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Background: The effectiveness of closed incision negative pressure wound therapy (ciNPWT) has been shown across various studies. However, studies with large patient cohorts comprising post-bariatric patient populations are missing. The objective of this research was to assess the influence of ciNPWT on post-operative wound complications in this demanding patient collective. Methods: We conducted a retrospective case-control study. Between 1 January 2013 and 31 December 2023, a total of 251 abdominoplasty procedures following massive weight loss were identified. Patients were matched based on resection weights. We matched 118 patients separated into two groups depending on post-surgical wound management (conventional wound dressings vs ciNPWT). The primary outcomes were wound-related disorders and secondary outcomes were the number of readmissions or reoperations within 30 days after the initial surgery. Results: The study revealed equal incidence of seroma formation (15 vs 15, p = 1.0), rates of wound dehiscence (23 vs 20, p = 0.56), surgical site infection (11 vs 6, p = 0.18), hematoma (17 vs 9, p = 0.07), complete removal of all drainages (6.7 vs 6.1 days, p = 0.34) and total number of readmission (12 vs 11, p = 0.77) or reoperations (12 vs 10, p = 0.63) within 30 days. The second hospital stay caused by revision was significantly shorter in the ciNPWT group (5.8 days vs 12.0 days, p = 0.02). Conclusion: Consequently, we did not find evidence to support the hypothesis that ciNPWT reduces complications after abdominoplasty in patients with massive weight loss.

Introduction: Inguinal lymph node dissection is frequently used in the diagnosis and treatment of malignant melanomas. However, postdissection, the high rates of complications have become a significant challenge. Seroma, infections, hematomas, and lymphedema are among the primary complications encountered. This study aims to compare the complications rate of vacuum-assisted closure (VAC) versus conventional dressing in patients undergoing inguinal lymph node dissection. Materials and Methods: Fourteen patients who underwent inguinal lymph node dissection due to malignant melanoma between 2019 and 2022 at our clinic were examined in this study. After dissection, VAC dressing applied to the wound site. VAC was operated at 120 mmHg negative pressure for all patients, switched to intermittent mode 24 h later, and changed every 4 days. Daily drain measurements were recorded for all patients. The remaining seven patients were followed up with conventional dressing without VAC. Daily drain measurements were also recorded for this group. Both groups were regularly monitored for seroma, wound site infection, and hematoma. Results: A total of 14 patients who underwent inguinal lymph node dissection due to malignant melanoma were divided into two groups: Conventionally followed (Group 1) and VAC followed (Group 2). The drainage removal time in patients followed with VAC was an average of 14.7 days while it was 8.3 days in the conventionally followed group. Seroma was observed in three patients in Group 1, whereas it was not observed in Group 2. Wound site infection was not encountered in Group 2, whereas it occurred in two patients in Group 1. Conclusion: Our study suggests that the application of VAC after inguinal lymph node dissection reduces complications such as seroma, wound site detachment, and infection. However, it is important to consider the disadvantages, such as the high cost of materials and prolonged drain removal time, when deciding on postdissection VAC application. [ABSTRACT FROM AUTHOR]

Objective: increase effectiveness of wounds treatment after various etiology by using VAC.Materials and methods: study included 128 patients with surgical infection. Specter of operations is presented: pilonidal cyst excision — 40 (31.2%), sternomediastinitis — 23 (18%), mesh hernioplasty — 16 (12.5%), laparotomy — 15 (11.7%), emergency laparotomy — 7 (5.5%), traumatology paraimplant complications — 7 (5.5%), abdominoplasty — 7 (5.5%), postoperative esophageal fistulas — 6 (4.7%), decubital ulcers — 4 (3.1%), mammoplasty — 3 (2.3%).Results: duration of VAC-therapy averaged 22.1±0.26 days. Systemic inflammatory reaction noted in 43 (33.6%) patients. Granulation tissue on 8th day of treatment noted in 98 (76.6%) cases. Microscopically, on day 8 of treatment, inflammatory-regenerative cytograms were detected in 104 (81.3%) patients. Over the course of 16 days, wounds decreased by 62.1±2.5% in all observations. In 47 (36.7%) cases, secondary sutures were applied, in 30 (23.4%) — grafting. A month later, healing was noted in 106 (82.8%) patients. Complications (wound bleeding) were noted in 7 (5.5%) patients. Reoperations were performed in 11 (8.5%) patients. Period of complete healing was 29.3±0.4 days.Conclusions: vacuum therapy is an effective way to treat wounds in purulent surgery. Time of complete reparative regeneration of wound and period of expensive inpatient treatment are reduced.

Limb-sparing surgery is the standard of care for primary bone tumors. However, such procedures are associated with high rates of wound complications, specifically in lower-extremity surgeries. Therefore, identifying and implementing interventions to minimize the likelihood of wound complications after limb-sparing resection of the lower extremity is crucial. Patients who underwent limb-sparing osteosarcoma or Ewing sarcoma resection during a 7-year period at a single institution were retrospectively reviewed. Data were collected on 39 patients who underwent limb-sparing resection of the femur. Patient demographics, tumor characteristics, and perioperative and postoperative data were extracted and analyzed. Patients who underwent resection before April 2017 received conventional postoperative incision dressings. Starting in April 2017, patients received vacuum-assisted closure (VAC) with the 3 M™ Prevena VAC system after surgical closure. Eighteen patients received conventional postoperative incision dressing, and 21 received incisional wound VAC. A wound complication was defined as any Clavien-Dindo classification greater than 0 within a 28-day postoperative period. Patients who received postoperative incisional wound VAC had lower rates of wound complications than those who received conventional incision dressings (14% vs. 50%; p = 0.035). Additionally, patients in whom wound complications developed had a longer average hospital stay than those without wound complications (5 days vs. 4 days; p = 0.029). Wound complications prolong the hospital stay and can delay adjuvant chemotherapy for bone tumors. The use of postoperative incisional wound VAC is associated with less likelihood of wound complications and should be considered in any high-risk surgical closure. Level III Treatment Study. • Rates of wound complication after resection of bone sarcomas are high. • Avoiding wound complication is important for prompt resumption of chemotherapy. • Use of VAC is associated with lower rates of wound complication after limb sparing resection of bone sarcoma. • Development of wound complication is associated with longer hospital stay and may contribute to delayed recommencing of chemotherapy. [ABSTRACT FROM AUTHOR]

