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A 63-year-old woman presented with acute left foot ischaemia with pain, sensory loss and moderate motor deficit. She was a heavy smoker with arterial hypertension, hyperlipidaemia and a history of left breast cancer 15 years ago. She urgently underwent a standard Fogarty embolectomy through a left

Purpose: Anastomotic leakage, a known major postoperative complication, potentially leads to readmission, reoperation, and increased mortality rates in patients, such as rectal cancer patients following a low anterior resection (LAR). Currently, vacuum-assisted closure, as featured by B-Braun (B-Braun Medical B.V.), is already being used for the treatment of gastrointestinal leakages and fistulas. The main aim of this study was to introduce a novel method for creating a vacuum-assisted drain for the treatment of anastomotic leakage after LAR.Methods: All 10 patients, who underwent LAR surgery from 2018 to 2019, were diagnosed with anastomotic leakage and had received neoadjuvant chemotherapy prior to surgery. Therefore, patients were treated with a handmade vacuum-assisted drain and were revisited every 5 to 7 days for further evaluations and drain replacement until leakage resolution. Physical features of cavity, time of diagnose, and duration of treatment were analyzed correspondingly. The handmade vacuum-assisted sponge drain was prepared for each patient in each session of follow-up.Results: Eight out of 10 patients experienced complete closure of the defect. The mean delay time from the day of operation to the diagnosis of anastomotic leakage was 61.0±80.4 days while the mean time for leakage closure was 117.6±68.3 days. Eventually, 7 cases underwent ileostomy reversal with no complications during a 3-month follow-up.Conclusion: In this study, we evaluated the healing process of anastomotic leakage after the usage of a handmade vacuum-assisted sponge drain in a case series method. In our trial, we provided an innovative cost-benefit method easily applicable in the operating room.

In the present study microwave (MW), ultraviolet (UV), and vacuum (VC) were applied individually as well as in combination as a non-chemical treatment method to investigate its efficiency in controlling adult stage of R. dominica in rice grains at 14, 16 and 18 % moisture content (MC); 180, 360, 540, 720, and 900W power levels, and for 10- 60 s holding time. The UV and VC levels were kept constant at 365 nm and 382 mm of Hg. Thus, the mortality of R. dominica, using MW, MW+UV, and MW+UV+VC at varying power levels, exposure times, and MC was evaluated along with the changes in the quality characteristics of the treated rice in comparison to the control rice. The mortality (%) of the R. dominica was 90-92 % for MW treatment, 90-100 % for both MW+UV, and MW+UV+VC treatments respectively. The temperature reached was 41℃ to 81℃ for the MW, 42 ℃ to 92 ℃ for the MW+ UV, 33 ℃ to 94 ℃ for the MW+UV+VC treatment at 180-900W respectively. The MC played a significant role in achieving a higher mortality rate of R. dominica in all the treatments (MW, MW+UV, and MW+UV+VC). The results also signified that the combinational approach of MW+UV+VC treatment works much better than the other two approaches (MW and MW+UV treatment) in terms of R. dominica mortality rate (%). Also, MW+UV+VC treatment leads to minimal changes in the quality attributes of the grain due to the additional presence of vacuum during the entire treatment process.

Flail chest is associated with high rates of morbidity and mortality and management of such condition is a multidisciplinary task that should be based on pain control, judicious fluid administration, adequate pulmonary hygiene and management of the paradoxical movements of the thoracic wall. Many methods of treating rib fractures and flail chest have been developed over the years. Our aim was to evaluate a novel method of flail chest stabilization using negative vacuum pressure and compare it to a traditional method. Material and methods: 10 patients with flail chest from trauma admitted in Thoracic Surgery Clinic from Clinical County Emergency Hospital of Craiova and County Emergency Hospital of Targoviste were submitted to stabilization using Vacuum Assisted Closure kit. This series of patients were compared with 10 patients in whom a traditional method of stabilization was used, selected from the database of patients from the Thoracic Surgery Clinic of Clinical Emergency Hospital of Craiova, used as control group. Results: The 2 groups were comparable as no statistically significant differences were found regarding the gender, mean age, type of trauma, associated trauma, preexistent conditions, number of rib fractures, presence of pulmonary contusion, thoracic deformity. The parameters investigated: number of days with mechanical ventilation, number of days spent in ICU, total hospital stay, mortality didn’t reach statistically significant differences. The only significant results found were for the pain scores recorded at 2 weeks and 1 month after discharge, the VAC stabilization being significantly better than traditional method. Conclusions: A larger study is required to establish if the advantages of the VAC assisted stabilization of the flail chest are superior to traditional treatment.

This study aimed to compare the effects of hot water and vacuum blanching methods on physico-chemical parameter, total phenols (TPC) and flavonoids content (TFC), and antioxidant activity of zucchini slices during 28 days storage. A significant decrease in Chroma parameter was observed over time, on the other hand, no significant differences were observed between the Hue angle ​​either between samples treated with the two blanching methods or during storage. A minimal reduction in the TPC was observed in all samples, independently by the applied treatment, compared to the value of untreated product whereas a more marked reduction in TFC compared to untreated zucchini slices was observed (− 39.91% and − 32.02% for vacuum blanched (ZS8) and hot water blanched (ZB8) zucchini treated for 8 min, respectively, respect the untreated zucchini samples at D0). First-order kinetic model was applied to monitor the effect of the two blanching processes on zucchini slices. The application of vacuum blanching allows for greater retention of bioactive compounds over time with a half-life time (t1/2) of 161 and 47 days for ZS8 versus 87 and 23 days for ZB8, respectively. Samples treated with both blanching procedure for 8 min exhibited a more markedly ABTS radical activity respect untreated one (IC50 values of 17.55 and 14.98 μg/mL for ZS8 and ZB8, respectively vs 20.45 μg/mL for untreated zucchini). In general, the results obtained allow to identify in the vacuum treatment a method applicable to zucchini slices to maintain their qualitative characteristics over time.

