Temporary Wound Closure Research Articles

Evaluation of the iTClamp 50 in a human cadaver model of severe compressible bleeding

Uncontrolled hemorrhage is a significant cause of preventable death. The iTClamp 50 is a temporary wound closure device designed to control bleeding within seconds of an injury. This study evaluates the ability of the iTClamp to control compressible bleeding in a human cadaver model. Sterile water was pumped through the major arteries to mimic blood flow. Full-thickness, elliptical segments of skin were excised; arteriotomies or complete transections were performed on the major arteries in the thigh (distal femoral), groin (common femoral), neck (carotid), and arm (brachial). Scalp wounds were created by making a 4.4-cm linear incision to the level of the bone. Fluid losses from the wounds were compared with and without the iTClamp applied and with and without movement of the cadaver. Angiographic images of pressure-injected contrast were obtained of the neck and groin wounds. Hematoma volumes and needle penetration depth into the skin were measured. In all wounds tested, application of the iTClamp significantly reduced fluid loss in all wounds studied (p < 0.05), and movement of the cadaver did not affect the function of the iTClamp. For example, in one groin wound, the average fluid loss during 1 minute was reduced from 728.4 ± 79.3 mL to 5.6 ± 3.4 mL. Distal flow was maintained during application of the iTClamp, as illustrated in angiographic images obtained of the iTClamp applied to the neck and groin wounds. The average needle penetration depth into the skin was 4.21 ± 0.02 mm; furthermore, the iTClamp did not cause any visible skin damage or skin tearing. The iTClamp is effective at controlling fluid loss from open wounds within multiple compressible areas. The iTClamp does not occlude distal flow, and aside from small needle punctures, there was no other visible skin damage or skin tearing.

Value innovation: an important aspect of global surgical care

IntroductionLimited resources in low- and middle-income countries (LMICs) drive tremendous innovation in medicine, as well as in other fields. It is not often recognized that several important surgical tools and methods, widely used in high-income countries, have their origins in LMICs. Surgical care around the world stands much to gain from these innovations. In this paper, we provide a short review of some of these succesful innovations and their origins that have had an important impact in healthcare delivery worldwide.ReviewExamples of LMIC innovations that have been adapted in high-income countries include the Bogotá bag for temporary abdominal wound closure, the orthopaedic external fixator for complex fractures, a hydrocephalus fluid valve for normal pressure hydrocephalus, and intra-ocular lens and manual small incision cataract surgery. LMIC innovations that have had tremendous potential global impact include mosquito net mesh for inguinal hernia repair, and a flutter valve for intercostal drainage of pneumothorax.ConclusionSurgical innovations from LMICs have been shown to have comparable outcomes at a fraction of the cost of tools used in high-income countries. These innovations have the potential to revolutionize global surgical care. Advocates should actively seek out these innovations, campaign for the financial gains from these innovations to benefit their originators and their countries, and find ways to develop and distribute them locally as well as globally.