Empyema necessitatis is a rare complication of an untreated or inadequately controlled empyema. We present the case of an 11-year-old female adolescent living in precarious conditions, overcrowding, incomplete vaccinations, irregular dental hygiene, and no significant family or personal medical history. The patient started with symptoms one week prior to her hospitalization, presenting a persistent sporadic dry cough, and was later diagnosed with complicated pneumonia, resulting in the placement of an endopleural tube. Vancomycin (40 mg/kg/day) and ceftriaxone (75 mg/kg/day) were administered. However, the clinical evolution was unfavorable, with fever and respiratory distress, so a right jugular catheter was placed. The CT scan showed a loculated collection that occupied the entire right lung parenchyma and pneumothorax at the right upper lobe level. After four days of treatment, the patient still presented purulent drainage with persistent right pleural effusion syndrome. P. melaninogenica and D. pneumosintes were identified from the purulent collection on the upper right lobe, so the antimicrobial treatment was adapted to a glycopeptide, Teicoplanin, at a weight-based dosing of 6 mg/kg/day and Metronidazole at a weight-based dosing of 30 mg/kg/day. In addition, VAC therapy was used for 26 days with favorable resolution. [ABSTRACT FROM AUTHOR]

Purpose: Soft tissue infections can be severe and life-threatening. Their treatment consists currently in radical surgical wound debridement and combined systemic antimicrobial therapy. Different side effects are possible. Local antibiotic therapy represents a new approach to reduce side effects and improve healing. The aim of this study is to assess the effectiveness of the local sprayed use of antibiotics with fibrin sealing compared with negative pressure wound therapy as an established treatment of soft-tissue infections. Methods: In this retrospective study, patients with soft tissue infections who underwent surgical treatment were analysed. One group consists of patients, who received local fibrin-antibiotic spray (FAS) (n = 62). Patients treated by vacuum-assisted wound therapy (VAWT) as the established treatment were the control group (n = 57). Main outcomes were differences in the success of healing, the duration until healing and the number of needed operations. Results: Clinical healing could be achieved for 55 patients (98.21%) in the FAS group vs. 47 patients (92.16%) in the VAWT group (p = 0.19). Time to require this was 10.65 ± 10.38 days in the FAS group and 22.85 ± 14.02 days in the VAWT group (p < 0.001). In the FAS group, patients underwent an average of 1.44 ± 0.72 vs.3.46 ± 1.66 operations in the VAWT group (p < 0.001). Conclusion: Compared to vacuum-assisted wound therapy in soft tissue infections, local fibrin-antibiotic spray shows faster clinical healing and less needed operations. Leading to shorter hospital stays and more satisfied patients. The combination of sprayed fibrin and antibiotics can be seen as a promising and effective method. [ABSTRACT FROM AUTHOR]

Vergence‐Accommodation Conflicts (VAC) occur in neareye displays when the binocular disparity of the 3D rendered content (vergence) does not match the display focal distance (accommodation). VAC has been shown to reduce perceptual image quality, cognitive performance, and oculomotor coordination. In this study, we aimed to investigate the impact of VAC on visual performance in augmented reality (AR). Specifically, we quantified the impact of AR VAC on the 'Time to Focus' (TTF); when the user switches focus between real world content and worldlocked AR rendered content. Our results show that TTF increases exponentially with VAC. The increase is more pronounced at closer vergence distances in displays with focal distance of 1 D or longer. Finally, we showed that VAC may have a differential effect across age groups; specifically, older users may be affected more in closer focal and longer vergence distances 186‐189. [ABSTRACT FROM AUTHOR]

The work presents the results of an experimental study of the characteristics of the RF capacitive discharge placed in a magnetic field with a predominant radial component. The experiments are performed in the plasma source, which has the geometry of a Hall thruster. The integrated characteristics of the discharge, as well as the axial distribution of the probe ion current in the channel of the plasma source, are measured using three diagrams of the organization of the external discharge circuit: with the open for DC discharge circuit, as well as in the combination of a capacitive discharge with a direct current discharge. The main measurements are made in the argon in the flowrate range of 0.75–1.8 mg/s and the power of the generator 80–300 W at a frequencies of 2, 4, and 13.56 MHz, the induction of the magnetic field lying in the range of 100–300 G. Evaluation of the parameters of the plasma engine based on capacitive RF discharge when working in air, argon and krypton are made. [ABSTRACT FROM AUTHOR]

