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Closure
Kinds of Closure Terms modified by Closure Selected AbstractsADJUSTMENT OF STREAM CHANNEL CAPACITY FOLLOWING DAM CLOSURE, YEGUA CREEK, TEXAS,JOURNAL OF THE AMERICAN WATER RESOURCES ASSOCIATION, Issue 6 2002Anne Chin ABSTRACT: In Yegua Creek, a principal tributary of the Brazos River in Texas, surveys of a 19 km channel reach downstream of Somerville Dam show that channel capacity decreased by an average of 65 percent in a 34 year period following dam closure. The decrease corresponds with an approximately 85 percent reduction in annual flood peaks. Channel depth has changed the most, decreasing by an average of 61 percent. Channel width remained stable with an average decrease of only 9 percent, reflecting cohesive bank materials along with the growth of riparian vegetation resulting from increased low flows during dry summer months. Although large changes in stream channel geometry are not uncommon downstream of dams, such pronounced reductions in channel capacity could have long-term implications for sediment delivery through the system. [source] LAPAROSCOPIC CLOSURE OF DUODENAL ULCER PERFORATIONSANZ JOURNAL OF SURGERY, Issue 9 2007Gnanaraj Jesudian MB BS, MCh(Urology), MS(Gen) No abstract is available for this article. [source] SUCTION DRAIN RETENTION SUTURES IN THE CLOSURE OF THE ACUTE BURST ABDOMENANZ JOURNAL OF SURGERY, Issue 6 2007Garcea Giuseppe MD No abstract is available for this article. [source] GS27P TECHNIQUES FOR CLOSURE OF MIDLINE ABDOMINAL INCISIONSANZ JOURNAL OF SURGERY, Issue 2007A. Ali Background A recent meta-analysis of randomised controlled trials of abdominal fascial closures concluded that in order to reduce incisional hernia rates without increasing wound pain, or the rate of dehiscence slowly absorbable continuous sutures appear to achieve the best results in abdominal fascial closures. We surveyed the techniques for abdominal fascial closure among general surgeons in Canberra, Australia. Methodology 49 out of 80 surgeons responded to the survey by form. The information collected included the seniority of the surgeon, the frequency of laparotomy closure, surgical technique and suture material utilised in abdominal fascial closure. Results 34 (69%) of the surgeons surveyed preferred a non-absorbable monofilament suture material for abdominal fascial closure with nylon being the most popular. Most (38, 78%) also preferred a non-absorbable monofilament suture in emergency surgery. 12 (24%) surgeons preferred to use slowly absorbable suture. The majority of surgeons (37, 76%) preferred continuous suture technique, whilst only 2 (4%) used continuous followed by interrupted suture closures. Only 5 (10%) complied with the dual recommendation of continuous suture technique and slowly absorbable suture. Conclusion The majority of surgeons preferred non-absorbable monofilament suture rather than slowly absorbable suture. Only 1 in 10 surgeons complied with both components of evidence base, which supports the use of slowly absorbable suture material and a continuous technique in abdominal fascial closure. A definitive RCT would confirm this observation. [source] PERCUTANEOUS TRANSCATHETER CLOSURE OF PATENT DUCTUS ARTERIOSUS WITH AN AMPLATZER DUCT OCCLUDER USING RETROGRADE GUIDEWIRE-ESTABLISHED FEMORAL ARTERIOVENOUS LOOPCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 5-6 2008Jian-Fa Zhang SUMMARY 1The traditional antegrade wire-guided percutaneous transcatheter approach is not ideal in closing some types of patent ductus arteriosus (PDA) with abnormal morphology. The aim of the present study was to evaluate the efficacy of a retrograde wire-guided transcatheter approach for closure of some types of PDA using the Amplatzer duct occluder (ADO). 2Nineteen patients with abnormal PDA morphology, including a smaller ostium of the side of the pulmonary artery compared with the side of the descending aorta, severe calcification or tortuosity, were included in the present study. In these patients, after the antegrade approach failed to cross a wire from the pulmonary artery via the PDA to the descending aorta, a retrograde guidewire was passed through the PDA in the opposite direction, from the descending aorta to the pulmonary artery, to establish a femoral arteriovenous loop that assisted the deployment of the ADO in all 19 patients. The size of the PDA, as determined by angiography, was 3.1 ± 1.1 mm and the diameter of the ADO selected was 6.5 ± 1.5 mm. 3In 16 cases, systolic murmur disappeared after the procedure. Systolic murmur (less than Grade II) and angiographic residual shunt remained in three cases immediately after the procedure, but disappeared 1 month later. Mean pulmonary arterial pressure decreased from 33 ± 8 to 22 ± 4 mmHg in all 19 patients (P < 0.01). There were no complications during or after the procedure. 