AST, total bilirubin, CO2, Hct and MCV showed statistically significant differences between Green Vac-Tube and previously used two vacuum tubes. Similar significant differences were also observed between previous two vacuum tubes. And 194 (4.37%) cases among 5,151 cases were in the critical region by Bland-Altman plot. All different cases, except Na+, K+ however, were clinically acceptable by CLIA'88 programs. CONCLUSIONS: Green Vac-tube has good analytical performance compared to previously-used tubes.