Aims The clinical significance and feasibility of the recently described non-invasive parameters exploring ventricular–arterial coupling (VAC) remain uncertain. This study aimed to assess VAC parameters for prognostic stratification in stable patients with left ventricular ejection fraction (LVEF) ≥40% following myocardial infarction (MI). Methods and results Between 2018 and 2021, patients with LVEF ≥40% were evaluated 1 month following MI using transthoracic echocardiography (TTE) and arterial tonometry at rest and after a handgrip test. VAC was studied via the ratio between arterial elastance (Ea) and end-systolic LV elastance (Ees) and between pulse wave velocity (PWV) and global longitudinal strain (GLS). Patients were followed for major adverse cardiovascular events (MACE): all-cause death, acute heart failure, stroke, AMI, and urgent cardiovascular hospitalization. Among the 374 patients included, Ea/Ees and PWV/GLS were obtained at rest for 354 (95%) and 253 patients (68%), respectively. Isometric exercise was workable in 335 patients (85%). During a median follow-up of 32 months (interquartile range: 16–42), 41 (11%) MACE occurred. Patients presenting MACE were significantly older and had a higher prevalence of peripheral arterial disease, lower GLS, higher Ea, PWV, and PWV/GLS ratio. The Ea/Ees ratio and standard TTE parameters during isometric exercise were not associated with MACE. After adjustment, the PWV/GLS ratio was the only VAC parameter independently associated with outcome. Receiver operating characteristic curve analysis identified a PWV/GLS ratio >0.70 (Youden's index = 0.37) as the best threshold to identify patients developing MACE: hazard ratio (95% confidence interval) = 2.2 (1.14–4.27), P = 0.02. Conclusion The PWV/GLS ratio, assessed 1 month after MI, identifies a group of patients at higher risk of MACE providing additional value on top of conventional non-invasive parameters. [ABSTRACT FROM AUTHOR]

Background Application of negative pressure wound therapy (NPWT) on free flaps not only reduces edema but also increases the pressure from outside. The impact of these opposite effects on flap perfusion remains elusive. This study evaluates the NPWT system's influence on macro- and microcirculation of free flaps and edema reduction to better assess the clinical value of this therapy in microsurgical reconstructions. Methods In this open-label, prospective cohort study, a total of 26 patients with free gracilis muscle flaps for distal lower extremity reconstruction were included. Flaps were covered with an NPWT (13 patients) or a conventional, fatty gauze dressing (13 patients) for 5 postoperative days (PODs). Changes in flap perfusion were analyzed by laser Doppler flowmetry, remission spectroscopy, and an implanted Doppler probe. Flap volume as a surrogate parameter for flap edema was evaluated by three-dimensional (3D) scans. Results No flap showed clinical evidence of circulatory disturbances. The groups showed significant differences in the dynamic of macrocirculatory blood flow velocity with an increase in the NPWT group and a decelerated flow in the control group from PODs 0 to 3 and PODs 3 to 5. No significant differences in microcirculation parameters were observed. 3D scans for estimation of edema development demonstrated significant differences in volume dynamics between the groups. Flap volume of the controls increased, while the volume in the NPWT group decreased during the first 5 PODs. The volume of NPWT-treated flaps decreased even further after NPWT removal from PODs 5 to 14 and significantly more than the flap volume in the control group. Conclusion NPWT is a safe form of dressing for free muscle flaps that enhances blood flow and results in a sustainable edema reduction. The use of NPWT dressings for free flaps should therefore be considered not only as a pure wound covering but also as a supportive therapy for free tissue transfer. [ABSTRACT FROM AUTHOR]

Background Diabetic foot ulcers constitute one of the most important complications of diabetes mellitus. If not treated promptly, progression of infection and sepsis may necessitate a limb amputation. Aim To assess wound healing and to assess the time for wound healing of diabetic foot ulcers using vacuum-assisted closure (VAC) in comparison with nano-silver coated dressing. Patients and methods This was a simple randomized cohort prospective trial included two groups of postoperative diabetic foot patients, in which we had a comparison between VAC and nano-silver dressing in order to investigate which procedures had the least time of follow up weeks for full granulation of wound. Results VAC significantly reduces the time to complete wound healing by enhancement the formation of granulation tissue. Conclusion The time to complete wound healing was significantly better in the VAC therapy group as compared with nano-silver dressing. [ABSTRACT FROM AUTHOR]

Empyema necessitatis is a rare complication of an untreated or inadequately controlled empyema. We present the case of an 11-year-old female adolescent living in precarious conditions, overcrowding, incomplete vaccinations, irregular dental hygiene, and no significant family or personal medical history. The patient started with symptoms one week prior to her hospitalization, presenting a persistent sporadic dry cough, and was later diagnosed with complicated pneumonia, resulting in the placement of an endopleural tube. Vancomycin (40 mg/kg/day) and ceftriaxone (75 mg/kg/day) were administered. However, the clinical evolution was unfavorable, with fever and respiratory distress, so a right jugular catheter was placed. The CT scan showed a loculated collection that occupied the entire right lung parenchyma and pneumothorax at the right upper lobe level. After four days of treatment, the patient still presented purulent drainage with persistent right pleural effusion syndrome. P. melaninogenica and D. pneumosintes were identified from the purulent collection on the upper right lobe, so the antimicrobial treatment was adapted to a glycopeptide, Teicoplanin, at a weight-based dosing of 6 mg/kg/day and Metronidazole at a weight-based dosing of 30 mg/kg/day. In addition, VAC therapy was used for 26 days with favorable resolution.