4The retrograde wire-guided technique offers an alternative approach to facilitate closure of a PDA that cannot be achieved by traditional antegrade wire-guided methods due to morphological abnormalities in the PDA. [source] Percutaneous Closure of a Large PDA in a 35-Year-Old Man with Elevated Pulmonary Vascular ResistanceCONGENITAL HEART DISEASE, Issue 2 2008John S. Hokanson MD ABSTRACT The presence of a large patent ductus arteriosus (PDA) may result in significant pulmonary hypertension, which may not be reversible. We present the case of a 35-year-old man with pulmonary hypertension who had successful percutaneous closure of a large PDA with an Amplatzer muscular ventricular septal defect occluder and resolution of his pulmonary hypertension. The use of prior balloon test occlusion of the PDA suggested that the procedure would be successful, despite the lack of an immediate fall in the pulmonary artery pressure. [source] Device Closure of a Secundum Atrial Septal Defect in a 4-Month-Old Infant with a Marginal Left Ventricle Following Coarctation RepairCONGENITAL HEART DISEASE, Issue 6 2007Emilie Jean-St-Michel BSc ABSTRACT A male infant presented at birth with severe coarctation of the aorta and marginal left ventricular and mitral valve dimensions associated with a large secundum atrial septal defect. Following successful arch repair, the left ventricle remained small with preferential left-to-right atrial shunting and a dilated right ventricle. Clinically, the infant continued with tachypnea, poor feeding, and failure to thrive. At 4 months of age, the defect was closed with an Amplatzer Atrial Septal Occluder which resulted in immediate left ventricular cavity enlargement and clinical improvement. [source] Successful Transcatheter Closure of an Aorto-Left Atrial FistulaCONGENITAL HEART DISEASE, Issue 6 2007Malek M. El Yaman MD ABSTRACT Aorto-left atrial fistula is a rare entity in which the integrity of the aortic root bordering the left atrium is disrupted. The clinical presentation is highly variable, depending predominantly on the size of the fistula and the pressure difference between the aorta and the left atrium. Surgical repair was the standard treatment. Recently, however, there have been reports of successful transcatheter closure. We report a 32-year-old male with Shone's syndrome who had multiple prior surgical procedures including aortic and mitral valve replacements. He presented with an aorto-left atrial fistula that was successfully closed percutaneously using an Amplatzer atrial septal defect device. [source] Transcatheter versus Surgical Closure of Secundum Atrial Septal Defect in Adults: Impact of Age at Intervention.CONGENITAL HEART DISEASE, Issue 3 2007A Concurrent Matched Comparative Study Abstract Objectives., To compare the short- and mid-term outcomes of surgical (SUR) vs. transcatheter closure of secundum atrial septal defect (ASD) using Amplatzer septal occluder (ASO) in adults with a very similar spectrum of the disease; and to identify predictors for the primary end point. Design., Single-center, concurrent comparative study. Surgically treated patients were randomly matched (2:1) by age, sex, date of procedure, ASD size, and hemodynamic profile. Setting., Tertiary referral center. Patients., One hundred sixty-two concurrent patients with ASD submitted to ASO (n = 54) or SUR closure (n = 108) according with their preferences. Main Outcome Measures., Primary end point was a composite index of major events including failure of the procedure, important bleeding, critical arrhythmias, serious infections, embolism, or any major cardiovascular intervention-related complication. Predictors of these major events were investigated. Results., Atrial septal defects were successfully closed in all patients, and there was no mortality. The primary event rate was 13.2% in ASO vs. 25.0% in SUR (P = .001). Multivariate analysis showed that higher rate of events was significantly associated with age >40 years; systemic/pulmonary output ratio <2.1; and systolic pulmonary arterial pressure >50 mm Hg; while in the ASO group the event rate was only associated with the ASD size (>15 cm2/m2; relative risk = 1.75, 95% confidence interval 1.01,8.8). There were no differences in the event-free survival curves in adults with ages <40 years. Conclusions., The efficacy for closure ASD was similar in both groups. The higher morbidity observed in SUR group was observed only in the patients submitted to the procedure with age >40 years. The length of hospital stay was shorter in the ASO group. Surgical closure is a safe and effective treatment, especially in young adults. There is certainly nothing wrong with continuing to do surgery in countries where the resources are limited. [source] Device Closure of Congenital Ventricular Septal DefectsCONGENITAL HEART DISEASE, Issue 2 2007Karim A. Diab MD ABSTRACT Ventricular septal defect is the most common congenital heart malformation. Surgical closure, when indicated, has been practiced for