Application of negative-pressure wound therapy dressings to the web spaces and small, often moist, areas of the hand can be technically demanding and time consuming. The researchers present a case report and technique for managing a devastating hand infection and soft-tissue defects by creating a self-fabricated sponge-glove that is easily reproducible. Vacuum-assisted therapy for combined volar dorsal soft-tissue defects of the hand, or "Hand Vac," is a novel approach for treating extensive hand wounds. This technique was used in a patient with diabetes with a deep space infection of the hand following serial debridements and antibiotic bead therapy. A single, medium size sponge was cut using a knife and scissors to create an easily applied glove that was then sealed with adhesive dressing and a single suction port. The patient avoided complete amputation of the hand and deep infection was eradicated. The wounds had progressive granulation and healing and were eventually covered with split-thickness skin grafts. The authors conclude that severe soft-tissue defects involving both the volar and dorsal aspects of the hand can be effectively managed with a single glove-like sponge and suction port.

To evaluate neonatal and maternal outcomes associated with detachment of non-metal vacuum cup during delivery and to identify risk factors for these detachments. This retrospective cohort study included women with singleton pregnancy, who underwent vacuum-assisted vaginal delivery with a non-metal vacuum cup in a single academic institution, January 2014–August 2019. Failed vacuum deliveries were excluded. Primary outcomes were defined as subgaleal hematoma (SGH) and cord blood pH 3700 g (14.1% vs, 10.3%, p = 0.006). Interestingly, there were more males in that group (60.6 vs. 54.6, p = 0.005). All these factors remained significant after controlling for potential confounders. Vacuum cup detachment has several predictive characteristics and is associated with adverse neonatal outcomes that should be incorporated into decisions made during the procedure.

Purpose Vacuum-assisted deliveries (VAD) are complex procedures that require training and experience to be performed proficiently. We aimed to evaluate if a more resource intensive practice-based training program for conducting VAD is more efficient compared to a purely theory-based training program, with respect to immediate training effects and persistence of skills 4–8 weeks after the initial training. Methods In this randomized-controlled study conducted in maternity staff, participants performed a simulated low-cavity non-rotational vacuum delivery before (baseline test) and immediately after the training (first post-training test) as well as 4–8 weeks thereafter (second post-training test). The study’s primary endpoint was to compare training effectiveness between the two study groups using a validated objective structured assessment of technical skills (OSATS) rating scale. Results Sixty-two participants were randomized to either the theory-based group (n = 31) or the practice-based group (n = 31). Total global and specific OSATS scores, as well as distance of cup application to the flexion point improved significantly from baseline test to the first post-training test in both groups (pall Conclusion A practice-based training program for conducting VAD results in comparable immediate improvement of skills compared to a theory-based training program, but the retention of skills 4–8 weeks after training is superior in a practice-based program. Future studies need to evaluate, whether VAD simulation training improves maternal and neonatal outcome after VAD.

We aimed to evaluate the effect of epidural analgesia (EA) on maternal and neonatal outcomes.We conducted a retrospective cohort database study on primiparous women who underwent a vacuum-assisted delivery (VAD) trial between 2005 and 2019 at a university-affiliated tertiary medical center. We compared women with and without the standard "one protocol" patient-controlled EA. The primary outcome was VAD failure. Secondary outcomes were maternal and neonatal morbidities. We performed univariate analysis, followed by multivariable logistic regression analysis to control for potential confounders. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated.Overall, 7042 primiparous women attempted VAD during the study period; 6238 (88.3%) and 804 (11.7%) women used and did not use EA, respectively. The VAD failure rate was significantly lower among women with than without EA use (2.5%EA use in primiparous women is associated with lower rates of VAD failure without an increase in adverse maternal or neonatal outcomes.

Vacuum-assisted abdominal closure (VAAC) has evolved as a promising method for treatment of emergent surgical patients. The aim of the study was an assessment of the complication rate and outcomes following routine application of VAAC in a cohort of patients suffering predominantly with peritonitis of the lower gastrointestinal tract (GIT) origin. The prospectively collected data was analysed retrospectively, including demographic data, aetiological factors, comorbid conditions and severity of the disease. The indications for VAAC included complicated intra-abdominal infection, purulent peritonitis with sepsis and/or risk of increased intra-abdominal pressure. In total, 130 patients were managed with VAAC. The median age was 63.5 years, with a predominance of male patients (61.5%). Systemic inflammatory response was present in 68.5%, the median C-reactive protein (CRP) was 239.58 mg/l, Procalcitonin (PCT) level 7.02 ng/ml, and lactate 1.84 mmol/l before intervention. The median Sequential Organ Failure Assessment (SOFA) score was 4 and the Mannheim Peritonitis Index was 26. Sepsis developed in 87.0% of patients, and 43.8% had septic shock. VAAC was applied in 58.5% due to a perforation of the lower GIT, in 26.1% due to perforation of the upper GIT, and in 15.4% for other reasons. A median of two (interquartile range, IQR 1–3) VAAC system changes were performed in a period of 7 (IQR 4–11) days. In 88.6% of cases, multiple types of microorganisms were present. The application of VAAC resulted in a significant decrease of the postoperative SOFA score, and CRP, PCT and lactate levels (p < 0.001). The complications included a “frozen abdomen”, enterocutaneous fistula, intraabdominal abscess and bleeding in 7.7%, 5.4% and 6.0% cases, respectively. Primary abdominal closure was accomplished in 76.2%, resulting in a 23.1% mortality rate. VAAC was found to be safe in the treatment of abdominal sepsis including in patients with faecal peritonitis. Complete abdominal closure can be achieved in the majority of patients resulting in a lower mortality rate.

Retained soft tissue foreign bodies following injuries are frequently seen in the Emergency and Plastic Surgery practice. The patients with such presentations require a watchful and detailed clinical assessment to overcome the anticipant possibility of missing them. However, the diagnosis based on the clinical evaluation is usually challenging and needs to be supported by imaging modalities that are suboptimal and may fail in identifying some types of foreign bodies. Owing to that, serious complications such as chronic pain, infection, and delayed wound healing can be faced that necessitate a prompt intervention to halt those detrimental consequences. The classical method of removal is a surgical exploration which is not free of risks. It can cause injuries to vital structures such as nerves and tendons if the foreign body is close to them, also it can be affected by the surgeon's experience and the foreign body's characteristics. In light of that, we conducted a single-center study to understand the utility of a novel vacuum-assisted technique for foreign body removal. The technique is noninvasive and facilitates a real-time foreign body extraction using readily available materials. Twenty patients with 23 Foreign Bodies of various kinds, shapes, and sizes were recruited in our study by using a nonprobability convenient sampling method. Results demonstrated the ability of the described technique to extract 22 of them with no noticeable side effects. This study may encourage further trials adopting similar principles to promote the management of retained foreign bodies with fewer complications, and a potential of time and cost-saving.