The issues of simulation modeling of an analog impulse neural network based on memristive elements in the problem of pattern recognition are studied. Simulation modeling allows us to configure the network at the level of a mathematical model, and subsequently use the obtained parameters directly in the process of operation. The network model is given as a dynamic system, which can consist of tens or hundreds of thousands of ordinary differential equations. Naturally, there is a need for an efficient and parallel implementation of an appropriate simulation model. Open multiprocessing (OpenMP) is used as the technology for parallelizing calculations, since it allows us to easily create multithreaded applications in various programming languages. The efficiency of parallelization is evaluated on the problem of modeling the process of training the network to recognize a set of five images of a size of 128 by 128 pixels, which leads to the solution of about 80 000 differential equations. In this problem, the calculations are accelerated by a factor of over six. According to the experimental data, the operating character of memristors is stochastic, as shown by the scatter in the current-voltage characteristics (VACs) when switching between high-resistance and low-resistance states. To take this feature into account, a memristor model with interval parameters is used, which gives upper and lower limits on the values of interest, and encloses the experimental curves in corridors. When simulating the operation of the entire analog self-learning impulse neural network, in each epoch of training, the parameters of the memristors are set randomly from the selected intervals. This approach makes it possible to dispense with the use of a stochastic mathematical apparatus, thereby further reducing computational costs. [ABSTRACT FROM AUTHOR]

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We now commonly use Negative Pressure Therapy (NPWT) as an adjunct to care in a variety of circumstances. In the management of wounds, ulcers or sores of varying size and with such a degree of secretions, exudate, oozing that the correct use of common dressing devices is not possible. Over time, this therapeutic choice has seen an important evolution in clinical indications and technology aimed at achieving an effective and consistent result.

Right ventricular rupture after deep sternal wound infection (DSWI) is a rare but fatal complication, and can occur with or without vacuum assisted closure (VAC) therapy. There is currently no strong evidence to suggest whether or not VAC therapy is a contributing factor to this complication. In total, 30 articles were retrieved and assessed through a systematic review strategy from 1953 to 2022. The keywords: 'vacuum assisted closure'; 'VAC'; 'negative pressure wound therapy'; 'deep sternal wound infection'; 'DSWI'; 'right ventricular rupture'; and 'cardiac rupture' were used in the search. Overall, 15 of the included articles satisfied the predefined eligibility criteria. Fatal right ventricular ruptures were reported in 18 (36%) out of 50 cases. In this article, the risk factors, mechanisms and management of right ventricular rupture are discussed. A novel view of the mechanism of VAC-associated right ventricular rupture is highlighted, with a focus on both pre- and intraoperative management. Declaration of interest: The authors have no conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

Necrotizing fasciitis is a deep soft tissue infection that causes progressive destruction of the muscle fascia and subcutaneous. One of its presentations is Fournier's Gangrene (FG) for which the diagnosis must be accurate and associated with early surgical debridement and broad-spectrum antibiotic therapy. If management is delayed, the impact on prognosis is negative. Current treatment options include a technique to improve cleaning and granulation of the cruciate area using a technological device and the vacuum assisted closure system (VAC). We describe a handmade technique of VAC therapy implemented in a series of cases of male patients diagnosed with FG, in response to the scarce economic resources of patients who are generally affected in our environment; proposing a more economical, safe and replicable option for our environment. [ABSTRACT FROM AUTHOR]

Background: The Primary objective of this prospective study is to study the rate of infection, number of days required for formation of healthy granulation tissue, healing of soft tissue injury and number of days of hospital stay and cost effectiveness associated with soft tissue injury treated by Vacuum Assisted closure therapy. Methods: This is a prospective observational study of 30 patients presenting with open musculoskeletal injuries in extremities that required coverage procedures in the department of Orthopaedics, Sri Aurobindo Medical College and PG Institute, Indore. All these patients had undergone wound debridement and fracture fixation. This was followed by application of Vacuum Assisted Closure (VAC). The infection rate analysed by clinical findings and investigations. Assessment of these wound(s) were done on a regular basis by wound bed score. Assessment of rate of granulation was done on every 3rd day. Based on the rate of granulation, definitive surgical intervention (skin grafting, secondary closures and flap cover procedures) was done. The patient was sent home after performing the definitive surgical intervention. Results: The infection rate was low when compared to literature study of conventional dressings. The primary wound coverage can be done earlier wound healing was also faster in patients. Conclusion: This is a simple and low cost method for treating soft tissue injury associated with severe open fractures. It can be done even in peripheral hospitals with low resources. The rate of granulation tissue formation is good with vacuum assisted closure. Also compliance of patient is good in vacuum assisted closure therapy.VAC dressing also provided the wound ready for SSG or flap rotation early as assessed by wound bed score.

Background: Inguinal lymph node dissection (ILND) is associated with a high complication rate. Retrospective studies suggest that incisional negative pressure wound therapy (iNPWT) might reduce complications, especially seroma, following ILND. Methods: This was a prospective multicenter, randomized (1:1), open-labeled, parallel-group trial. Patients with macrometastic melanoma to the inguinal lymph nodes and eligible for ILND were randomized to receive either iNPWT for 14 postoperative days or conventional wound dressing. The primary outcome was seroma incidence. Secondary outcomes included surgical-site infection, wound rupture, wound necrosis, hematoma, rehospitalization and readmission rates between groups. All outcomes were registered 3 months after ILND and analyzed according to the intention-to-treat principle. Results: The trial was terminated early due to a low recruitment rate as a consequence of a change in the national treatment protocol, and the estimated sample size was not reached. Twenty patients were included and randomized in the study. The trial showed less seroma formation between the iNPWT 6/11 (55%) and control 7/9 (78%) groups; however, this was not statistically significant (p = 0.29). Similarly, there were no differences in the rates of surgical-site infection (p = 0.63), wound rupture (p = 0.19), wound necrosis (p = 0.82), hematoma (p = 0.19), reoperation (p = 0.82) or readmission (p = 0.34) between groups. Conclusion: There was a tendency toward fewer complications in the iNPWT group, however this trial was underpowered and could not confirm the hypothesis that iNPWT reduces complications after ILND. Future randomized controlled trials are required to fully evaluate the treatment potential of iNPWT. Trial registration: The trial was prospectively registered at https://clinicaltrials.gov/ct2/show/NCT03433937.