over 50 years with good results; however, surgical closure is still associated with significant morbidity and mortality. Over the past decade, several occluding devices have been developed that made catheter device closure an attractive alternative to surgery with widely satisfactory results. In this article, a comprehensive review of percutaneous and perventricular (hybrid) device closure of each type of ventricular septal defect is presented. [source] Double Purse-String Closure for Scalp and Extremity WoundsDERMATOLOGIC SURGERY, Issue 3 2007ANTONIO P. CRUZ MD First page of article [source] Use of Purse-String Suture Technique in Closure of Flesh Tunnel Defects of the Bilateral EarlobesDERMATOLOGIC SURGERY, Issue 8 2006ANDREW P. KONTOS MD No abstract is available for this article. [source] Inverted Island Pedicle Transposition for Closure of Full-Thickness Nasal Mucosa DefectsDERMATOLOGIC SURGERY, Issue 5 2006ADAM J. MAMELAK MD First page of article [source] Combined Linear Closure and Burow's Graft for a Dorsal Nasal DefectDERMATOLOGIC SURGERY, Issue 1 2006DANIEL S. BEHROOZAN MD First page of article [source] Partial Closure of Transposition FlapDERMATOLOGIC SURGERY, Issue 11 2000Raymond T. Kuwahara MD [source] Closure of the Greater Saphenous Vein with Endoluminal Radiofrequency Thermal Heating of the Vein Wall in Combination with Ambulatory Phlebectomy: Preliminary 6-Month Follow-upDERMATOLOGIC SURGERY, Issue 5 2000Mitchel P. Goldman MD Background. Incompetence of the saphenofemoral junction with reflux into the greater saphenous vein is one cause of chronic venous hypertension which may lead to the development of varicose and telangiectatic leg veins. Therefore treatment is necessary. Objective. To evaluate a novel method for closing the incompetent greater saphenous vein at its junction with the femoral vein through an endoluminal approach. Methods. Ten patients with reflux at the saphenofemoral junction into the greater saphenous vein were treated with radiofrequency heating of the vein wall through an endoluminal catheter. Patients were evaluated at 3 and 6 months to determine treatment efficacy as well as adverse sequelae. Results. All treated patients achieved complete closure of the saphenofemoral junction and greater saphenous vein. Complete treatment took an average of 20 minutes. Adverse sequelae were minimal, with 2 of 12 patients having mild erythema for 2,3 days. Conclusion. Endoluminal radiofrequency thermal heating of an incompetent greater saphenous vein has been shown to be easily accomplished and efficacious throughout the 6-month follow-up period. [source] Stellate Purse-String ClosureDERMATOLOGIC SURGERY, Issue 5 2000Minh Dang MD Background. There are fundamental concepts we use in managing surgical defects. Whether planning a primary closure or a local flap, we frequently modify the basic design to maximize aesthetic outcomes, taking into consideration a number of factors including the location of the defect and tissue availability. Objective. We describe the stellate modified purse-string closure, a novel flap modification. Method. Report of an illustrated case. Result. A patient with vertex scalp defect was reconstructed using the stellate purse-string flap. Conclusion. Certain modifications of commonly used reconstructive techniques can be utilized in specific situations to enhance cosmesis. Advantages of this modification are discussed. [source] The value of debridement and Vacuum-Assisted Closure (V.A.C.) Therapy in diabetic foot ulcersDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue S1 2008Magnus Eneroth Abstract Background Treatment of diabetic foot ulcers includes a number of different regimes such as glycaemic control, re-vascularization, surgical, local wound treatment, offloading and other non-surgical treatments. Although considered the standard of care, the scientific evidence behind the various debridements used is scarce. This presentation will focus on debridement and V.A.C. Therapy, two treatments widely used in patients with diabetes and foot ulcers. Methods A review of existing literature on these treatments in diabetic foot ulcers, with focus on description of the various types of debridements used, the principles behind negative pressure wound therapy (NPWT) using the V.A.C. Therapy system and level of evidence. Results Five randomized controlled trials (RCT) of debridement were identified; three assessed the effectiveness of a hydrogel as a debridement method, one evaluated surgical debridement and one evaluated larval therapy. Pooling the three hydrogel RCTs suggested that hydrogels are significantly more effective than gauze or standard care in healing diabetic foot ulcers. Surgical debridement and larval therapy showed no significant benefit. Other debridement methods such as enzyme preparations or polysaccharide beads have not been evaluated in RCTs of people with diabetes. More than 300 articles have been