Michael Engelhardt

Literature on the Subject of Vacuum Therapy Review and Update

Introduction:Today, vacuum therapy can be regarded as established in routine clinical use. Many hundreds of reports on the subject of vacuum therapy have appeared in medical literature. This review intends to give an overview of the peer-reviewed literature published to date and its quality considering criteria of evidence-based medicine (EbM).Methods:Literature search (MEDLINE, EMBASE, Cochrane, extensive manual search); up to May 31, 2006; evidence level: Classification of the Oxford Centre for Evidence-based Medicine.Results:Five hundred and fifty peer-reviewed citations were identified. Impressive jump in the annual publication rate is found from the year 2000 onwards; continuous broadening of the fields of indications; over 85% of all reports are case reports/series (only n = 27; EbM level < 4). To date, most of the publications are by authors from the United States, Germany, United Kingdom, Austria, the Netherlands, Switzerland, France, and Sweden. 7.5% of all peer-reviewed articles investigate scientific back grounds.Discussion:The clinical significance of this therapy is underlined by an obviously continuously marked extension of the range of indications in all surgical fields, and even in extreme ages of the patients. There is a considerable deficit of basic pathophysiological research and well-designed studies. This “deficiency,” however, when judged against the quality of the general medical literature, does not point to the poor efficacy or low benefit of vacuum therapy but should rather be seen as a symptom of the clinical practitioners problems in dealing with modern aspects of the theoretical background of EbM.

Richard von Volkmann: Surgeon and Renaissance Man

Richard von Volkmann (1830–1889), one of the most important surgeons of the 19th century, is regarded as one of the fathers of orthopaedic surgery. He was a contemporary of Langenbeck, Esmarch, Lister, Billroth, Kocher, and Trendelenburg. He was head of the Department of Surgery at the University of Halle, Germany (1867–1889). His popularity attracted doctors and patients from all over the world. He was the lead physician for the German military during two wars. From this experience, he compared the mortality of civilian and war injuries and investigated the general poor hygienic conditions in civilian hospitals. This led him to introduce the “antiseptic technique” to Germany that was developed by Lister. His powers of observation and creativity led him to findings and achievements that to this day bear his name: Volkmann’s contracture and the Hueter-Volkmann law. Additionally, he was a gifted writer; he published not only scientific literature but also books of children’s fairy tales and poems under the pen name of Richard Leander, assuring him a permanent place in the world of literature as well as orthopaedics.

The impact of surgical site occurrences and the role of closed incision negative pressure therapy

Surgical site occurrences are observed in up to 60% of inpatient surgical procedures in industrialised countries. The most relevant postoperative complication is surgical site infection (SSI) because of its impact on patient outcomes and enormous treatment costs. Literature reviews (‘SSI’, ‘deep sternal wound infections’ (DSWI), ‘closed incision negative pressure wound therapy’ (ciNPT) were performed by electronically searching MEDLINE (PubMed) and subsequently using a ‘snowball’ method of continued searches of the references in the identified publications. Search criteria included publications in all languages, various study types and publication in a peer‐reviewed journal. The SSI literature search identified 1325, the DSWI search 590 and the ciNPT search 103 publications that fulfilled the search criteria. Patient‐related SSI risk factors (diabetes mellitus, obesity, smoking, hypertension, female gender) and operation‐related SSI risk factors (re‐exploration, emergency operations, prolonged ventilation, prolonged operation duration) exist. We found that patient‐ and operation‐related SSI risk factors were often different for each speciality and/or operative procedure. Based on the evidence, we found that high‐risk incisions (sternotomy and incisions in extremities after high‐energy open trauma) are principally recommended for ciNPT use. In ‘lower’‐risk incisions, the addition of patient‐related or operation‐related risk factors justifies the application of ciNPT.

Closed-incision negative pressure therapy to reduce groin wound infections in vascular surgery: a randomised controlled trial: Closed incision negative pressure therapy for reduction of groin wound infection

Groin wound infections pose a major problem in vascular surgery. Closed‐incision negative pressure therapy (ciNPT) was especially designed for the management of incisions at risk of surgical site infections. The aim of this study was to investigate whether ciNPT is able to reduce the incidence of wound infections after vascular surgery.

Quality-of-life evaluation in chronic wounds: comparative analysis of three disease-specific questionnaires

The study directly compared the feasibility and performance of three instruments measuring health‐related quality of life (HRQoL) in chronic ulcers: the Freiburg Life Quality Assessment for wounds (FLQA‐w), the Cardiff Wound Impact Schedule (CWIS) and the Würzburg Wound Score (WWS). The questionnaires were evaluated in a randomly assigned order in a longitudinal observational study of leg ulcer patients. Psychometric properties (internal consistency, responsiveness and construct validity) were analysed. Patient acceptance was recorded. Analysis of n = 154 patients revealed good internal consistency (Cronbachs alpha ≥ 0·85) for all instruments. There were minor floor effects in all questionnaires (<1%) and some ceiling effects in the CWIS. Construct validity was satisfactory, for example, correlation with EuroQoL‐5D was r = 0·70 in the FLQA‐w, r = 0·47/0·67/0·68 in the CWIS dimensions and r = 0·60 in the WWS. The proportion of missing values was higher in the CWIS, and overall patient acceptance was highest in the FLQA‐w for wounds (54% best preferences) and lowest in the WWS (14%). In conclusion, the FLQA‐w, the CWIS and the WWS are reliable, sensitive and valid instruments for the assessment of HRQoL in leg ulcers. However, they show differences in clinical feasibility and patient acceptance.