Binocular Near Eye Displays require matching between the focus of the displayed image and the convergence of the two eyes. We present simple test methods for determining both the virtual focus and the vergence distance in Near Eye Displays. [ABSTRACT FROM AUTHOR]

Multiple instability was found on the volt–ampere characteristic of the palladium-surface-oxidized indium phosphide structure. The effect is recorded when recording the dependence of differential conductivity and differential capacitance on the applied external voltage. A mechanism for the appearance of instabilities is proposed. [ABSTRACT FROM AUTHOR]

The Vedas are said to be not a human creation (apauruṣeya), but Revelation imparted to the Vedic sages who have put it down in inspired verses. Vedas’ words are therefore divine and eternal, and thus extensively praised. Vāc, the Vedic word, is eulogised in several hymns, among which Vāk Sūkta (X.125) is by far the most illustrative of all. In some teachings of the Upanishads, Vāc is equated to Brahman alongside other interpretations. When analysing the nature of the word, centuries later, philosophers and grammarians refer to it as śabda, and no longer as Vāc, the latter remains somehow confined to a rather poetical and mystical reality. Yet, the idea of the eternal and divine character of the scriptures is superimposed on the Sanskrit language also, despite certain historical change remarks on the grammarians' side. In the 5th century CE, Bhartṛhari displays a genuine linguistic and philosophical thought of the folding and unfolding of Reality and its understanding as Word-Principle (brahman śabda-tattva). From an auxiliary science of preserving the correct forms of the Vedas, Sanskrit grammar acquires a hermeneutical role and empowers itself as a way to salvation, an idea supported by previous evidence of grammar's role in producing celestial happiness (abhyudaya), merit and righteousness (dharma). I seek in this paper to analyse and point out the strongholds that underpin Sanskrit as a divine language and how continuity and change coexist to support over millennia this undaunted approach.

Objective: The purpose of this case series was to evaluate the efficacy of a synthetic biodegradable temporising matrix (BTM; PolyNovo Biomaterials Pty Ltd, Australia) and compare the outcome of BTM patients with and without negative pressure wound therapy (NPWT). Method: A retrospective chart review was conducted on patients admitted with deep full-thickness burns, traumatic or complex wound injuries treated with BTM. Electronic medical records and images were evaluated by a team of clinical professionals. Endpoints included: the measure of successful BTM integration; and comparison between patients treated with and without NPWT. Additional measures were BTM total surface area, BTM sites, timeliness of BTM application and any complications. Results: A total of 28 patients were evaluated and 23 (82.1%) demonstrated overall successful BTM integration. Patients treated with BTM in conjunction with NPWT (n=16) demonstrated a significantly higher (p=0.046) integration rate compared to patients treated without NPWT (n=12) (93.8% versus 58.3%, respectively). Patients treated with BTM with NPWT continued to successfully integrate and sustain favourable outcomes despite the presence of severe infection or the development of haematomas. Conclusion: A significantly higher integration rate was demonstrated when BTM was used in conjunction with NPWT. The results of this study further support the efficacy of successful integration of BTM as a replacement for tissue loss in the treatment of deep, full-thickness burns, traumatic and complex wound injuries, and particularly favourable outcomes with the use of NPWT. To the best of our knowledge, this is the first reported case series comparing the clinical outcomes of BTM with and without the use of NPWT. [ABSTRACT FROM AUTHOR]

Objective: To determine if prophylactic negative pressure wound therapy (pNPWT) allows for the prevention of surgical site infections (SSIs) in abdominal surgery. Method: A non-systematic review assessing the evidence was conducted in 2020. Results: Retrospectve studies comparing patients with pNPWT with patients receiving standard wound dressing after abdominal surgery showed encouragning results in favour of pNPWT for reducing the incidence of SSIs, but randomised controlled trials have so far reported mixed results. Conclusion: New randomised controlled trials including a sufficient number of patients at risk of SSIs are needed for confirming the results of non-interventional studies. [ABSTRACT FROM AUTHOR]

Aim and objective -To compare with different site of infection & comorbidities among study group Study of various clinical features to rule out accurate diagnosis. To use negative pressure wound therapy (NPWT) in patients with chronic venous leg ulceration. Material and method-The present study was conducted in department of general surgery Rajshree medical research institute, BareillyThis is an observation and comparative type of study. Result and conclusion-Healing of chronic leg ulcer is a complex process attributed to several elements. Although various parameters earlier proved to positively affect the healing of ulcers but the present study recommends that V.A.C. therapy should be considered as the treatment of choice for chronic leg ulcers owing to its significant advantages in the time to complete healing compared with conventional wound care. In this present study V.A.C. therapy overall appears to be superior to other wound care techniques. [ABSTRACT FROM AUTHOR]

The present article is concerned with the famous hymn to Vāc (RV X 125). Vāc is the Vedic goddess of voice, and the hymn is composed in the ātmastuti (self-praising) style, which heavily relies on the polyptoton of first-person pronoun aham. Phonological puns such as anagrams and alliterations enrich the message of the poet, who depicts Voice/Speech as the world’s primordial principle. The famous expression ‘Me have the gods distributed in many places’ (v. 3c) is interpreted as a grammatical allusion to name inflection. The second part focuses on the actual emission of sound waves and its conceptualization in ancient cultures, particularly with reference to Vedic and Greek thought and to the imagery of speech as a sharp arrow that strikes the air. [ABSTRACT FROM AUTHOR]