published on negative pressure wound therapy, including several small RCTs and a larger multi-centre RCT of diabetic foot ulcers. Negative pressure wound therapy seems to be a safe and effective treatment for complex diabetic foot wounds, and could lead to a higher proportion of healed wounds, faster healing rates, and potentially fewer re-amputations than standard care. Conclusions Although debridement of the ulcer is considered a prerequisite for healing of diabetic foot ulcers, the grade of evidence is quite low. This may be due to a lack of studies rather than lack of effect. Negative pressure wound therapy seems to be safe and effective in the treatment of some diabetic foot ulcers, although there is still only one well-performed trial that evaluates the effect. Copyright © 2008 John Wiley & Sons, Ltd. [source] Knowability, Closure, and Anti-RealismDIALECTICA, Issue 1 2008Sven Rosenkranz In light of the paradox of knowability anti-realists ought to revise their wholesale equation of truth and knowability, lest they be committed to the absurd conclusion that there are no truths that will never be known. The task accordingly becomes to identify the problematic statements the knowability of whose truth would force that conclusion and to restrict the equation in appropriate ways to all but the problematic statements. This restriction strategy was first implemented by Tennant. However, recently Williamson and Brogaard and Salerno have argued that the restriction strategy, and in particular Tennant's implementation of it, fail to avert the paradoxical conclusion. Here I argue, first, that the arguments devised by Brogaard and Salerno are ineffective because they rely on an invalid closure principle and, second, that while Williamson's argument may suffice to undermine Tennant's specific proposal, it fails to discredit the restriction strategy as such. To this end, I give a better characterisation of the problematic cases, which is immune to Williamson's criticism, and then show how the restricted anti-realist thesis fares in light of the meaning-theoretical arguments anti-realists typically advance in support of their view. [source] Aortic Valve Closure: Relation to Tissue Velocities by Doppler and Speckle Tracking in Patients with Infarction and at High Heart RatesECHOCARDIOGRAPHY, Issue 4 2010Ph.D., Svein A. Aase M.Sc. Aim: To resolve the event in tissue Doppler (TDI)- and speckle tracking-based velocity/time curves that most accurately represent aortic valve closure (AVC) in infarcted ventricles and at high heart rates. Methods: We studied the timing of AVC in 13 patients with myocardial infarction and in 8 patients at peak dobutamine stress echo. An acquisition setup for recording alternating B-mode and TDI image frames was used to achieve the same frame rate in both cases (mean 136.7 frames per second [FPS] for infarcted ventricles, mean 136.9 FPS for high heart rates). The reference method was visual assessment of AVC in the high frame rate narrow sector B-mode images of the aortic valve. Results: The initial negative velocities after ejection in the velocity/time curves occurred before AVC, 44.9 ± 21.0 msec before the reference in the high heart rate material, and 25.2 ± 15.2 msec before the reference in the infarction material. Using this time point as a marker for AVC may cause inaccuracies when estimating end-systolic strain. A more accurate but still a practical marker for AVC was the time point of zero crossing after the initial negative velocities after ejection, 5.4 ± 15.3 msec before the reference in high heart rates and 8.2 ± 12.9 msec after the reference in the infarction material. Conclusion: The suggested marker of AVC at high heart rate and in infarcted ventricles was the time point of zero crossing after the initial negative velocities after ejection in velocity/time curves. (Echocardiography 2010;27:363-369) [source] Transcatheter Intracardiac Echocardiography-Assisted Closure of Interatrial Shunts: Complications and Midterm Follow-UpECHOCARDIOGRAPHY, Issue 2 2009Gianluca Rigatelli M.D. Objective: It has been suggested that intracardiac echocardiography (ICE) improves the safety and effectiveness of transcatheter device-based closure of interatrial shunts, but the impact of this technique on midterm follow-up is unknown. We sought to prospectively evaluate midterm follow-up results of ICE-aided transcatheter closure of interatrial shunts in adults. Methods: Over a 48-month period, we prospectively enrolled 140 consecutive patients (mean age 43 ± 15. 