RESUMO
(1) Background: Negative pressure wound therapy (NPWT) has been effectively used for wound management in comparison to traditional dressings. The purpose of this study was to provide an evidence-based review of NPWT in head and neck cancer patients, as well as the impact of previous irradiation and other risk factors on wound healing. (2) Material and Methods: We conducted a comprehensive search in PubMed, Medline, Embase, Web of Science, and Cochrane Library databases for relevant literature. (3) Results: 15 studies fulfilled the inclusion criteria. The most common etiologies requiring NPWT were defects post tumor resection and flap reconstruction and oro/pharyngo-cutaneous fistulas. The neck was found to be the most common site of involvement (47.3%). The overall wound healing response rate was 87.5%. The median negative pressure recorded was 125 mm of Hg, with a median dressing change time of three days. Previous irradiation (p = 0.01; OR = 4.07) and diabetes mellitus (DM) (p = 0.001; OR = 5.62) were found to be significantly associated with delayed wound healing after NPWT. (4) Conclusion: NPWT treats complex wounds in head and neck cancer patients and should represent a significant armamentarium in head and neck cancers. Previous irradiation and DM have detrimental effects on wound healing after NPWT.
RESUMO
OBJECTIVE: Vascular surgeons perform numerous highly sophisticated and delicate procedures. Due to restrictions in training time and the advent of endovascular techniques, new concepts including alternative environments for training and assessment of surgical skills are required. Over the past decade, training on simulators and synthetic models has become more sophisticated and lifelike. This study was designed to evaluate the impact of a 3-day intense training course in open vascular surgery on both specific and global vascular surgical skills. METHODS: Prospective observational cohort analysis with various parameter measurements of both surgical skills and the technical quality of the finished product, performed before and after 3 days of simulator training of 10 participants (seven male and three female) in a vascular surgery training course. The simulator model used was a conventional carotid endarterectomy with a Dacron patch plasty on a lifelike carotid bench model under pulsatile pressure. The primary end points were assessment of any changes in the participants' surgical skills and in the technical quality of their completed carotid patches documented by procedure-based assessment forms. Scores ranging from 1 (inadequate) to 5 (excellent) were compared by a related-sample Wilcoxon signed test. Interobserver reliability was estimated by Cronbach's alpha (CA). RESULTS: A significant improvement in surgical skills tasks was observed (P < .001). The mean score increased significantly by 21.5% from fair (3.43 ± 0.93) to satisfactory (4.17 ± 0.69; P < .001). The mean score for the quality of the carotid patch increased significantly by 0.96 (27%) from fair (3.55 ± 0.87) to satisfactory (4.51 ± 0.76; P < .01). The median interassessor reliability for the quality of the carotid patch was acceptable (CA = 0.713) and for surgical skills was low (CA = 0.424). CONCLUSIONS: This study shows that lifelike simulation featuring pulsatile flow can increase surgical skills and technical quality in a highly sophisticated multistep vascular intervention. This training provides comparatively inexpensive and lifelike training possibilities for the adoption and assessment of surgical skills required to perform delicate vascular surgical procedures.