To our knowledge this is the first systematic review of the immediate application of negative pressure wound therapy (NPWT) to the head and neck in free flap reconstruction. We conducted a systematic search of the PubMed and Cochrane databases in October 2021 using the MeSH terms 'negative pressure wound therapy', 'free flaps', 'microsurgery', and 'vacuum-assisted closure'. Included studies evaluated the use of immediate NPWT in head and neck free flap reconstruction. Outcomes, indications, monitoring, and reported complications were retrieved. Of the 908 articles searched, nine published between 2000 and 2021 were included: four retrospective studies and five case series. NPWT was applied to 56 free flaps, and 54 had successful outcomes. The most common reported indication for flap reconstruction was malignancy. NPWT has the potential to be a valuable tool for complicated wounds, and further studies are needed to quantify functional and aesthetic outcomes. [ABSTRACT FROM AUTHOR]

IntroductionOmphalocele represents a rare congenital abdominal wall defect. In giant omphalocele, due to the viscero-abdominal disproportion, gradual reintegration of eviscerated organs is often associated with medical challenges. We report our preliminary experience combining staged gravitational reduction with vacuum (VAC) therapy as a novel approach for treatment of giant omphalocele.Patients and methodsRetrospective chart review of six patients (five females) born between September 2018 and May 2022 who underwent staged reduction of giant omphalocele in conjunction with VAC therapy was conducted. Treatment was performed at two German third-level Pediatric Surgery Departments. Biometric and periprocedural data were assessed. Main outcome measure was the feasibility of VAC therapy for giant omphalocele. Data are reported as median and interquartile range (Q1–Q3).ResultsGestational age was 37 (37–38) weeks, and birth weight was 2700 (2500–3000) g. VAC dressing was changed every 3 (3–4) days until abdominal fascia closure at the age of 9 (3–13) days. Time to first/full oral feeds was 3 (1–5)/20 (12–24) days with a hospital stay of 22 (17–30) days. Follow-up was 8 (5–22) months and complications were of minor extent (none: n = 2; Clavien–Dindo I: n = 3; Clavien–Dindo II: n = 1), comprising a delayed neo-umbilical cord rest separation (n = 2) and/or concomitant neo-umbilical site infection (n = 2) with no repeat surgery.ConclusionIn neonates with giant omphalocele, VAC constitutes a promising and technically feasible enhancement of the staged gravitational reduction method. This study shows evidence that VAC may accelerate restoration of the abdominal wall integrity in giant omphalocele, thus minimizing associated comorbidities inherent to a prolonged hospitalization.

BACKGROUND: This study investigated the influence of the storage method on the physicochemical characteristics and microbial growth of m. longissimus thoracis et lumborum (LTL), m. biceps femoris (BF) and m. vastus lateralis (VL) of wild boar. Muscles were stored in a vacuum (VAC), in a modified high‐oxygen atmosphere (MAP) or meat seasoning cabinet (DRY‐AGED) for 21 days. RESULTS: Wild boar meat was characterised by a high protein and low fat content and a good amount of potassium, sodium, calcium, magnesium, zinc and iron. Significantly higher (P < 0.05) pH values were noted for DRY‐AGED muscles stored for 21 days (up to 5.89 for VL). On day 21, a significant decrease in pH was noted for all MAP muscles (down to 5.23 for BF). Storage losses due to desiccation and water loss were significantly higher for DRY‐AGED samples and ranged from 25.63% to 32.89% on day 21. MAP affected protein and lipid oxidation, which was also reflected in Warner–Bratzler shear force VAC and DRY‐AGED had positive results regarding tenderness, whereas on day 21 the MAP‐stored meat had toughened significantly (from 35.3 N to 50.7 N in LTL). Lipids were oxidised much faster than proteins during prolonged storage in MAP. Compared to the other methods, DRY‐AGED had the best effect on microbial growth. CONCLUSION: These results indicate that the recommended methods for the storage of wild boar meat are either vacuum packing or dry ageing. The high oxygen content of MAP negatively affected the quality of wild boar meat and carried a risk of increased protein carbonylation. © 2022 Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

Oxidation processes affect proteins from various molecular pathways and are crucial for wild boar meat quality, shelf life and human health. This study investigated the effects of different storage methods on the formation and composition of oxygen-induced protein aggregates in the muscles of European wild boar (Sus scrofa scrofa). Vacuum packaging (VAC), modified atmosphere packaging (MAP) and dry-ageing (DA) were compared over a 21-day storage period. The results showed significant differences in protein aggregation depending on the method and storage time. The most intense protein aggregation occurred in the MAP (80 % O 2), while air DA (20.9 % O 2) resulted in intermediate levels of protein aggregation. Crucial myofibrillar proteins involved in aggregate formation were titin, myosin isoforms (MYH1, MYH2 and MYH7) and nebulin, which were cross-linked with small sarcoplasmic enzymes, such as muscle creatine kinase, isocitrate dehydrogenase and ATPase 1. High‑oxygen storage conditions also promoted the oxidation of ATP synthase, beta-enolase 3, ADP/ATP translocase and myoglobin. [Display omitted] • Oxidative changes, especially protein aggregation in wild boar meat were studied. • MAP with 80 % O₂/20 % CO₂ promotes protein aggregation during storage. • Structural and enzymatic protein changes may lead to loss of function. • Myosin, titin, and nebulin mainly formed aggregates. • High oxygen storage affects enzymes like creatine kinase and isocitrate dehydrogenase. [ABSTRACT FROM AUTHOR]

