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Abstract

Sir:FigureWe appreciate the kind comments regarding our recent article and congratulate the authors on their innovation of a portable system and successful outcome in this very challenging case. Since the description of Argenta and Morykwas in 1997 of vacuum-assisted closure,1 many clinicians have reported remarkable and unexpected outcomes in a variety of complex wounds with negative pressure. We, along with many investigators throughout the world, have studied the mechanism of action2 of these devices and have also thought of device modifications to further improve efficacy and to allow this technology to be more readily available throughout the world. A portable negative-pressure wound therapy device that is low cost, nonelectrical, and reusable could have a dramatic effect, particularly in the developing world. One of us (D.R.Z.) has developed such a device that can be fabricated using blow-molding technology and that achieves suction values up to 75 mmHg (Fig. 1). This device has been used on eight patients in Haiti and 12 patients in Rwanda and currently is being studied in a prospective fashion in Rwinkwavu Hospital and the Central University Teaching Hospital in Kigali, Rwanda. Conditions in these countries vary significantly from those seen in the United States or Brazil, and we hope that through carefully designed clinical trials, we will be able to learn the most effective applications of these technologies and avoid wounds where these devices can possibly cause harm.3 Once a final device is realized, the appropriate approvals, distribution, and training will need to be achieved for widespread clinical application.Fig. 1: The Wound-Pump, a simplified negative-pressure wound therapy device, applied to an ankle wound during the Haiti earthquake relief effort.This is an exciting time for the development of wound care devices that can make dramatic differences for our patients. We believe that further research into the mechanism of action, innovation in device design, and careful clinical trials will lead to better treatments for specific wound types for patients worldwide. Dennis P. Orgill, M.D., Ph.D. Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. Danielle R. Zurovcik, M.S. Massachusetts Institute of Technology, Cambridge, Mass. Gita N. Mody, M.D. Brigham and Women's Hospital, Boston, Mass. DISCLOSURE Dr. Orgill has been an investigator on a grant to Brigham and Women's Hospital from Kinetic Concepts, Inc., and served as an expert witness and consultant for Kinetic Concepts, Inc. Ms. Zurovcik is an inventor of the device described in this communication. Dr. Mody has no conflicts of interest to disclose.