5 years, 98 females) who had been referred to our center for catheter-based closure of interatrial shunts. All patients were screened with transesophageal echocardiography (TEE) before the operation. Patients who met the inclusion criteria underwent ICE study and attempted closure. Immediate success rates, predischarge occlusion rates, complication rates, as well as fluoroscopy and procedural times, patients' radiological exposure, midterm complication rates, and midterm occlusion rates were evaluated. Results: One hundred patients out of 140 (71.4%) underwent an attempt at transcatheter closure. After ICE study and measurements, the TEE-planned device type and size was changed in 31 patients with patent foramen ovale whereas the TEE-planned device size was changed in 41 patients with atrial septal defect (globally 72%). Procedural success rate, predischarge occlusion rate, and complication rate were 99, 90.7, and 12%, respectively. On mean follow-up of 36.6 ± 14.8 months the follow-up occlusion rate was 96.5%. No aortic erosion or device thrombosis was observed. Conclusions: ICE-guided interatrial shunt transcatheter closure is safe and effective and appears to have excellent midterm results thus avoiding the complications caused by device oversizing, such as aortic erosion and device thrombosis. [source] Ring Closure of Alkoxycarbonyl(tetracarbonyl)pyruvoyliron Complexes into Metallalactones Induced by Nucleophilic Attack of CarbanionsEUROPEAN JOURNAL OF INORGANIC CHEMISTRY, Issue 7 2006Patrice Cabon Abstract The reaction of carbanions with the pyruvoyl-substituted iron complex [(CO)4Fe(CO2CH3){C(O)C(O)CH3}] (1) affords the anionic trifunctionalized metallalactones [(CO)3Fe{C(O)C(CH3)(CRR,R,)OC4(O)(Fe,C4)}(CO2CH3)], (3), whose formation results from the addition of the nucleophile to the , carbonyl of the pyruvoyl moiety, followed by attack of the oxygen of this , carbonyl on a terminal carbonyl ligand. These anionic lactones react, at low temperature, with HCl to give rise to the neutral lactones [(CO)4Fe{C(O)C(CH3)(CRR,R,)OC4(O)(Fe,C4)}] (2), which were previously obtained by addition of NuH nucleophiles to 1. Complex 3(3), whose lactonic ring formation has been performed using the diethyl malonate anion (R = R, = CO2C2H5; R, = H), and the dimethyl-substituted neutral lactone 2(1) (R = R, = R, = H) have been characterized by X-ray diffraction studies. (© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2006) [source] Closure of plane-strain cracks under large-scale yielding conditionsFATIGUE & FRACTURE OF ENGINEERING MATERIALS AND STRUCTURES, Issue 2 2002C. H. Wang Abstract ,This paper presents computational and theoretical investigations of the plasticity-induced crack-closure of a plane-strain crack under large-scale yielding conditions. Solutions of the crack-tip opening displacements for a stationary crack and a growing fatigue crack have been obtained using the finite element method. The self-similar crack-closure model has been extended to the plane strain case by introducing two plastic constraint factors: one for tension yielding and the other for compression yielding. These two plastic constraint factors are identified by matching the model predictions with the computational results. It is shown that the first constraint factor decreases rapidly with the applied stress while the second constraint factor is approximately equal to unity. The findings of this study allow the cohesive-zone based crack-closure model to be extended to plane-strain cracks, especially under large-scale yielding conditions. [source] Spatial and temporal trends in abundance of Atlantic salmon, Salmo salar, in Newfoundland with emphasis on impacts of the 1992 closure of the commercial fisheryFISHERIES MANAGEMENT & ECOLOGY, Issue 6 2004J. B. Dempson Abstract Closure of the Newfoundland commercial Atlantic salmon, Salmo salar L., fishery in 1992 was the most restrictive measure introduced to help rebuild depressed local stocks of salmon. Here, the effects of the closure are evaluated by analysing trends in abundance since 1984, and estimates of survival in both freshwater and marine environments derived from enumeration of salmon at fish counting facilities. While freshwater production of smolts generally has been maintained, marine survival rates remain low (2,10%), and highly variable. Overall, total stock size differs little from that prior to the closure of the commercial salmon fishery. Spawning escapements have increased by a factor of 2 or 3 in some rivers, but in other areas total returns are lower on average than those prior to the fishery closure. Factors other than exploitation are contributing to lack of stock recovery, resulting in continued conservation concerns. [source] Site Closure Through AlchemyGROUND WATER MONITORING & REMEDIATION, Issue 3 2003Evan K. Nyer No abstract is available for this article. [source] Patent Foramen Ovale and Migraine,Bringing Closure to the SubjectHEADACHE, Issue 4 2006Todd J. Schwedt MD There is increasing interest in the relationship between migraine and patent foramen ovale (PFO). PFO is more common in migraineurs with aura, and migraine with aura is more prevalent in patients with PFO. Retrospective analyses of PFO closure for stroke prevention and decompression illness in divers have suggested that migraineurs with and without aura may