Paraffinoma of the Knee 60 Years after Primary Injection

Paraffinoma of the Knee 60 Years after Primary Injection

The iTClamp Controls Junctional Bleeding in a Lethal Swine Exsanguination Model

Objective. Severe hemorrhage is a leading cause of death and difficult to control even by trained medical personnel. Current interventions have significant limitations in the prehospital setting; therefore, a need exists for a new and effective treatment. iTraumaCare has designed a temporary wound closure device, the iTClamp, which controls external hemorrhage from open wounds within compressible zones. The device approximates the wound edges, sealing the skin within a pressure bar, enabling creation of a hematoma and subsequent clot formation. The objective of this study is to test the effectiveness of the iTClamp to control external bleeding due to a major vascular injury to the groin in an in vivo swine model. Methods. Twenty Yorkshire-cross male swine were enrolled in this study. A complex groin injury was created by complete excision of the femoral artery and vein along with some surrounding muscle. The animals were divided into four treatment groups: control (no treatment), early iTClamp treatment, late iTClamp treatment, and standard gauze treatment. Survival rate, survival time, and blood loss were the primary endpoints. Physiologic parameters (heart rate, blood pressure, oxygen saturation) were monitored throughout the experiment and blood samples were collected to analyze partial thromboplastin time and fibrinogen. Results: All (100%) of the animals treated with the iTClamp lived through the end of the experiment, compared to 60% in standard gauze treated and 0% of untreated control animals (early and late iTClamp vs. control and standard gauze, Fisher's exact, p = 0.003). Both the early iTClamp and late iTClamp treatment groups survived significantly longer than the untreated control pigs (Mann-Whitney U-test, p < 0.009). External blood loss was significantly lower in animals treated with the iTClamp (early) compared to no treatment (Mann-Whitney U-test, p < 0.008). There was no significant change in physiologic or hematologic parameters between treatment groups. Conclusions: The iTClamp showed statistically significant improvement in survival, survival time, and estimated blood loss when compared to no treatment. This proof-of-concept study demonstrates the potential of the iTClamp to control severe bleeding and prevent blood loss.

Development and ultra-structure of an ultra-thin silicone epidermis of bioengineered alternative tissue.

Burn wound care today has a primary objective of temporary or permanent wound closure. Commercially available engineered alternative tissues have become a valuable adjunct to the treatment of burn injuries. Their constituents can be biological, alloplastic or a combination of both. Here the authors describe the aspects of the development of a siloxane epidermis for a collagen-glycosaminoglycan and for nylon-based artificial skin replacement products. A method to fabricate an ultra-thin epidermal equivalent is described. Pores, to allow the escape of wound exudate, were punched and a tri-filament nylon mesh or collagen scaffold was imbedded and silicone polymerisation followed at 120°C for 5 minutes. The ultra-structure of these bilaminates was assessed through scanning electron microscopy. An ultra-thin biomedical grade siloxane film was reliably created through precision coating on a pre-treated polyethylene terephthalate carrier.

Parental allografts in the management of Adams–Oliver syndrome

Dear Editor: We read with interest the report of Udayakumaran et al. [5]. The case they present is strikingly similar to that of a girl with Adams–Oliver syndrome (AOS) who has been under our care since 2005. Our patient was born with a 10×12 cm full-thickness scalp defect with present but abnormal underlying dura. We elected to cover the defect with a scalp transposition flap but, as in Udayakumaran’s case, the flap failed. Likewise, we covered the defect with a paternal split thickness skin graft which was repeated on three occasions over the following 2 months until the wound had developed a sufficiently robust vascularised connective tissue bed to receive a meshed split thickness autograft. The graft matured well and over the following 7 years, new bone continues to form beneath it, closing the calvarial defect. Both cases illustrate key points in the management of this very rare condition which we wish to emphasise. Although scalp flaps appear to be an attractive option for achieving rapid closure of aplasia cutis congenita and AOS scalp defects, they are prone to a high rate of failure probably due to abnormal vascular anatomy [4]. Although free transfer techniques would avoid this problem, successful microsurgery in the neonate remains a considerable challenge. Conservative approaches employing repeat dressings are well described [3], but are slow to achieve epithelialisation in large defects. Repeated dressing changes risk infection and haemorrhage [1], which may be fatal, as well requiring extended nursing involvement and likely distress to the infant. Early skin grafting offers a middle course between these two approaches but can be impeded by the lack of available donor skin. Further, the initial wound bed may well be fragile and poorly vascularised, resulting in a poor quality, unstable graft with likely areas of loss, if an autograft is applied immediately. Allografts initially survive and provide temporary wound closure, reducing dressing demands along with the associated risk of bleeding and serious infection. Further, allografts promote development and maturation of the underlying wound bed [2]. Temporising with parental allografts also allows the infant to grow sufficiently to provide an adequate autograft. Overgrafting the final autograft with parental allograft also enables a thin widely meshed autograft to be used, minimising donor site morbidity. In retrospect, we would suggest that in patients with a large scalp defect, parental allografts should be considered as a first-line measure rather than as a salvage procedure pending definitive autografting. Lastly, we note the authors’ plan to evaluate the need for cranioplasty at a future date. Our and others’ [6] experience of new bone formation beneath skin grafts in calvarial defects in young children with intact dura suggests that a cranioplasty may well not be required.