Objectives To determine the association between the number of pulls during vacuum-assisted deliver and neonatal and maternal complications. Methods This was a single-center observational study using a cohort of pregnancies who underwent vacuum-assisted delivery from 2013 to 2020. We excluded pregnancies transitioning to cesarean section after a failed attempt at vacuum-assisted delivery. The number of pulls to deliver the neonate was categorized into 1, 2, 3, and ≥4 pulls. We used logistic regression models to investigate the association between the number of pulls and neonatal intensive care unit (NICU) admission and maternal composite outcome (severe perineal laceration, cervical laceration, transfusion, and postpartum hemorrhage ≥500 mL). Results We extracted 480 vacuum-assisted deliveries among 7,321 vaginal deliveries. The proportion of pregnancies receiving 1, 2, 3, or ≥4 pulls were 51.9, 28.3, 10.8, and 9.0%, respectively. The crude prevalence of NICU admission with 1, 2, 3, and ≥4 pulls were 10.8, 16.2, 15.4, and 27.9%, respectively. The prevalence of NICU admission, amount of postpartum hemorrhage, and postpartum hemorrhage ≥500 mL were significantly different between the four groups. Multivariable logistic regression analysis found the prevalence of NICU admission in the ≥4 pulls group was significantly higher compared with the 1 pull group (adjusted odds ratio, 3.3; 95% confidence interval, 1.4–7.8). In contrast, maternal complications were not significantly associated with the number of pulls. Conclusions Vacuum-assisted delivery with four or more pulls was significantly associated with an increased risk of NICU admission. However, the number of pulls was not associated with maternal complications.

Background Low and mid station vacuum assisted deliveries (VAD) are delicate manual procedures that entail a high degree of subjectivity from the operator and are associated with adverse neonatal outcome. Little has been done to improve the procedure, including the technical development, traction force and the possibility of objective documentation. We aimed to explore if a digital handle with instant haptic feedback on traction force would reduce the neonatal risk during low or mid station VAD. Methods A two centre, randomised superiority trial at Karolinska University Hospital, Sweden, 2016–2018. Cases were randomised bedside to either a conventional or a digital handle attached to a Bird metal cup (50 mm, 80 kPa). The digital handle measured applied force including an instant notification by vibration when high levels of traction force were predicted according to a predefined algorithm. Primary outcome was a composite of hypoxic ischaemic encephalopathy, intracranial haemorrhage, seizures, death and/or subgaleal hematoma. Three hundred eighty low and mid VAD in each group were estimated to decrease primary outcome from six to 2 %. Results After 2 years, an interim analyse was undertaken. Meeting the inclusion criteria, 567 vacuum extractions were randomized to the use of a digital handle (n = 296) or a conventional handle (n = 271). Primary outcome did not differ between the two groups: (2.7% digital handle vs 2.6% conventional handle). The incidence of primary outcome differed significantly between the two delivery wards (4% vs 0.9%, p Conclusions The incidence of primary outcome was lower than estimated and the study was underpowered. However, the difference between the two delivery wards might reflect varying degree of experience of the technical equipment. An objective documentation of the extraction procedure is an attractive alternative in respect to safety and clinical training. To demonstrate improved safety, a multicentre study is required to reach an adequate cohort. This was beyond the scope of the study. Trial registration ClinicalTrials.gov NCT03071783, March 1, 2017, retrospectively registered.

In a surgical ward, acute and continual wounds have an effect on a minimal of 1% of the population. Vacuum-assisted wound closure (VAC) is a technique of Negative pressure in the wound to improve the healing process. To study the advantage of a vacuum assisted closure over conventional dressing in the management of chronic non-healing diabetic ulcers. To study the difference in the rate of amputation, hospital stays in case and control groups. Group1-case group – vacuum associated closure therapy. Group 2-Control group -conventional dressings. Most of the patients in the study population was in the age group of 41 -60 years. 82% of the study population was within the age group of 41-60 years. The two groups are comparable with their baseline characteristic of age, and the P-value is less than 0.05. Wounds were more common in males than females. Out of the 44 patients, 26 were male, i.e. 57% of the study population were males. About 68% of wounds occurred in the foot. About 50% of the culture showed staphylococcus. Nearly 27% of study participants had no growth. The hospital stay is less in VAC dressing when compared to the conventional dressings, who have an average hospital stay of 28 days and the relation is statistically significant (p-value

Introduction: Vacuum assisted venous drainage (VAVD) requires the sealing of the hard-shell venous reservoir, thereby creating circumstances where reservoir pressurization may occur. Manufacturers utilize integrated pressure relief valves (IPRV) to mitigate pressurization risk; however, accidents have been reported even with these devices. We have undertaken a performance evaluation of IPRV’s in a large number of hard-shell venous reservoirs. Methods: Reservoirs were sealed and gas insufflated while measuring reservoir internal pressure. Linear regression models were developed to depict the association between internal pressure and gas inflow rate. External secondary one-way valves (ESOV) were assessed for pressure mitigation performance. An assisted venous drainage survey was circulated to Canadian Clinical Perfusionists. Results: The reservoirs tested were adult ( n = 9, 64%) and pediatric ( n = 5, 36%) designs. Significant variability ( p Conclusions: Significant variability among reservoir’s IPRV to mitigate reservoir pressurization exists. The predictive models are extremely accurate at estimating the internal pressure. ESOV performance limitations moderate their utility as a backup pressure mitigation technique. A significant number of reservoir pressurization events are occurring with the use of VAVD. As a result, standardized communication from manufacturers on the purpose and performance of IPRV is recommended in order to delineate the limitations of these devices.

