[Indications and safety aspects of vacuum-assisted wound closure]. / Indikationen und Sicherheitsaspekte der Vakuumtherapie.

Problem wounds continue to challenge medical care. In recent times, good results have been achieved through the application of negative pressure wound therapy. This approach, known as vacuum-assisted wound closure (VAC) involves the use of a defined,controlled negative pressure over a polyurethane or polyvinyl sponge placed in the wound. The wound effluent is evacuated continuously. The result is an improvement of microcirculation, and wound healing is enhanced. Animal experiments have confirmed an increase in cell growth. The basis for surgical wound management continues to be appropriate debridement. In this connection, negative pressure therapy, as a supportive measure, has proved to have major advantages over traditional methods of wound management, advantages that need to be further investigated clinically and experimentally. Consideration of the safety aspects and risk factors associated with the procedure can contribute to the optimization of therapeutic safety.

Consensus of the German and Austrian Societies for Wound Healing and Wound Management on vacuum closure and the V.A.C. treatment unit.

Within the framework of the Three-Country Congress on V.A.C. Treatment (Vacuum Assisted Closure Treatment) held on May 16/17, 2003 in Salzburg, a Consensus Conference involving members of the Committees of the German and Austrian Societies for Wound Management was convened. In view of the divergence of opinion on the effectiveness of the treatment among the cost carriers, it appeared appropriate for the two Societies for Wound Healing in Germany and Austria to arrive at a consensus on the importance of and the indications for the management of wounds with the vacuum closure method. Since the first clinical applications in the nineteen-forties, both the indication spectrum and the number of applications have increased continually. In addition to diverse vacuum closure systems, there is patented computer-controlled system technology available that is established V.A.C. treatment. Although this is a hospital-based system, it can also be used on an outpatient basis by appropriately trained physicians and nursing staff and in instructed patients. For some indications, vacuum closure and V.A.C. management is considered the treatment of choice, since no equivalent alternative methods are available. A con-benefit analysis shows that vacuum closure and V.A.C. treatment is cost effective.

Lipid peroxidation and antioxidative vitamins under extreme endurance stress.

The aim of this study was to examine whether extreme endurance stress of trained athletes can influence lipid peroxidation and muscle enzymes. A randomized and placebo-controlled study was carried out on 24 trained long-distance runners who were substituted with alpha-tocopherol (400 I.U. d-1) and ascorbic acid (200 mg d-1) during 4.5 weeks prior to a marathon race. The serum concentrations of retinol, ascorbic acid, beta-carotene, alpha-tocopherol, malondialdehyde (TBARS) and uric acid as well as glutathione peroxidase (GSH Px) and catalase were measured 4.5 weeks before (A), immediately before (B), immediately after (C) and 24 h after (D) the course. After competition (C) TBARS serum concentrations of the athletes (n = 22) decreased in both groups (P < 0.0001). The ascorbic acid serum concentration increased significantly in the supplemented group from (A) to (B) (P < 0.01), from (B) to (C) (P < 0.001) and in the placebo group a significant increase from (B) to (C) (P < 0.01) was observed. The alpha-tocopherol serum concentration increased significantly in the supplemented group from (A) to (B) (P < 0.001) and from (B) to (C) (P < 0.05). The enzymes glutathione peroxidase (GSH Px) and catalase measured in erythrocytes as well as the serum selenium levels did not show significant differences at any time. A significant increase of CK concentration was observed from (C) to (D) in the supplemented group (P < 0.01) and in the placebo group (P < 0.001). The increase of CK serum concentration is remarkably lower in the supplemented group compared with the placebo group (P < 0.01). It is concluded that endurance training coupled with antioxidant vitamin supplementation reduces blood CK increase under exercise stress.