Application of negative pressure wound therapy in patients with wound dehiscence after abdominal open surgery: a single center experience

PurposeSince the 1990's, negative pressure wound therapy (NPWT) has been used to treat soft tissue defects, burn wounds, and to achieve skin graft fixation. In the field of abdominal surgery, the application of NPWT is increasing in cases with an open abdominal wound requiring temporary wound closure and a second look operation. In the present study, the authors analyzed patients that underwent NPWT for postoperative wound dehiscence.MethodsThe computerized records of patients that had undergone an abdominal operation from November 2009 to May 2012 were retrospectively analyzed.ResultsThe number of total enrolled patients was 50, and 30 patients (60%) underwent an emergency operation. Diagnoses were as follows: panperitonitis or intra-abdominal abscess (24 cases, 48%), intestinal obstruction (10 cases, 20%), cancer (7 cases, 14%), mesentery ischemia (3 cases, 6%), and hemoperitoneum (1 case, 2%). NPWT was applied at a mean of 12.9 ± 8.2 days after surgery and mean NPWT duration was 17.9 days (2 to 96 days). The 11 patients (22%) with unsuccessful wound closure had a deeper and more complex wound than the other 39 patients (78%) (90.9% vs. 38.5%, P = 0.005). There were two complication cases (4%) due to delayed wound healing.ConclusionMost patients recovered well due to granulation formation and suturing. NPWT was found to be convenient and safe, but a prospective comparative study is needed to confirm the usefulness of NPWT in patients whose wounds are dehisced.

Vacuum-packing temporary abdominal closure in post laparotomy wound sepsis and wound dehiscence

Background/Aim: Post-laparotomy wound sepsis and dehiscence occur in 0.25% to 3% of patients. Frequently, definitive fascial and/or cutaneous reconstructions cannot be performed in an immediate setting due to the wound condition or the general condition of the patient. Commercial VAC (Kinetic Concepts, Inc, San Antonio, TX) have been predominantly used for treatment of the open abdomen and in abdominal sepsis. However, commercial devices are either not available or prohibitively expensive for most patients in resource-poor regions. The method described herein is a relatively crude and low cost one applying the principals of topical negative pressure and temporary abdominal wound closure and our aim is to check its foasibility, safety and efficacy as a temporary abdominal closure method in post laparotomy wound sepsis and wound dehiscence. Patients and methods: This prospective study included 17 patients with significant post laparotomy wound dehiscence admitted to surgery department between June 2008 and May 2011. Vacuum packing closure therapy was administered for the whole 17 patients. Eleven patients (64 %) had complete fascial dehiscence with exposed bowel and six patients (36 %) had partial thickness fascial dehiscence. The evaluations included descriptive characteristics of the patients, rate of primary fascial closure and vacuum packing related morbidity and mortality. Results: Of these 11 patients with full thickness wound dehiscence and bowel exposure, two patients died of vacuum packing unrelated problems, six patients underwent successful primary fascial closure. In those 6 patients with partial thickness wound dehiscence. vacuum packing therapy achieved satisfactory wound healing in all the patients, Problems related to vacuum packing therapy included necrosis of fascial edges (2 patients) and blister under the adhesive tape (2 patients). No variables had a significant influence on vacuum packing wound therapy specific morbidity or primary closure rate in the univariate analysis. Three variables showed a significant influence on mortality: age (P<O.OOJ), adult respiratory distress syndrome (P=O.Ol), multiorganfailure (P=O.Ol) andMPI(P=O.Ol). Conclusion: Vacuum-packing therapy is safe and effective temporary abdominal closure in post laparotomy wound sepsis and dehiscence. Its effectiveness is similar to the known commercial device but the cost is much less which could be advisable in health care systems with limited funds in poor developing countries.