derive significant benefit from PFO closure, but to date no prospective, randomized, sham-controlled study to confirm this has been completed. Herein we review published data regarding the relationship between migraine and PFO and discuss the rationale, justification, and important factors to consider in the conduct of prospective, controlled, clinical trials designed to evaluate the efficacy and safety of percutaneous device closure of PFO for migraine prevention. [source] Transformation Into Daily Migraine With Aura Following Transcutaneous Atrial Septal Defect ClosureHEADACHE, Issue 5 2003A. E. Yankovsky MD A link between migraine with aura and cardiac right-to-left shunting has been previously reported. Abortion or decreased frequency of migraine with aura attacks after atrial septal defect closure has been reported in the literature. We report the first case of transformation of migraine with aura into a daily pattern after atrial septal defect closure. A 48-year-old male who had been suffering from rather infrequent attacks of migraine with sensory and visual aura underwent transcutaneous closure of an atrial septal defect. His migraine attacks changed into a daily pattern the day following the procedure and remained so for 6 months. This change in pattern may be related to a changed intra-atrial pressure after the closure or some other unknown factor. [source] Synthesis of Highly Functionalized , -Lactones via 1,5-Electrocyclic Ring ClosureHELVETICA CHIMICA ACTA, Issue 6 2006Olcay Anaç Abstract We have investigated 1,5-electrocyclic ring-closure reactions of conjugated esters with dimethyl diazomalonate in the presence of [Cu(acac)2] as catalyst. Our new protocol offers an easy entry to various polyfunctionalized , -lactones in high yields. Their subsequent derivatives may be used as valuable intermediates, especially in the synthesis of natural products and their analogues. [source] Age of closure of the foramen of Huschke: an osteological studyINTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 1 2006L. T. Humphrey Abstract The foramen of Huschke is a dehiscence in the antero-inferior surface of the tympanic plate, which forms during the normal post-natal development of the temporal bone. Closure of the foramen is generally reported to take place by 5 years of age, although a persistent foramen has been observed in 0,67% of adult crania depending on the population. A persistent foramen of Huschke in adult life may be involved in abnormalities of the external auditory canal and related structures, which can lead to otological complications. This paper examines age-related changes in the development of the tympanic plate from the perinatal to the adult condition using two osteological samples from Britain, and is the first systematic evaluation beyond the age of six years. The results suggest that the widely cited chronology for the closure of the foramen of Huschke is erroneous. Earlier stages of formation may be used for narrowing age estimation in fragmentary remains of juveniles in a skeletal collection of unknown age or in a forensic or clinical context. Copyright © 2005 John Wiley & Sons, Ltd. [source] A Clinical Review of Infected Wound Treatment with Vacuum Assisted Closure® (V.A.C.®) Therapy: Experience and Case SeriesINTERNATIONAL WOUND JOURNAL, Issue 2009Allen Gabriel ABSTRACT Over the last decade Vacuum Assisted Closure® (KCI Licensing, Inc., San Antonio, TX) has been established as an effective wound care modality for managing complex acute and chronic wounds. The therapy has been widely adopted by many institutions to treat a variety of wound types. Increasingly, the therapy is being used to manage infected and critically colonized, difficult-to-treat wounds. This growing interest coupled with practitioner uncertainty in using the therapy in the presence of infection prompted the convening of an interprofessional expert advisory panel to determine appropriate use of the different modalities of negative pressure wound therapy (NPWT) as delivered by V.A.C.® Therapy and V.A.C. Instill® with either GranuFoamÔ or GranuFoam SilverÔ Dressings. The panel reviewed infected wound treatment methods within the context of evidence-based medicine coupled with experiential insight using V.A.C.® Therapy Systems to manage a variety of infected wounds. The primary objectives of the panel were 1) to exchange state-of-practice evidence, 2) to review and evaluate the strength of existing data, and 3) to develop practice recommendations based on published evidence and clinical experience regarding use of the V.A.C.® Therapy Systems in infected wounds. These recommendations are meant to identify which infected wounds will benefit from the most appropriate V.A.C.® Therapy System modality and provide an infected wound treatment algorithm that may lead to a better understanding of optimal treatment strategies. [source] | ||||||||||||||||||||||||||||||||||||||||||||||||||||