This study evaluated whether episiotomy during vacuum-assisted delivery leads to fewer third- and fourth-degree tears. This was a retrospective cohort study of all nulliparas who underwent a singleton, soft cup, vacuum-assisted vaginal delivery in one institution, from January 2014 to August 2019. Failed vacuum deliveries were excluded. Based on power analysis calculation, a sample size of 500 women in each group was sufficient to detect an advantage of episiotomy, if present. Primary outcome was third- or fourth-degree perineal tear. Secondary outcomes were other maternal complications, and low neonatal cord pH and Apgar scores. Outcomes were compared between women with and without episiotomy. During the study period, 2370 nulliparas had a vacuum-assisted vaginal delivery using soft vacuum cup and met the study inclusion criteria. Episiotomy was performed in 1868 (79%) women, and 502 (21%) delivered without episiotomy. Background characteristics were similar in both groups. There were no significant differences in the rates of third and fourth grade perineal lacerations between the two groups. Episiotomy was associated with higher rate of postpartum hemorrhage (p

Complications during childbirth result in the need for clinicians to use ‘assisted delivery’ in over 12% of cases (UK). After more than 50 years in clinical practice, vacuum assisted delivery (VAD) devices remain a mainstay in physically assisting child delivery; sometimes preferred over forceps due to their ease of use and reduced maternal morbidity. Despite their popularity and enduring track-record, VAD devices have shown little evidence of innovation or design change since their inception. In addition, evidence on the safety and functionality of VAD devices remains limited but does present opportunities for improvements to reduce adverse clinical outcomes. Consequently in this review we examine the literature and patent landscape surrounding VAD biomechanics, design evolution and performance from an engineering perspective, aiming to collate the limited but valuable information from a disparate field and provide a series of recommendations to inform future research into improved, safer, VAD systems.

In this article, bamboo nonwoven fabric (BF) is introduced as reinforcement into the vinyl ester (VE) matrix for the manufacturing of BF/VE composites through Vacuum Assisted Resin Transfer Mold pr...

Purpose To describe the vacuum-assisted mini-percutaneous nephrolithotomy (vmPCNL) technique performed via the 16Ch ClearPetra sheath, to evaluate its outcomes and to analyze intrarenal pressure (IRP) fluctuations during surgery. Methods Data from all consecutive vmPCNL procedures from September 2017 to October 2019 were prospectively collected. Data included patients’ and stones characteristics, intra and peri-operative items, post-operative complications and stone clearance. Patients undergoing vmPCNL from March to October 2019 were submitted to IRP measurement during surgery. Results A total of 122 vmPCNL procedures were performed. Median stone volume was 1.92 cm3. Median operative time was 90 min and median lithotripsy and lapaxy time was 28 min. Stone clearance rate was 71.3%. Thirty-one (25.2%) patients experienced post-operative complications, seven of which were Clavien 3. Postoperative fever occurred in nine (7.4%) patients and one (0.8%) needed a transfusion. No sepsis were observed. IRPs were measured in 22 procedures. Mean IRP was 15.3 cmH2O and median accumulative time with IRP > 40.78 cmH2O (pyelovenous backflow threshold) was 28.52 sec. Maximum IRP peaks were reached during the surgical steps when aspiration is closed (mainly pyelograms), whereas during lithotripsy and suction-mediated lapaxy, the threshold of 40.78 cmH2O was overcome in three procedures. Conclusions vmPCNL is a safe procedure with satisfactory stone clearance rates. Mean IRP was always lower than the threshold of pyelo-venous backflow and the accumulative time with IRP over this limit was short in most of the procedures. During lithotripsy and vacuum-mediated lapaxy, IRP rarely raised over the threshold.

Purpose Despite paucity of data, there exists growing popularity of catheter-based extraction methods for intravascular thrombi and vegetations. We describe a large single center experience with vacuum-assisted extraction techniques (VAET) for right-sided intravascular and cardiac masses. Methods We retrospectively reviewed the perioperative course of patients undergoing VAET between 2014 and 2019. Primary outcomes were survival and freedom from recurrent bacteremia. Procedural success was a composite definition of survival, majority of mass extraction, absence of recurrent bacteremia, and valve function not requiring further intervention during index hospitalization. Results Of the entire cohort (n = 58), 48% and 52% underwent VAET for vegetations and sterile thrombi, respectively. Of those with positive cultures, the most common organism isolated was Staphylococcus aureus (48%). Preoperative active bacteremia was present in 36% (21/58) and of these patients, 76% (16/21) had neither recurrent nor persistent bacteremia post-op. The majority of masses (67%, 38/58) were debulked with an average reduction in size of 42%. Conversion to open surgery occurred in 3.5% (2/58). Intraoperative and 30-day survival were 98% (57/58) and 90% (28/31), respectively. Overall success was 86% (50/58). The prevalence of moderate/severe tricuspid regurgitation was 37% pre-op and 61% post-op. Average length of intensive care unit and overall hospital stay was 5.6 and 16 days, respectively. Conclusions In this single center experience, VAET was conducted safely with a high degree of success and freedom from short-term recurrent bacteremia. This minimally invasive procedure is an attractive alternative to traditional open techniques for removal of right-sided intravascular and cardiac masses.

Background Surgical embolectomy and thrombolytic therapy are two common approaches for the treatment of large intra-cardiac or intravascular thrombi to prevent new or worsening pulmonary embolism (PE). Considering high operative mortality with surgical embolectomy and high bleeding risk with thrombolytic therapy, patients who are poor candidates for these treatments may benefit from percutaneous aspiration thrombectomy/Vacuum-assisted thrombectomy (VAT). AngioVac aspiration system was granted 510(k) clearance by the United States Food and Drug Administration (FDA) in April 2009. We present a case series to describe its use and outcomes in evacuating large caval thrombi or intracardiac masses. Methods We did a retrospective analysis of AngioVac catheter based thrombectomy in 16 consecutive patients treated between January 2016 and January 2019 to report case characteristics and in-hospital clinical outcomes. Results Sixteen patients (mean age 48) underwent 16 AngioVac procedures over 48 months. Indications included intracardiac mass (68.8%), caval thrombus (56.3%), and catheter associated thrombus (43.8%). 7 (43.8%) patients had concurrent PE. Peri-procedure mortality was 0% and in-hospital mortality was 12.5% at a mean follow-up of 14 days. There were no pulmonary hemorrhages, strokes or myocardial infarctions. 62.5% had a significant drop in hemoglobin, which required a blood transfusion but there was no episode of overt bleeding. Conclusion The AngioVac aspiration system has been shown to be effective at aspirating large volumes of intravascular and intracardiac thrombus. It is a reasonable alternative to surgical thrombectomy in patients with large central thrombi or masses in-transit who are at risk of complicated PE.