Experience with the use of close-relative allograft for the management of extensive thermal injury in local national casualties during Operation Iraqi Freedom

The care of host nation burn victims in Iraq and Afghanistan has been a significant challenge to US military healthcare providers. To provide burn care in an austere environment is more challenging by limitations in resources such as inadequate medical supplies, infection control issues, and a lack of blood or tissue banking capabilities. Large full thickness burns pose a significant obstacle due to limitations in the casualties' available donor skin, which can be used to achieve wound coverage. In US burn centers, allograft stored in skin banks provides temporary coverage during donor site healing in the management of large total body surface area burns. This report is a study of two severely burned Iraqi children with inadequate donor site surface area to achieve wound coverage that were managed with close-relative allograft harvested from their fathers to achieve temporary wound closure. A brief literature review and future recommendations are included.

Temporary Sternotomy Wound Closure With Blood Bag

Many situations are encountered in cardiac surgery, especially paediatric cardiac surgery, which are associated with significant myocardial oedema. In such cases it is inadvisable or impossible to close the sternum primarily. Here we describe a simple and inexpensive technique of temporary sternotomy wound closure with a sterile blood bag.

PR19 ABDOMINAL COMPARTMENT SYNDROME IN BURNS PATIENTS: FROM DIAGNOSIS TO FOLLOW‐UP

Acute increase in intra‐abdominal pressure is a known complication of patients undergoing burns resuscitation. It can progress rapidly in the absence of primary abdominal pathology, causing multiple organ dysfunction. This is known as secondary abdominal compartment syndrome (ACS). Intravascular fluid replacement and decompressive laparotomy form the standard management practices for ACS. Despite these measures, survival rates of secondary ACS in burns patients remain extremely poor. The medical records of four severely burnt patients are reviewed. All four patients underwent decompressive laparotomy. Three patients had either vacuum‐assisted closure therapy or a Silastic bowel bag inserted and temporary abdominal wound closure was gained using an absorbable synthetic mesh. There was one survivor. Early recognition and alternatives to standard therapy may result in possible decrease in mortality figures. However, the poor outcome may be intrinsic to the severe burn injuries rather than a reflection of current practices. Patients that survive open laparotomy face a new set of complications on road to recovery that are often ignored.

Der Einsatz der Vakuumversiegelung zur Konditionierung von Weichteildefekten

Acute or chronic wounds requiring temporary wound coverage and closure. Soft-tissue defects unsuitable for any type of wound closure. Soft-tissue defects associated with infection. Temporary or definite wound closure according to a general concept for treatment of acute or chronic wounds. Support of wound healing through enhanced cell proliferation and formation of granulation tissue. Improvement of local blood circulation and eradication of infection. Surgical debridement. Temporary wound closure with vacuum-assisted closure therapy. Second look with change of vacuum-assisted closure systems, irrigation and debridement procedures. Definitive wound closure through - vacuum-aided wound reduction and secondary suture or - mesh grafting or - debridement and flap coverage. Embedded in the general concept of treatment algorithm for acute or chronic wounds, vacuum-assisted wound closure is part of the therapy. Vacuum therapy facilitates direct wound closure or improves wound conditioning to assist further surgical procedures.

Improved Survival Following Thermal Injury in Adult Patients Treated at a Regional Burn Center

