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Weijiao Liu,1,2,* Wei Gu,1,* Xiaofeng Jin,1,* Jian Wang1,3 1Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China; 2Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital Pinggu Campus, Capital Medical University, Beijing, People’s Republic of China; 3State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jian WangDepartment of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, People’s Republic of ChinaEmail wangjianent@126.comPurpose: Surgical drainage is an essential part of treatment for deep neck infections (DNIs) or deep neck multiple-space infections (DNMIs). With the emergence and application of new technologies and new materials, vacuum-assisted closure (VAC) in the treatment of DNMIs has been reported. However, reports on the timing of VAC placement are limited. Herein, we compared simultaneous versus staged VAC placement in the treatment of DNMIs.Patients and Methods: Medical data from 24 patients with DNMIs who had received VAC treatment in the last five years were analyzed. The patients were classified into a simultaneous VAC placement group (11 patients) and a staged VAC placement group (13 patients) according to the timing of VAC placement when incision and drainage were performed.Results: No differences in baseline characteristics were found between the two groups. All patients in the two groups survived and recovered. The hospitalization duration (days), time to wound healing (days), number of debridement procedures, and disease course (days) in the simultaneous VAC placement group and staged VAC placement group were 10 (4– 18) and 22 (8– 35), 21 (4– 39) and 50 (9– 86), one (1– 2) and two (1– 4), and 31.5 (11– 49) and 56 (19– 98), respectively. The results in the simultaneous VAC placement group were better than those in the staged VAC placement group (P = 0.001, 0.016, 0.045, and 0.016, respectively). The numbers of VAC sponge changes in the simultaneous VAC placement group and staged VAC placement group were two (1– 2) and two (1– 4), respectively, with no statistically significant difference (P = 0.336).Conclusion: Simultaneous VAC placement during incision and drainage may shorten the wound healing time, hospitalization duration, and disease course and may reduce the number of debridement procedures.Keywords: deep neck multiple-space infections, DNMIs, necrotizing fasciitis, surgical treatment, negative pressure wound therapy

We introduce individual bias to the simulation model of exploration and exploitation and examine the joint effects of individual bias and other parameters, aiming to answer two questions: First, whether reducing individual bias can increase organizational objectivity? Second, whether measures, such as increasing organization size, can increase organizational objectivity in the presence of individual bias? Our results show that individual bias has both positive and negative effects, and reducing individual bias may be not beneficial when organization size is large or environment is turbulent. Diverse knowledge resulting from large organization size can help avoid the negative effects of individual bias when the bias is strong enough so that the individuals who are less limited by bias can be distinguished as the source of learning. Our results also suggest that increasing interpersonal learning, decreasing learning from the organization, task complexity, and environmental turbulence, and maintaining personnel turnover can improve organizational objectivity in the presence of individual bias.