Objective:Cesarean section or operative vaginal delivery can be performed in the second stage of labor. The aim of our study was to compare cesarean deliveries performed in the second stage of labor and vacuum assisted vaginal deliveries in terms of maternal and neonatal outcomes.Methods:Between January 2017 and January 2018, the patients who delivered by cesarean section in the second stage of labor and vacuum assisted vaginal deliveries were retrospectively evaluated. Neonatal and maternal outcome parameters were compared between the two groups.Results:A total of 113 patients, 53 patients in the vacuum delivery group and 60 patients in the cesarean section group, were included in the study. There was no difference between the groups in terms of maternal adverse outcomes. In terms of neonatal outcomes, umbilical cord pH was lower in the vacuum assisted delivery group (p=0.026).Conclusion:Since maternal and neonatal complications are similar, operative vaginal delivery may be considered as an alternative mode of delivery in the second stage of delivery in the appropriate patient group.

Objective: To assess the safety and efficacy of a novel vacuum-assisted access sheath (VAAS) in minimally invasive percutaneous nephrolithotomy (MPCNL). Materials and Methods: Seventy-five consecut...

Purpose To evaluate the value of ultrasound (US)-guided vacuum-assisted excisional biopsy (VAB) in treating benign phyllodes tumors (PTs) of the breasts and to investigate the lesion characteristics that could affect the local recurrence rate. Patient and Methods From December 2008 to February 2018, 93 patients with PTs diagnosed on histology underwent US-guided, 7-gauge VAB. The recurrence rate of benign PT and complications of VAB were evaluated on follow-up US every three to six months. The lesion characteristics were analyzed to identify the factors affecting the recurrence rate. Results Of the 87 patients, local recurrence was found in 15 patients (17%) in a mean follow-up period of 35.8 months, and the rate of complete excision was 82.8% (72/87). PTs with a largest diameter less than 3.3 cm had a significantly lower recurrence rate than PTs with a largest diameter larger than 3.3 cm (P Conclusions In conclusion, US-guided VAB is an effective method to treat benign PT, especially in lesions with a diameter less than 3.3 cm.

Active drains, which work by negative pressure, are commonly used to drain closed airtight wounds. Higher negative pressure is used in vacuum-assisted wound closure dressings. Gastrointestinal leaks may be difficult to treat by surgical approach because of their association with high morbidity and mortality. Recently, endoscopic approaches have been applied with several degrees of success. Most recently, endoluminal vacuum-assisted wound closure (EVAC) has been employed with high success rates in decreasing both morbidity and mortality. In the present paper, the authors describe the successful use of Endo-SPONGE (B. Braun Medical B.V.) EVAC system therapy to drain an open rectal wound, following a perforation occurred during stapled hemorrhoidectomy.

Purpose: This study aims to compare the feasibility of VAE and BLES in the treatment of intraductal papillomas. Material and methods: Patients with a suspected intraductal papilloma who underwent a BLES or a VAE procedure were included in this retrospective study. The BLES procedures were performed between November 2011 and June 2016 and the VAE procedures between May 2018 and September 2020 at the Department of Radiology of Helsinki University Hospital (HUH). The procedures were performed with an intent of complete removal of the lesions. Results: In total, 72 patients underwent 78 BLES procedures and 95 patients underwent 99 VAE procedures. Altogether 52 (60%) papillomas with or without atypia were completely removed with VAE, whereas 24 (46%) were completely removed with BLES, p = 0.115. The median radiological size of the high-risk lesions completely removed with BLES was 6 mm (4-12 mm), whereas with VAE it was 8 mm (3-22 mm), p = 0.016. Surgery was omitted in 90 (94.7%) non-malignant breast lesions treated with VAE and in 66 (90.4%) treated with BLES, p = 0.368. Conclusion: Both VAE and BLES were feasible in the treatment of intraductal papillomas. In most non-malignant lesions surgery was avoided, but VAE was feasible in larger lesions than BLES. However, follow-up ultrasound was needed more often after VAE. The histopathologic assessment is more reliable after BLES, as the lesion is removed as a single sample. (C) 2021 The Authors. Published by Elsevier Ltd.

The nature of reparative and morphological changes in wounds was examined against the background of vacuum therapy in the comprehensive treatment of purulent and necrotic lesions of diabetic foot syndrome. We conducted comprehensive examination and treatment of 107 patients with DFS of grade II-IV according to Meggit-Wagner. The average age of patients was 53.2–4.3 years; there were 39 (36.4%) male and 68 (63.6%) female patients. Depending on the methods of topical treatment, patients were divided into two groups. The main group consisted of 55 (51.4%) subjects who underwent vacuum therapy during the topical treatment, and the comparison group comprised 52 (48.6%) patients who received standardized local treatment depending on the course of the wound process. In addition to the clinical studies, all patients underwent a comprehensive laboratory and instrumental examination, as well as measuring the area and pH of wounds on the 1st, 4th, 7th, 10th and 13th day after surgery. The analysis of the obtained results gives ground to establish that at a certain level of pH, there is a corresponding cytological pattern. The wide range of fluctuations in the pH of the wound medium in patients with purulent and necrotic lesions of diabetic foot syndrome leads to corresponding changes in cells, which is manifested by a long-lasting inflammatory process. In the main group, the rate of wound reduction was greatest on the 8th-10th days, and in the comparison group – on the 14th-15th days. Inpatient treatment was 14.2 bed-days in the main group and 23.5 ± 2.9 in the comparison group (p

An axillary breast is a common condition, which can cause various diseases arising from the breast tissue. Among these diseases, phyllodes tumors are very rare fibroepithelial tumors, which resemble fibroadenomas. Surgical removal is the treatment of choice for phyllodes tumors to prevent recurrence. Inpatient treatment and general anesthesia are required for surgical removal, and fibrosis, skin scarring, and neurological symptoms may occur after surgery. Ultrasound-guided vacuum-assisted excision, because of its advantages, is an alternative to surgical excision for clinically benign breast masses. Therefore, in cases of clinically benign or concordant benign lesions, following a core needle biopsy, ultrasound-guided vacuum-assisted excision can be considered with sufficient preoperative measures and close follow-up of the ectopic axillary breast.