Since January 1999, changes in the management of acute burn patients at a regional adult burn center included no hydrotherapy, blood sparing surgical techniques, a restrictive blood transfusion strategy, newer protective modes of mechanical ventilation, aggressive surgical wound excision, temporary wound closure with allograft skin, employment of advanced critical care trained nurses, and an increased number of dedicated full-time fellowship-trained burn surgeons. The purpose of this study was to determine the composite effect of these modifications on burn patients' survival. A retrospective hospital chart review was conducted among adult burn patients admitted during a 10-year period (1996-2005). Patients were stratified in two time periods: PAST (1996-1998) and RECENT (1999-2005). RECENT patients were selected by matching age, gender, total body surface area burn, full thickness burn, and presence of inhalation injury with PAST patients. All values are mean +/- SD. Student's t-test and chi2 analysis were performed accordingly with a P < .05 considered significant. Of 1569 acute burn patients admitted between 1996 and 2005, 96 (6%) were excluded because they received comfort measures only. Of the remaining 1473 patients, 684 patients (PAST = 342, RECENT = 342) were selected by the matching criteria. More RECENT patients required mechanical ventilation (25% vs 17%, P = .011), with a trend toward more prolonged duration (9 vs 11.5 days, P = .175), more escharotomies (9.6% vs 5.6%, P = .036), more operations (1.1 vs 0.8, P = .003), and more temporary allograft skin (10% vs 2%, P < .001) than did PAST patients. RECENT patients had lower mortality than did PAST patients (2.3% vs 5.6%, P = .048), specifically patients aged 60 or older (5.4% vs 25.5%, P = .004), patients with TBSA lower than 20% (1% vs 3.9%, P = .031), patients on mechanical ventilation (9.3% vs 27.6%, P = .006), and patients who had surgery (2.6% vs 7.3%, P = .032). The significant decrease in burn patient's mortality was likely due to the composite effects of improvements in clinical care between the two time periods.

Improved survival following thermal injury in adult patients treated at a regional burn center.

Since January 1999, changes in the management of acute burn patients at a regional adult burn center included no hydrotherapy, blood sparing surgical techniques, a restrictive blood transfusion strategy, newer protective modes of mechanical ventilation, aggressive surgical wound excision, temporary wound closure with allograft skin, employment of advanced critical care trained nurses, and an increased number of dedicated full-time fellowship-trained burn surgeons. The purpose of this study was to determine the composite effect of these modifications on burn patients' survival. A retrospective hospital chart review was conducted among adult burn patients admitted during a 10-year period (1996-2005). Patients were stratified in two time periods: PAST (1996-1998) and RECENT (1999-2005). RECENT patients were selected by matching age, gender, total body surface area burn, full thickness burn, and presence of inhalation injury with PAST patients. All values are mean +/- SD. Student's t-test and chi2 analysis were performed accordingly with a P < .05 considered significant. Of 1569 acute burn patients admitted between 1996 and 2005, 96 (6%) were excluded because they received comfort measures only. Of the remaining 1473 patients, 684 patients (PAST = 342, RECENT = 342) were selected by the matching criteria. More RECENT patients required mechanical ventilation (25% vs 17%, P = .011), with a trend toward more prolonged duration (9 vs 11.5 days, P = .175), more escharotomies (9.6% vs 5.6%, P = .036), more operations (1.1 vs 0.8, P = .003), and more temporary allograft skin (10% vs 2%, P < .001) than did PAST patients. RECENT patients had lower mortality than did PAST patients (2.3% vs 5.6%, P = .048), specifically patients aged 60 or older (5.4% vs 25.5%, P = .004), patients with TBSA lower than 20% (1% vs 3.9%, P = .031), patients on mechanical ventilation (9.3% vs 27.6%, P = .006), and patients who had surgery (2.6% vs 7.3%, P = .032). The significant decrease in burn patient's mortality was likely due to the composite effects of improvements in clinical care between the two time periods.

Weichteildefekte an der Streckseite der Hand durch Paravasate im Rahmen systemischer Chemotherapien - chirurgische Therapieoptionen

Systemic treatment with chemotherapeutic agents is often applied by infusions over peripheral vein cannulae located on the hands and lower arms. Dislocation of the cannulae or vein perforation causes an extravasation of the cytostatic agent. This complication occurs in approximately 0.1 - 6 % of intravenous treatments and is rarely noticed before administration of greater volumes. Depending on the tissue toxicity of the administered substances, the extravasation results in tissue damage of different extents. In a few cases, only conservative therapy is required. The majority of patients, however, needs immediate surgical therapy. The reason for this is the severe tissue damage caused by the chemotherapeutic agent that accumulates in the subcutaneous fat where it destroys the connective and fat tissue, nerves, vessels, tendons and muscles, impairing the functionality of the entire hand and arm. In very severe cases, partial or complete amputation of the extremity is the only treatment. The application of antidotes has been discussed controversially and is not a standard procedure. In the past 11 years, 18 patients with extravasations of chemotherapeutics on the dorsum of the hand were admitted to our department. After radical debridement no primary closure of the resulting defect was advisable in the first operation. In all cases we could later perform a stable wound closure. In our opinion, this two-step procedure with primary radical debridement, temporary wound coverage and later wound closure should be performed regularly.

