Vacuum-assisted closure for the treatment of degloving injuries

Degloving injuries of the hand and foot pose difficult reconstructive and rehabilitation challenges. After an excellent experience with split-thickness skin grafting with the vacuum-assisted closure device, we began studies with full-thickness skin grafts and traumatized skin. The device has been used with successful reapplication of full-thickness degloved skin in two patients. The first patient suffered degloving of the foot; the second patient, degloving of the hand.     

Vacuum-assisted closure: microdeformations of wounds and cell proliferation

The mechanism of action of the Vacuum Assisted Closure Therapy (VAC; KCI, San Antonio, Texas), a recent novel innovation in the care of wounds, remains unknown. In vitro studies have revealed that cells allowed to stretch tend to divide and proliferate in the presence of soluble mitogens, whereas retracted cells remain quiescent. The authors hypothesize that application of micromechanical forces to wounds in vivo can promote wound healing through this cell shape-dependent, mechanical control mechanism. The authors created a computer model (finite element) of a wound and simulated VAC application. Finite element modeling is commonly used to engineer complex systems by breaking them down into simple discrete elements. In this model, the authors altered the pressure, pore diameter, and pore volume fraction to study the effects of vacuum-induced material deformations. The authors compared the morphology of deformation of this wound model with histologic sections of wounds treated with the VAC. The finite element model showed that most elements stretched by VAC application experienced deformations of 5 to 20 percent strain, which are similar to in vitro strain levels shown to promote cellular proliferation. Importantly, the deformation predicted by the model also was similar in morphology to the surface undulations observed in histologic cross-sections of the wounds. The authors hypothesize that this tissue deformation stretches individual cells, thereby promoting proliferation in the wound microenvironment. The application of micromechanical forces may be a useful method with which to stimulate wound healing through promotion of cell division, angiogenesis, and local elaboration of growth factors. Finite element modeling of the VAC device is consistent with this mechanism of action.     

Vacuum-assisted closure in the treatment of sternal wound infection after cardiac surgery

Aim: Vacuum-assisted closure (VAC) was primarily designed for the treatment of pressure ulcers or chronic, debilitating wounds. Recently, VAC has become an encouraging treatment modality for sternal wound infection after cardiac surgery, providing superior results to conventional treatment strategies. Methods: From November 2004 to September 2006, 34 patients, undergoing VAC therapy for sternal wound infection following cardiac surgery, were prospectively evaluated. Ten patients (29 %) were treated for superficial sternal wound infection and 24 (71 %) for deep sternal wound infection. The median age was 69.9 years (range 48 to 82) and the median BMI was 33.4 kg/m(2) (range 28 to 41). Twenty patients (59 %) were women and 19 patients (59 %) were diabetics. Owing to sternal wound infection complications, 16 patients (47 %) were readmitted to the department. VAC was used following the previous failure of the conventional treatment strategy in 7 patients (21 %). Results: Thirty-three patients (97 %) were treated successfully. One patient (3 %) died of multiple organ failure. The overall length of hospitalization was 34.6 days (range 9 to 62). The median number of dressing changes was 4.6 (range 3 to 10). The median VAC treatment time until surgical closure was 9.2 days (range 6 to 21 days). VAC therapy was solely used as a bridge to definite wound closure. Three patients (9 %) with chronic fistula were re-admitted 1 to 6 months after VAC therapy. Conclusions: VAC therapy is a safe and reliable option in the treatment of sternal wound infection in cardiac surgery. VAC therapy should be considered an effective adjunct to conventional treatment modalities for the treatment of extensive and life-threatening wound infections following cardiac surgery, particularly in the presence of risk factors.     

Loads on an internal spinal fixation device during sitting.

Sitting is often assumed to involve high loads on the spine as well as on implants for stabilising the spine. Loads on internal spinal fixation devices were therefore measured in ten patients sitting on several types of seats, including a stool, a stool with a padded wedge, a chair, a physiotherapy ball, a knee-stool, and a bench. The patients also successively sat relaxed and erect on a stool. In addition, six of them sat on a special chair allowing different inclinations of the backrest. Implant loads were also measured for standing up and sitting down. There were only minor differences in fixator loads for sitting on the different types of seats. Sitting erect caused an average of 11% higher implant loads than sitting relaxed. Implant loads decreased with increasing inclination of the upper body while sitting on a chair with an adjustable backrest. Implant loads were about 27% higher for standing up and sitting down than for sitting.     

Accidental renal injury by an external heating device during surgery in rats

Hypothermia can be caused by anaesthesia and/or surgery and represents a daily challenge in the operating room. Experimental animal surgery settings typically use heating pads or warming blankets to maintain the rodent's body temperature during long-lasting experiments. Warming is crucial in small animal experiments because these animals quickly lose temperature due to their large body surface to body weight ratio. While establishing a left ventricular infarction model in rats, we inserted a rectal temperature probe. The heating pad's set point was 37°C. Although a dual set point control circuit should prevent overheating, we observed a maximum heating pad's surface temperature of 43°C between the animal's back and the surface of the heating pad. At the end of the experiments, which lasted up to 8 h, the animals showed severe haematuria and segmental kidney damage. We hypothesized that overheating of the heating pad and uneven distribution of temperature led to kidney damage. Therefore, the maximal temperature of commonly used heating pads must be tightly controlled to avoid overheating, which may cause kidney or tissue injury, may falsify the experimental data and could influence the study results.     

Flow simulation along a seal: the impact of an external device

An increasing number of marine mammal studies on physiology, behaviour and ecology rely on data, which have been collected from back-mounted devices, such as bio-logging tags and satellite transmitters. However, external devices may influence an animal’s hydrodynamics, behaviour and energy expenditure and, therefore, can impede the individual animal. To investigate the influence of external devices on seals, the water flow along a grey seal was simulated using computational fluid dynamics calculations. The simulations revealed several changes in forces and moments and thus balance, due to this device. The investigated satellite transmitter creates an average 12% increase of the drag coefficient. Additionally, there are significant relative transmitter-induced increases in pitching moment (32%) and lift (240%). The simulations also showed that the transmitter generates areas of decreased wall shear stress on the seal’s back. The results of this study demonstrate that external devices can change the hydrodynamics of the seal, which is expected to alter the seal’s physiology and behaviour and its use of the ecosystem. Long-term attachment may have adverse effects on the animal’s welfare. It is important to take these effects into consideration when studying tagged seals; otherwise, the value of the data obtained will be poor. Therefore, interpretations and extrapolations regarding ‘natural behaviour’ of animals in their ‘natural environment’ should only be made with great caution.     

A new method for fixation of external prostheses

As more extensive craniofacial resections for recurrent orbital and nasoethmoidal carcinoma are performed, the need for complex external prostheses increases. A new method of stabilization for large prostheses using osseointegrated implants is presented. This is illustrated in a typical patient who underwent a large naso-orbital maxillary resection for recurrent basal cell carcinoma.