Background: The vacuum-assisted system in wound closure (VAC) is a new modality, which is recently used widely as a treatment of severely infected wounds. It is a noninvasive way that improves healing of severely infected wounds that fail to respond to conventional ways of treatment. This type of treatment depends on applying air tight controlled negative pressure suction directly to the infected wounds. The mechanism of action of this treatment depends on allowing the growth of healthy granulation tissues of the infected wounds. Objective: To evaluate the effect of vacuum assisted suction in treatment of deep sternal wound infection after cardiac surgery. Patients and Methods: In Cairo University Hospitals, in the period between January 2018 and January 2019, 17 patients (6 men, 11 women) with a median age of 62.5 years (range 50 to 75 years) underwent open heart surgery, which was complicated by sternal dehiscence and deep sternal wound infection. All those patients were subjected to the VAC system before any surgical intervention. Results: All patients involved in this study had complete wound healing without need of any major surgical intervention (muscle or omental flaps) even without wound debridement. The VAC system was applied for a mean of 21.5 days (range 15 to 28 days), VAC system was removed when the wound became completely clean with healthy granulation tissues. After removal of the VAC system, 9 patients (52.9%) were subjected to closure of the skin and subcutaneous tissues by interrupted stitches while the remaining 8 patients (47.1%) the wound was completely closed in all layers up to the skin. Duration of hospital stay varied from 22 to 45 days (median 33.5 days). There were no mortalities among all the patients who were involved in this study. Conclusion: The VAC system is a noninvasive, safe and very effective as a treatment for deep sternal wound infections following cardiac surgery.

Purpose To perform a cost analysis between vacuum-assisted percutaneous nephrolithotomy (vmPCNL) and minimally invasive PCNL (MIP) and explore potential predictors of costs associated with the procedures. Methods We analyzed data from 225 patients who underwent vmPCNL or MIP at a single tertiary referral academic center between January 2016 and December 2020. We collected patients’ demographics, peri-and postoperative data and detailed expense records. After propensity score matching, 108 (66.7%) vmPCNL and 54 (33.3%) MIP procedures were analyzed. Descriptive statistics assessed differences in clinical and operative parameters. Univariable and multivariable linear regression models tested the association between clinical variables and costs. Results Operative time (OT) was shorter for vmPCNL, and the use of additional instruments to complete litholapaxy was more frequent in MIP (all p ≤ 0.01). Length of stay (LOS) was longer for MIP patients (p = 0.03) and the stone-free (SF) rate was higher after vmPCNL (p = 0.04). The overall instrumentation cost was higher for vmPCNL (p p = 0.9). However, the overall cost for the hospitalization was higher for MIP than vmPCNL (p = 0.01). Univariable linear regression revealed that patient’s comorbidities, OT, any postoperative complication and LOS were associated with hospitalization costs (all p p Conclusion vmPCNL may represent a valid option due to clinical and economic benefits. Shorter OT, the lower need for disposable equipment and the lower complication rate reduced procedural and hospitalization costs.

Objective:To assess the benefits of negative pressure wound therapy (NPWT) in complex therapy of patients with enterocuta‑ neous fistulas.Methods: From 2014 to 2019 in Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, 24 patients were managed with vacuum assisted techniques. For comparison, a comparable group of 23 observations (control) was formed retrospectively based on an analysis of medical records.Results: When using NPWT, the terms of wound cleansing and the formation of a laparostomy were reduced, and conditions were created for its early closure. With a small laparostomy, the use of NPWT contributed to self-epithelialization of the wound around the fistula.Conclusions: The use of NPWT more than halves the time of formation of a laparostomy, shortens the time for cleansing the wound and creates the conditions for its closure. Surgical tactics using NPWT can more than three times reduce the number of local complications in patients with unformed intestinal fistulas and less often change the combination of antibacterial drugs.

An acute epidural hematoma (AEDH) has been reported to occur as a serious morbidity in association with a vacuum-assisted delivery. We experienced a neonate case with an AEDH who was delivered by emergency cesarean section after an attempted vacuum extraction procedure. Magnetic resonance imaging suggested a liquefied hematoma of fluid-fluid levels, with enlargement to a maximum thickness of 18 mm and lateral ventricular compression. Absence of symptoms indicating increased intracranial pressure, such as a tense anterior fontanelle, increased head circumference, seizure, and apnea, led to successful conservative therapy. Less-invasive treatment options and conservative management to avoid a craniotomy for an AEDH occurring in neonates are also discussed.

Failed vacuum-assisted delivery (VD) is associated with increased risk of maternal perineal trauma and neonatal morbidity. Knowledge of the risk factors related to failed VD is essential in the clinical decision-making.To elucidate the strength of association and the predictive accuracy of different ante-partum ultrasound parameters in predicting the risk of failed VD prior to the onset of Labor and to test the diagnostic performance of a multiparametric model including pregnancy and Labor characteristics, ante and intra-partum ultrasound in anticipating failed VD.Prospective study of consecutive singleton pregnancies complicated by VD undergoing a dedicated ultrasound assessment at 36-38 weeks of gestation. Head circumference (HC), estimated fetal weight (EFW) and subpubic angle and (SPA) were recorded before the onset of Labor. At the time of the VD, occiput position, head perineum distance (HPD) and angle of progression (AOP) were also recorded. Multivariate logistic regression and area under the curve (AUC) analyses were used to explore the strength of association and test the diagnostic accuracy of different maternal, Labor and ultrasound characteristics in predicting g failed VD.Four hundred eight pregnancies with successful and 26 with failed VD were included in the analysis. Fetuses experiencing failed VD had a larger HC (1.21 versus 1.07 MoM;Antepartum prediction of failed VD is feasible. HC, SPA but not EFW are independently associated and predictive of failed VD. Adding these variables to a multiparametric model including maternal and intrapartum ultrasound parameters improves the diagnostic accuracy for failed VD.