Cobertura temporária da cavidade abdominal com curativo a vácuo

OBJETIVO: Descrever técnica de curativo para cobertura temporária da cavidade abdominal que utiliza sistema de vácuo. MÉTODO: A técnica foi aplicada em 12 pacientes. Inicialmente coloca-se sobre a laparostomia a bolsa plástica fenestrada, em seguida a primeira camada de compressas. Sobre esta, coloca-se o tubo de látex. Este é recoberto por outra camada de compressas as quais são fixadas sobre o curativo com o campo cirúrgico auto-aderente. O tubo de látex é conectado ao sistema de vácuo com pressão de -10 a -50 mmHg. Trocam-se os curativos a cada 12 horas. Material utilizado bolsa plástica de solução salina, compressas cirúrgicas, tubo de látex, campo cirúrgico auto-aderente de 50cm x 30cm e vácuo do sistema de gases hospitalares. RESULTADOS:A peritonite grave foi a indicação mais freqüente para laparostomia, seguida da síndrome de compartimento abdominal. Fechamento definitivo da cavidade abdominal foi possível em oito pacientes (67%) em média após 11 dias (9 a 21 dias) da laparostomia. Não houve complicações associadas ao método. O custo diário aproximado do curativo foi de R$ 50,00. CONCLUSÃO: O curativo a vácuo proporcionou boa contenção das vísceras abdominais, controlou o extravasamento de secreções e o edema. Permitiu o fechamento definitivo da cavidade abdominal na maioria dos casos e foi de baixo custo.

The cuticular purse string suture: a modified purse string suture for the partial closure of round postoperative wounds

The purse string suture can be used to provide primary closure for small skin defects or as a partial closure for larger round wounds. The size of the defect is reduced secondary to the tension placed on the suture, which uniformly advances the skin from the entire periphery of the wound. We reviewed retrospectively the features of 98 consecutive patients for whom a total of 100 cuticular purse string sutures were used to partially close their postoperative surgical defects. The location and types of the tumors removed were also summarized. Postoperative wounds were created following Mohs' micrographic excision of nonmelanoma skin cancer (basal cell carcinoma, 44; squamous cell carcinoma, 25), wide local excision of melanoma (29), or conservative excision of benign cutaneous neoplasms (two). The incidence of purse string suture for partial closure of each tumor was 4.1% for basal cell carcinoma, 7.3% for squamous cell carcinoma, and 46.3% for melanoma. The tumors were equally distributed on the trunk, head and neck, and extremities; however, purse string closures for basal cell carcinomas were more frequent on the trunk, head, and neck, relative to squamous cell carcinomas and melanomas, which were more common on the extremities. Concurrent medical problems and/or the use of an agent with anticoagulant or antiplatelet effects were noted in more than 50% of patients. Absorbable material of thicker diameter was most frequently used for the suture, and the postoperative wound area decreased by 6-90% (mean, 60%) following purse string partial closure. The suture was usually removed after 3-4 weeks. Postoperative complications occurred in six patients: allergic contact dermatitis in two, wound infection in two, exuberant granulation tissue in one, and hypertrophic scar in one. All of the wounds healed completely with either a round or linear scar. The cuticular purse string suture is a rapid and simple procedure that provides complete or partial closure of round skin defects and excellent long-term cosmetic and functional results. This closure provides uniform tension to the wound, enhances hemostasis at the tissue edge, and significantly decreases the size of the defect. Partial wound closure with the purse string suture may be advantageous following the local excision of melanoma, either as definitive surgical wound management or as a temporary partial wound closure prior to subsequent complete repair of the surgical defect. The purse string suture is also useful following nonmelanoma skin cancer removal in patients who insist on maintaining an active lifestyle in the immediate postoperative period, who are receiving one or more systemic anticoagulant and/or antiplatelet agents, and who have large surgical wounds that would require either a skin graft or a local cutaneous flap in order to close the postoperative defect.

