Mechanisms governing the effects of vacuum-assisted closure in cardiac surgery

SUMMARY:: Vacuum-assisted closure has been adopted as the first-line treatment for poststernotomy mediastinitis as a result of the excellent clinical outcome achieved with its use. Scientific evidence regarding the mechanisms by which vacuum-assisted closure promotes wound healing has started to emerge, although knowledge regarding the effects on heart and lung function is still limited. The organs in the mediastinum are hemodynamically crucial, and in patients with poststernotomy mediastinitis, vulnerable bypass grafts and reduced cardiac function must be taken into consideration during vacuum-assisted closure therapy. This article provides an overview of the effects of vacuum-assisted closure on heart and lung function and summarizes the current knowledge on the mechanisms by which vacuum-assisted closure therapy promotes wound healing.     

The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone

Lower-extremity wounds with exposed tendon, bone, or orthopedic hardware present a difficult treatment challenge. In this series of patients, subatmospheric pressure therapy was applied to such lower-extremity wounds. Seventy-five patients with lower-extremity wounds, most of which were the result of trauma, were selected for this study. Dressings made of sterile open-cell foam with embedded fenestrated tubing were contoured to the wound size and placed into the wound. The site was covered with an adhesive plastic sheet. The sheet was placed beneath any external fixation devices, or the fixation device was enclosed within the sheet. The tubing was connected to the vacuum-assisted closure pump. Continuous subatmospheric suction pressure (125 mmHg) was applied to the wound site. The wounds were inspected and the dressings were changed every 48 hours.Vacuum-assisted closure therapy greatly reduced the amount of tissue edema, diminishing the circumference of the extremity and thus decreasing the surface area of the wound. Profuse granulation tissue formed rapidly, covering bone and hardware. The wounds were closed primarily and covered with split-thickness skin grafts, or a regional flap was rotated into the granulating bed to fill the defect. Successful coverage was obtained without complication in 71 of 75 patients. Wounds have been stable from 6 months up to 6 years.     

Rethinking Ancient Maya Social Organization: Replacing "Lineage" with "House"

Long-standing disagreements concerning prehispanic Maya kinship and social organization have focused on the nature of their corporate groups, generally presumed to have been lineages. Specific debates center on whether the lineages were patrilineal or incorporated some kind of double-descent reckoning, how descent was combined with locality to define a group, and the status of lineage-outsiders within a group. It is argued here that Maya social organization is better approached within the contemporary critique of kinship, replacing "lineage" with Lévi-Strauss's model of the "house"—a corporate group maintaining an estate perpetuated by the recruitment of members whose relationships are expressed "in the language" of kinship and affinity and affirmed by purposeful actions. In this perspective, the operation of corporate groups is the primary concern, and relationships construed in terms of consanguinity and affinity are seen as strategies pursued to enhance and perpetuate the group, [ancestor veneration, house society, kinship, Maya, social organization]     

Maya mobile medicine in Guatemala: the "other" public health

Maya mobile medical providers in highland Guatemala and the goods and services that they offer from "soapboxes" on street corners, local markets, and on buses exemplify an important yet underinvestigated domain of localized health care, one that I refer to as the "other" public health. This medical and linguistic examination of traveling medical salespeople calls for a reconsideration (on a global scale) of what has come to be understood as "public health," arguing that "othered," local forms of public health that are often overlooked by anthropologists as "nontraditional" and delegitimized by bio-medicine as nonscientific merit serious consideration and investigation. This ethnography of marginalized forms of public health offers global insights into emerging heterodoxical forms of public health care that contest bio-medical authority and challenge our preexisting definitions of what counts as "access," wellness seeking, and even health care itself.