Objectives and background: Tissue stabilized-guided subcision (TS-GS) treatment has emerged as a single session treatment for cellulite dimples. To date, studies on a few patients were reported. We...

Introduction The vacuum-assisted drainage has many applications in managing complex wound healing. It quickens the recovery period by its hyperemic effect on the exposed zone, decreasing bacterial colonization, preventing tissue edema, and promoting granulation of the wound. However, its use in anastomotic leak after IPAA is scarcely studied, especially because a proprietary endoluminal vacuum-assisted closure system was removed from the US market. Technique We applied a hand-crafted endoluminal vacuum-assisted closure system using the existing standard wound vacuum-assisted closure supplies to 2 patients who developed an anastomotic leak with a presacral abscess after completion proctectomy with J-pouch construction. Results We changed the endoluminal vacuum-assisted closure drain every 2 to 3 days, and both patients had substantial improvements in their abscess cavity after the seventh and ninth applications. Conclusions Anastomotic leak at the IPAA traditionally takes up to a year to heal, which causes a significant toll on the psychosocial life of the patient and delayed stoma closure. Therefore, we believe that facilitating the healing process by using our hand-crafted endoluminal vacuum-assisted closure drain might provide a great value to patients' quality of life.

Purpose of the study. Improve treatment results of patients with abdominal sepsis, due to the diffuse acute secondary peritonitis, by choosing of the optimal method of laparostomy. Materials and methods. The analysis of treatment of 35 patients with common secondary peritonitis and abdominal sepsis accompanied by septic shock with score of the Mannheim Peritonitis Index 29, which were treated by laparostomy, during the period from 2014 to 2019, was performed. The patients were divided into 2 groups. The treatment group consists of 17 patients who were treated by negative pressure therapy (NPT) – a technique of vacuum-assisted closure of theabdominalcavity(VAC) withanegativepressure levels from 50 to 125 mm Hg in the continuous or intermittent modes. The control group consists of 18 patients, who were treated by laparostomy with planned abdominal sanations, with intervals between sanations of 24, 36, 48 hours, depending on the degree of development of peritonitis and the condition of the patient (as needed). Results. The average length of hospital stay in ICU department was 11,3 days in treatment group (from 5,2 to 16,4 days), compared with the control group 22,9 days (from 3,4 to 47,4 days). The number of relaparotomies during which the replacing or removing of VAC-bandages was performed at the end of NTP was 3,8 (from 1 to 4) in the treatment group and 6,8 (from 3 to 11) in the control group. Adequate source control of abdominal sepsis was achieved in all operated patients of the treatment group, and in the control group only in 7 patients (38,9%). The overall mortality rate in both groups was 20%. In the treatment group, which were treated by applying NTP 2 patients were died (11,8%) while in the control group this count was 27,8% (7 patients). Conclusion. The experience of applying NTP and VAC-bandages in the complex treatment of abdominal sepsis, with values of the SOFA 3, shows better results in comparison with other methods of open abdomen, reducing the length of stay in the ICU by 2 times, the mortality rate is 3 times and this allows to complete treatment with final closure of the abdominal cavity more than in 50% of patients.

Background: Vacuum-assisted venous drainage has gained widespread use within the pediatric perfusion community for use during cardiopulmonary bypass. It is questioned whether its efficiency may be compromised with application of excessive cardiotomy suction to the infant hard-shell venous reservoir. An in vitro simulation circuit was used to research this phenomenon. A comparison of three different infant hard-shell venous reservoirs also took place to determine if one reservoir type was more advantageous when handling cardiotomy suction. The reservoirs tested were the Maquet VHK 11000, Medtronic Affinity Pixie, and Terumo Capiox FX05. Methods: The in vitro simulation circuit consisted of a 1 L reservoir bag that was cannulated at one access point with an Edwards Lifesciences 10Fr aortic cannula and the other access area with an Edwards Lifesciences 10Fr right angle venous cannula and 12Fr right angle venous cannula that were joined together. Key points of measurement and response variables were the pressures on the connection of the venous cannulas, inlet of the venous reservoir, and flow through the venous line. Vacuum was applied and manipulated with a Maquet VAVD Controller to settings of −20 mmHg, −30 mmHg, –40 mmHg, −50 mmHg, and −60 mmHg. Cardiotomy suction was added at settings of 1 LPM, 2 LPM, 3 LPM, and 4 LPM. Values from each response variable were monitored and recorded. These data were utilized to compare the reservoirs with a random coefficient model for each response variable. Conclusions: There is an adverse effect of excessive cardiotomy suction on the efficacy of vacuum-assisted venous drainage in infant hard-shell venous reservoirs. There is no significant difference between the VHK 11000, Pixie, and FX05 regarding their ability to handle this occurrence. An important discovery was that the FX05 showed a greater transfer of vacuum to the venous cannulas and reservoir inlet.

To perform a systematic review of reports in which the AngioVac™ percutaneous vacuum-assisted aspiration system was successfully used to debulk or remove vegetations prior to percutaneous lead extraction. We included all studies and case reports that used a percutaneous aspiration technique for vegetation removal or debulking with percutaneous lead extraction for patients with lead-associated endocarditis. Ten reports and retrospective data from our centers were used, which included a total of 88 patients and 205 leads. The percutaneous aspiration procedure was completely or partially successful in 86 patients (97.7%). The lead extraction procedure itself was successful in 87 patients (98.9%). The aspiration procedure and lead extraction were done concomitantly in 81 patients (92.0%). Four patients (4.5%) had major complications (two due to vascular injuries, one due to coronary sinus injury, and one due to tricuspid valve injury). There were no complications from the aspiration procedure, and no cases were associated with procedure-related mortality. While patients with large vegetations have historically been referred for surgical lead extraction, data are lacking in its techniques and outcomes. Existing data suggest that percutaneous vacuum-assisted aspiration for vegetation removal or debulking in endocarditis prior to or concurrent with percutaneous lead extraction has a high success rate with a low complication rate across a broad series of patients.