The Saṁhitā Upaniṣad [SU] is a little-known Vedic text that presents 'typical' Upaniṣadic teachings on the truth of identity alongside seemingly out-of-place descriptions of rites used to protect oneself against enemies and even against death. The difference between these contents is striking, but what it has to tell us about the SU's main concerns is vulnerable to historical and text critical methods that rely on structure, style, and linguistic archaism to divide texts into discrete strata. What if the modern text critical practice of individually identifying and classifying textual contents obscures the use and meaning of the word saṁhitā in the SU? Is it possible that the SU's diverse contents are intrinsically related? This article explores these questions through a close examination of a sequence of passages illustrating the contrast that has led previous scholars to see the SU as miscellaneous in character and lacking internal coherence. Through this examination, I identify a wider context for saṁhitā in the specific relationship the SU depicts between the person (puruṣa) and speech (vāc). I argue that the SU's treatment of saṁhitā draws upon an understanding of recitation in the perspective of one's vulnerability and the dynamics involved in developments of personhood. These findings allow the SU to emerge as an intriguing and coherent text that merits closer examination and establishes a promising approach for the study of the R̥gvedic Āraṇyakas. [ABSTRACT FROM AUTHOR]

Mine blast injuries occupy one of the leading places among the total number of injuries received during combat operations. Victims who are lucky enough to survive the incident often lose working capacity for life. Significant contamination and complete or partial loss of limb tissue require urgent medical care followed by tissue reconstruction aimed at restoring limb function and eliminating pain syndrome. At the same time, in the absence of adequate cleaning of the injury of the limbs and the impossibility of its reconstruction, the most frequent result in the treatment of patients of this category is the amputation of the affected limb. Among the possible effective means that help to improve the results of treatment and reduce the risks of negative consequences is the wound therapy with negative pressure (Vacuum assisted closure (VAC)/negative pressure wound therapy (NPWT)), which has become a generally accepted method in the process of curation of patients with mine blast injuries. [ABSTRACT FROM AUTHOR]

Background: Incarcerated abdominal wall hernias may have a variety of manifestations and the most dreaded consequence is strangulation leading to obstruction and perforation of hollow viscus. Very rarely, such a perforation presents with fistulization into the abdominal wall and skin, which is often not considered but may complicate the management approach. Case presentation: We reported on presentation and management of a 56-year-old morbidly obese male with a fistulizing incarcerated ventral wall hernia and postoperative abdominal wall necrosis. Discussion: Contained bowel perforations caused by ventral hernia incarceration are a rare and not well recognized problem and are confined to a handful of case reports in the surgical literature. Conclusion: The most recognized complications of ventral hernias are incarceration and strangulation leading to obstruction and consequent perforation; however, as the case described below reveals, intestinal perforation and bowel-skin fistulization may occur as unusual incident. Management should involve operative reduction, resection of the involved bowel and staged repair of abdominal wall defect. [ABSTRACT FROM AUTHOR]

Purpose: Definitive fascial closure is an essential treatment objective after open abdomen treatment and mitigates morbidity and mortality. There is a paucity of evidence on factors that promote or prevent definitive fascial closure. Methods: A multi-center multivariable analysis of data from the Open Abdomen Route of the European Hernia Society included all cases between 1 May 2015 and 31 December 2019. Different treatment elements, i.e. the use of a visceral protective layer, negative-pressure wound therapy and dynamic closure techniques, as well as patient characteristics were included in the multivariable analysis. The study was registered in the International Clinical Trials Registry Platform via the German Registry for Clinical Trials (DRK00021719). Results: Data were included from 630 patients from eleven surgical departments in six European countries. Indications for OAT were peritonitis (46%), abdominal compartment syndrome (20.5%), burst abdomen (11.3%), abdominal trauma (9%), and other conditions (13.2%). The overall definitive fascial closure rate was 57.5% in the intention-to-treat analysis and 71% in the per-protocol analysis. The multivariable analysis showed a positive correlation of negative-pressure wound therapy (odds ratio: 2.496, p < 0.001) and dynamic closure techniques (odds ratio: 2.687, p < 0.001) with fascial closure and a negative correlation of intra-abdominal contamination (odds ratio: 0.630, p = 0.029) and the number of surgical procedures before OAT (odds ratio: 0.740, p = 0.005) with DFC. Conclusion: The clinical course and prognosis of open abdomen treatment can significantly be improved by the use of treatment elements such as negative-pressure wound therapy and dynamic closure techniques, which are associated with definitive fascial closure. [ABSTRACT FROM AUTHOR]

Introduction: Diabetic foot ulcer (DFU) is a common complication of uncontrolled diabetes. Negative pressure wound therapy (NPWT) with irrigation of normal saline is one of the methods for wound care and dressing techniques in DFU. Wound assessment is another aspect of DFU management for deciding whether the wound is prepared or not for coverage. The present study uses DEPA score as a wound assessment tool in DFU. Materials and Methods: This case series include 11 patients with DFU who were treated using NPWT with simultaneous irrigation of normal saline. Results: All 11 patients were male and age more than 60. Most patients have duration of diabetes for less than 10 years. Staphylococcus aureus (n = 5, 45.4%) was most common bacterial flora. Most patients in series presented with DEPA score more than 7 and after application of NPWT instillation therapy significant improvement seen with score in most of the patient with DEPA score below 6. Mean time for NPWT (irrigation) application was 15 days. Mean time of wound preparation was 18.7 days. Final surgical procedures executed in all patients, split skin grafting performed in 7 patients. 4 patients had wound coverage by reverse sural flap (2), medial plantar flap (1) and local flap coverage (1). Conclusion: NPWT with normal saline irrigation is an effective method of wound preparation in DFU. DEPA score is an important tool for assessment of wound preparation which gives exact information for timing of wound coverage once diabetic foot wound is prepared. [ABSTRACT FROM AUTHOR]