Experience with Vacuum-Pack Temporary Abdominal Wound Closure in 258 Trauma and General and Vascular Surgical Patients

Temporary closure of an open abdominal wound by vacuum-pack is the method of choice for patients requiring open abdomen management in our institution. We have previously reported our experience with a vacuum-pack in trauma patients and have expanded its use to general and vascular surgery patients. This is a descriptive study performed through review of medical records of all patients undergoing vacuum-pack closure after celiotomy from January 1999 to May 2006. Clinical and demographic data were collected. Seven hundred seventeen vacuum-pack closures were performed in 258 surgical patients (116 trauma versus 142 general and vascular surgery). The most common indication for open abdomen management was damage control in trauma patients and planned reexploration in general and vascular surgery patients. Total abdominal complication rate was 15.5% (14.7% trauma versus 16.2% general and vascular surgery). Fistulas occurred in 13 (5%), intraabdominal abscesses in 9 (3.5%), bowel obstruction in 3 (1.2%), abdominal compartment syndrome in 3 (1.2%), and evisceration in 1 (0.4%). Two hundred twenty-six patients survived to permanent abdominal wound closure. Of these, 154 (68.1%) patients underwent primary fascial closure of their abdominal wounds. Seventy-two patients (31.9%) required delayed closure. In-hospital mortality rate was 26.0% (25.9% trauma versus 26.1% general and vascular surgery). The cost of vacuum-pack materials is less than $50. Indication for open abdomen management varied between general and vascular surgery and trauma patients. Complication rates were similar. Primary closure of open abdominal wounds was achieved in 68.4% of patients. Vacuum-pack temporary abdominal wound closure, initially used in trauma patients, continues to demonstrate ease of mastery, effectiveness in patient care and comfort, consistently low associated complication rate, and low cost in both general and vascular surgery and trauma patients.

Behandlungskonzepte bei Verbrennungen

The best treatment for burns and scalds depends on the depth of the skin necrosis. Epidermal and superficial dermal burn injuries (IIa) can heal spontaneously with conservative treatment without scar development, but deep dermal or full-thickness burns constitute an absolute indication for surgery. Full-thickness or split-thickness skin grafts are used for wound closure. In the case of extensive burn injuries allografts are used for temporary wound closure. In certain licensed laboratories autologous keratinocytes can be cultured for transplantation. In circumferential burn injuries affecting the extremities or the trunk the rigid eschar has to be incised to relieve the pressure behind it. Following a debridement conservative treatment of superficial dermal burns involving wound coverage with biosynthetic dressings or nanocristalline silver gauze dressings or use of special disinfecting ointments can be implemented.

Clinical application of vacuum pack system for temporary abdominal closure

To investigate the clinical application of a new temporary abdominal wound closure,vacuum system for temporary management of the open abdomen. Vacuum pack system consisted of polyethylene sheet,surgical towel,silicone drain, adhesive plastic drape. Clinical data of the patients undergoing exploratory celiotomy were recorded,and the indications for such temporary abdominal closure and its complications were reviewed. Thirteen trauma patients underwent such vacuum abdominal closure for 15 times, including 5 times (33.3%) for increased intra- abdominal pressure so that tension-free fascial closure was unable to achieve, 4 times (26.7%) for reexploration, 2 times (13.3%) for damage control, and 4 times (26.7%) for combined factors. Finally, seven patients (53.8%) received direct closure and 5 patients (38.5%) received skin grafting after granulation because the defect could not be closed directly. One patient (7.7%) died before abdominal closure was attempted. None of the patients developed enterocutaneous fistula and evisceration. Three patients (23.1%) developed intra-abdominal abscess. The vacuum pack is a better temporary abdominal wound closure device, and primary closure can be achieved in most of the patients. The technique is simple and easily mastered with a low complication rate.