Introduction: Pelvic exenteration is a highly invasive procedure, with a reported rate of 20%–80% for serious complications. Thus, the prevention of postoperative complications is a major issue. Many previous reports have emphasized the importance of filling the dead space to prevent postoperative complications. In addition to filling the dead space, we believe that achieving sufficient drainage is extremely important. In this paper, we present a new combined method of the extended rectus abdominis myocutaneous flap and vacuum drainage with multiple drains, which achieved a lower frequency of complications. Case Presentation: The subjects were 6 patients who underwent reconstruction following pelvic exenteration during a 7-year period between April 2005 and September 2013. We retrospectively measured the volume of the pelvic cavity and that of the rectus abdominis flap on lateral computed tomography (CT) scans to calculate the percentage of the dead space that was filled by the flap. There were no problems with flap engraftment in any of the patients. There were no serious complications, and no patient required additional surgery. The percentage of the dead space filled ranged from 25% to 46% (mean: 32%). Conclusion: The rectus flap + vacuum drainage method, which uses an extended rectus abdominis myocutaneous flap to decrease the pelvic dead space and multiple vacuum suction drains, was associated with the prevention of serious complications.

Endoluminal vacuum therapy (EVAC) is an emerging procedure used to treat anastomotic leaks and/or perforations that would otherwise require surgery. The aim of this study was to determine time to proficiency in EVAC and the cost effectiveness of the procedure. We retrospectively reviewed a prospectively maintained IRB approved database for all patients undergoing EVAC after esophageal and gastric complications between October 2013 and December 2017. Proficiency was determined by obtaining predicted estimates and analyzing the point at which average procedure time plateaued based on case volume. Total cost was calculated based on supplies and location where the procedure was performed. There were 50 patients (17 males, 33 female), with a mean age of 52.1 years. EVAC was placed in 23 (46%) patients with esophageal injuries and 28 (56%) with gastric injuries. Two advanced endoscopists performed all EVAC procedures in this study (1 surgeon, 1 gastroenterologist). The average procedure time for all patients was 43.5 min and the average wheel in/wheel out time for all patients was 75.6 min. Analysis of the trend based on average procedure times for EVAC revealed that proficiency was obtained after 10 cases. Total cost of the procedure is significantly lower in the GI lab compared to the operating room ($4528 vs. $11889). The majority of EVAC were performed in the GI lab (62%) compared to the operating room (38%). Successful outcomes in managing anastomotic leaks or intestinal perforations non-operatively has led to an increased interest in EVAC. For advanced endoscopists, time to proficiency is approximately 10 cases. Performing the procedure in the GI lab has a 2.5 reduction in total cost compared to the operating room.

Objective: Our purpose was to evaluate the impact of active delivery of the anterior arm with Couder’s Maneuver (CM) during vacuum-assisted vaginal delivery (VAVD) on perineal tears. This maneuver ...

The purpose of this study was to evaluate the hemodynamic properties and microemboli capture associated with different vacuum-assisted venous drainage (VAVD) vacuum levels and venous reservoir levels in a neonatal cardiopulmonary bypass circuit. Trials were conducted in 2 parallel circuits to compare the performance of Capiox Baby RX05 oxygenator with separate AF02 arterial filter to Capiox FX05 oxygenator with integrated arterial filter. Arterial cannula flow rate to the patient was held at 500 mL/min and temperature maintained at 32°C, while VAVD vacuum levels (0 mm Hg, -15 mm Hg, -30 mm Hg, -45 mm Hg, -60 mm Hg) and venous reservoir levels (50 mL, 200 mL) were evaluated in both oxygenators. Hemodynamic parameters measuring flow, pressure, and total hemodynamic energy were made in real time using a custom-made data acquisition system and Labview software. Nearly 10 cc bolus of air was injected into the venous line and gaseous microemboli detected using an Emboli Detection and Classification Quantifier. Diverted blood flow via the arterial filter's purge line and mean pressures increased with increasing VAVD levels (P < 0.01). Mean pressures were lower with lower venous reservoir levels and were greater in RX05 groups compared to FX05 (P < 0.01). Microemboli detected at the preoxygenator site increased with higher VAVD vacuum levels and lower venous reservoir levels (P < 0.01). The amount of microemboli captured by the FX05 oxygenator with integrated arterial filter was greater than by the RX05 oxygenator alone, although both oxygenators were able to clear microemboli before reaching the pseudo-patient.

Background Endoluminal vacuum-assisted therapy (EVT) has been introduced recently to treat colorectal anastomotic leakage. The aim of this study was to evaluate the safety and efficacy of EVT in the treatment of anastomotic leakage and rectal stump insufficiency after Hartmann's procedure. Methods A systematic search of MEDLINE, Scopus and Cochrane databases was performed using search terms related to EVT and anastomotic leakage or rectal stump insufficiency in line with the PRISMA checklist. Observational studies, RCTs and case series studies published to July 2017 were included. Primary outcomes of the review were the success of EVT, defined as complete or partial healing of the anastomotic defect and associated cavity, and the rate of stoma reversal after EVT. Secondary outcomes included the duration of treatment to complete healing, complications of treatment and the need for further intervention. A meta-analysis was conducted. The potential effect of clinical confounders on the failure of EVT was investigated using the random-effects meta-regression model. Results Of 476 articles identified, 17 studies reporting on 276 patients were ultimately included. The weighted mean rate of success was 85·3 (95 per cent c.i. 80·1 to 90·5) per cent, with a median duration from inception of EVT to complete healing of 47 (range 40-105) days. The weighted mean rate of stoma reversal across the studies was 75·9 (64·6 to 87·2) per cent. Twenty-five patients (9·1 per cent) required additional interventions after EVT. Thirty-eight patients (13·8 per cent) developed complications. The weighted mean complication rate across the studies was 11·1 (6·0 to 16·2) per cent. Variables significantly associated with failure included preoperative radiotherapy, absence of diverting stoma, complications and male sex. Conclusion EVT is associated with a high rate of complete healing of anastomotic leakage and stoma reversal. It is an effective option in appropriately selected patients with anastomotic leakage.