Background Diabetic foot ulcers (DFUs) constitute one of the most important complications of diabetes mellitus. If not treated promptly, progression of infection and sepsis may necessitate a limb amputation. Aim The aim of the study was to evaluate the clinical efficacy of negative-pressure wound therapy using vacuum-assisted closure (VAC) compared with the conventional dressing on the postoperative wound healing in diabetic foot patients. Patients and methods This was a randomized controlled trial that included two groups of postoperative diabetic foot patients, in which we had a comparison between VAC and conventional wound dressing in order to investigate which procedures had the least time of follow-up weeks for full granulation of wound. Results Negative-pressure wound therapy significantly reduces the time to complete wound healing by enhancing the formation granulation tissue. Conclusion The time to complete wound healing was significantly better in the VAC therapy group as compared to conventional dressing. [ABSTRACT FROM AUTHOR]

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INTRODUCTION: The incidence of compound fractures and severe soft tissue loss has increased manifolds due to high speed traffics. Negative Pressure Wound Therapy (NPWT) is a treatment modality for managing soft tissue aspect of such injuries. It reduces the need of flap coverage. However, many patients from developing countries cannot afford a conventional NPWT. We developed an indigenous low cost NPWT for our patients and supplemented it with Topical Pressurised Oxygen Therapy (TPOT). We conducted this study to compare its treatment outcome with the use of conventional NPWT. MATERIALS AND METHODS: The study was conducted from 2018 to 2020 at a tertiary care teaching hospital. A total of 86 patients were treated with NPWT and their results were assessed for various parameters like reduction in wound size, discharge, infection, etc. We included patients with acute traumatic wounds as well as chronic infected wounds, and placed them in three treatment groups to receive either conventional NPWT, Indigenous NPWT and lastly NPWT with supplement TPOT. RESULTS: We observed a significant reduction of wound size, discharge and infection control in all three groups. The efficacy of indigenous NPWT is at par with conventional NPWT. Only six patients who had several comorbidities required flap coverage while in another four patients we could not achieve desired result due to technical limitations. CONCLUSION: Indigenous NPWT with added TPOT is a very potent and cost effective method to control infection and rapid management of severe trauma seen in orthopaedic practice. It also decreases the dependency on plastic surgeons for management of such wounds.

Background The management of complex soft tissue defects with exposed bones/tendons is always a challenging task for the surgeon and the problem becomes more pronounced when it comes to the management of these wounds in children. Though flap procedures are considered the standard for managing the complex soft tissue defects with exposed bones/tendons yet small blood vessels for anastomosis, long operative period, increased chances of perioperative thrombosis, and difficult perioperative management in children add to the difficulty in performing flap procedures in children. The vacuum-assisted closure (VAC) therapy has emerged as a novel modality for the management of the difficult wounds with added advantages, especially in children. Objective To evaluate the efficacy of VAC in the management of wounds with exposed bones/tendons in children. Patients and Method Forty-six children of complex wounds with exposed bones/tendons were included in the study from July 2016 to June 2018. Results Out of 46 patients, 31 were male; the patients had a mean age of 8.4 years. Road traffic accident was the most common mode of injury (54%), with most of the wounds located over extremities. The mean duration of VAC therapy was 12 days. More than 90% coverage of the exposed structure was seen in 89% of patients. The wounds were definitively managed by split-thickness skin graft in 89% of patients and flap cover in 6.5% of patients. The mean cost of the VAC therapy at our government run hospital was 187 Indian rupees per day. No significant major complications were seen during the treatment. Conclusion VAC therapy is an efficient, safe, and cost-effective modality of treatment for the management of complex wounds in the pediatric population.

Objective:Management of Fournier’s gangrene (FG) includes large wound debridement, broad-spectrum antibiotic, wound care and re-debridement if necessary. The aim of our study was to compare standard open wound care and vacuum-assisted closure (VAC) therapy in patients with FG.Materials and Methods:Thirty-three patients (29 males and 4 females) who underwent surgery for FG were enrolled in the present study. The data was evaluated retrospectively. The patients were divided into two groups according to wound care after large wound debridement. Standard open wound care with antibiotic pomade was performed twice a day in 14 patients and VAC therapy was performed every 48-72 hours in 17 patients. The data of the two groups were compared.Results:Twenty-three (69.7%) patients had Diabetes Mellitus and 20 patients (60%) had poor hygiene. The re-debridement rate in patients who received standard open wound care was statistically higher than in those who underwent VAC therapy (p=0.016). There were no statistically significant differences in mortality rate, length of hospital stay and need for reconstruction between the groups. When the data were analyzed, no statistically significant difference was found in FG Severity index score, length of hospital stay and mortality rate. However, the relationship between mortality rate and location of lesion was statistically significant (p=0.03). Four patients died, 3 (75%) due to wide necrotizing fasciitis extending to the abdominal wall.Conclusion:The present study showed that the technique used for wound care did not influence mortality, need for reconstruction and length of hospital stay. The only advantage of VAC therapy was decreased re-debridement rate in patients with FG.