Treatment of the Open Abdomen with the Commercially Available Vacuum-Assisted Closure System in Patients with Abdominal Sepsis: Low Primary Closure Rate

Background: Abdominal Vacuum-Assisted Closure (V.A.C.) systems for treatment of open abdomens have been predominantly used for trauma patients with a high primary fascial closure rate. Use of the V.A.C. technique in abdominal sepsis is less well established. Methods: All patients with abdominal sepsis and treatment with the abdominal V.A.C. system between 2004 and 2007 were prospectively assessed. End points were fascial closure, V.A.C.-related morbidity, and quality of life score (SF-36) at follow-up. Results: Thirty patients with abdominal sepsis were included in the study. Primary fascial closure was feasible in 10, partial closure in 4, and no closure in 16 patients. Median number of V.A.C. changes was 3 (range, 1-10). Nine patients died. V.A.C.-related morbidity was as follows: two fistulas, three fascial edge necroses, one skin blister, and four prolapses of small bowel between the fascia and foam. Univariate analysis showed no variables influencing primary closure rate or V.A.C.-related morbidity. Mortality was significantly influenced by age (P<0.001), respiratory failure (P=0.01), and pneumonia (P=0.03). At follow-up, V.A.C. patients scored lower in the physical health scores and similar in the mental health scores compared with the normal population. Conclusions: Treatment of the open abdomen in patients with abdominal sepsis with the abdominal V.A.C. system is safe with good long-term quality of life. Primary closure rate in these patients is substantially lower than in trauma patients. Stepwise closure of the fascia during V.A.C. changes should be attempted to avoid additional lateral retraction of fascial edges. V.A.C.-related complications may be avoided with careful surgical techniqu

Treatment of the open abdomen with the commercially available vacuum-assisted closure system in patients with abdominal sepsis

Background: Abdominal Vacuum-Assisted Closure (V.A.C.) systems for treatment of open abdomens have been predominantly used for trauma patients with a high primary fascial closure rate. Use of the V.A.C. technique in abdominal sepsis is less well established. Methods: All patients with abdominal sepsis and treatment with the abdominal V.A.C. system between 2004 and 2007 were prospectively assessed. End points were fascial closure, V.A.C.-related morbidity, and quality of life score (SF-36) at follow-up. Results: Thirty patients with abdominal sepsis were included in the study. Primary fascial closure was feasible in 10, partial closure in 4, and no closure in 16 patients. Median number of V.A.C. changes was 3 (range, 1-10). Nine patients died. V.A.C.-related morbidity was as follows: two fistulas, three fascial edge necroses, one skin blister, and four prolapses of small bowel between the fascia and foam. Univariate analysis showed no variables influencing primary closure rate or V.A.C.-related morbidity. Mortality was significantly influenced by age (P<0.001), respiratory failure (P=0.01), and pneumonia (P=0.03). At follow-up, V.A.C. patients scored lower in the physical health scores and similar in the mental health scores compared with the normal population. Conclusions: Treatment of the open abdomen in patients with abdominal sepsis with the abdominal V.A.C. system is safe with good long-term quality of life. Primary closure rate in these patients is substantially lower than in trauma patients. Stepwise closure of the fascia during V.A.C. changes should be attempted to avoid additional lateral retraction of fascial edges. V.A.C.-related complications may be avoided with careful surgical techniqu

A framework for conceptualizing, representing, and analyzing distributed interaction.

The relationship between interaction and learning is a central concern of the learning sciences, and analysis of interaction has emerged as a major theme within the current literature on computersupported collaborative learning. The nature of technology-mediated interaction poses analytic challenges. Interaction may be distributed across actors, space, and time, and vary from synchronous, quasi-synchronous, and asynchronous, even within one data set. Often multiple media are involved and the data comes in a variety of formats. As a consequence, there are multiple analytic artifacts to inspect and the interaction may not be apparent upon inspection, being distributed across these artifacts. To address these problems as they were encountered in several studies in our own laboratory, we developed a framework for conceptualizing and representing distributed interaction. The framework assumes an analytic concern with uncovering or characterizing the organization of interaction in sequential records of events. The framework includes a media independent characterization of the most fundamental unit of interaction, which we call uptake. Uptake is present when a participant takes aspects of prior events as having relevance for ongoing activity. Uptake can be refined into interactional relationships of argumentation, information sharing, transactivity, and so forth. for specific analytic objectives. Faced with the myriad of ways in which uptake can manifest in practice, we represent data using graphs of relationships between events that capture the potential ways in which one act can be contingent upon another. These contingency graphs serve as abstract transcripts that document in one representation interaction that is distributed across multiple media. This paper summarizes the requirements that motivate the framework, and discusses the theoretical foundations on which it is based. It then presents the framework and its application in detail, with examples from our work to illustrate how we have used it to support both ideographic and nomothetic research, using qualitative and quantitative methods. The paper concludes with a discussion of the framework’s potential role in supporting dialogue between various analytic concerns and methods represented in CSCL

Treatment of the open abdomen with the commercially available vacuum-assisted closure system in patients with abdominal sepsis : low primary closure rate

Abdominal Vacuum-Assisted Closure (V.A.C.) systems for treatment of open abdomens have been predominantly used for trauma patients with a high primary fascial closure rate. Use of the V.A.C. technique in abdominal sepsis is less well established