***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Large wounds result ing from severe injuries are generally treated with extended reconstructive operations ( e.g. , free flaps ) , which are accompanied by long hospitalizations and risks of infection , thrombosis , and flap loss . Integra is a collagen template that can be used for reconstruction of defects . The take rate and the rate of infection are essential for the successful use of Integra ( Johnson and Johnson , Hamburg , Germany ) . Whether the take rate and integration of Integra could be improved with the use of fibrin glue and negative-pressure therapy was assessed . Between January of 2002 and December of 2002 , patients with large defects who underwent Integra grafting for reconstruction were r and omly divided into groups receiving either a new treatment with fibrin glue-anchored Integra and postoperative negative-pressure therapy or conventional treatment .  Demographic features , cause of the wound , location of the wound , take rate , complications of Integra coverage , time from Integra coverage to skin transplantation , and functional and aesthetic results were assessed . Twelve patients ( with similar group distributions with respect to sex , age , and location and cause of the injury ) were included in the study .  The take rate was 78 ± 8 percent in the conventional treatment group and 98 ± 2 percent in the fibrin/negative-pressure therapy group ( p < 0.003 ) . The mean period from Integra coverage to skin transplantation was 24 ± 3 days in the conventional treatment group but only 10 ± 1 days in the fibrin/negative-pressure therapy group ( p < 0.002 ) . The decrease in the interval between coverage with Integra and skin transplantation result ed in shorter hospital stays . The use of fibrin glue and negative-pressure therapy in combination with Integra could shorten the period from coverage to integration , which would be beneficial in terms of decreased risks of infection , thrombosis , and catabolism . Therefore , it is suggested that Integra be used in combination with fibrin glue and negative-pressure therapy to improve clinical outcomes and shorten hospital stays , with decreased risks of accompanying complications Background : Vacuum-assisted closure therapy is a relatively new concept described in the literature that increases wound-healing capacity . The authors aim ed to investigate the effect of vacuum-assisted closure therapy on wound healing , granulation tissue formation , bacterial clearance , pain , time involvement of the staff , and total costs in all types of wounds in comparison with modern wound dressings . Methods : Sixty-five patients with a chronic or acute wound were r and omized to initial treatment with vacuum-assisted closure or modern dressings .  The authors ’ primary endpoint was a granulated wound or a wound ready for skin grafting or healing by secondary intention . Results : The time to the primary endpoint with  vacuum-assisted closure therapy  was not significantly shorter , except for patients with cardiovascular disease and /or diabetics . Vacuum-assisted closure therapy did not result in significantly faster granulation or wound surface reduction or better bacterial clearance , but patient comfort was an important advantage . Time involvement and costs of nursing staff were significantly lower for the vacuum-assisted closure therapy , but overall costs were similar for both groups . Conclusions : With vacuum-assisted closure therapy , wound healing is at least as fast as with modern wound dressings . Especially cardiovascular and diabetic patients benefit from this therapy . The total costs of vacuum-assisted closure are comparable to those of modern wound dressings , but the advantage is its comfort for patients and nursing staff Vacuum-assisted closure has become a new technique in the challenging management of contaminated , acute , and chronic wounds . Although promising clinical results have been described , scientific proof to substantiate the mechanism of action of this therapy is scarce . In the present study , we examined whether the positive effect on wound healing found in vacuum-assisted closure-treated wounds could be explained by an effect on the bacterial load . Fifty-four patients who needed open wound management before surgical closure were included in this study . Wounds were r and omized to either vacuum-assisted closure therapy ( n= 29 ) or treatment by conventional moist gauze therapy ( n= 25 ) . Healing was characterized by development of a clean granulating wound bed ( " ready for surgical therapy " ) and reduction of wound surface area . To quantify bacterial load , biopsies were collected . No significant difference was found in time needed to reach " ready for surgical therapy " comparing both therapies . Wound surface area reduction was significantly larger in vacuum-assisted closure-treated wounds : 3.8 + /- 0.5 percent/day ( mean + /- SEM ) compared to conventional-treated wounds ( 1.7 + /- 0.6 percent/day ; p < 0.05 ) . The total quantitative bacterial load was generally stable in both therapies . However , nonfermentative gram negative bacilli showed a significant decrease in vacuum-assisted closure-treated wounds ( p < 0.05 ) , whereas Staphylococcus aureus showed a significant increase in vacuum-assisted closure-treated wounds ( p < 0.05 ) . In conclusion , this study shows a positive effect of  vacuum-assisted closure therapy  on wound healing , expressed as a significant reduction of wound surface area . However , this could not be explained by a significant quantitative reduction of the bacterial load OBJECTIVE Topical negative pressure ( TNP ) ( vacuum therapy ) is frequently used in the management of acute , traumatic , infected and chronic full-thickness wounds . This prospect i ve clinical r and omised trial compared the costs of TNP with conventional therapy ( moist gauze ) in the management of full-thickness wounds that required surgical closure . METHOD The direct medical costs of the total number of re sources needed to achieve a healthy , granulating wound bed that was ' ready for surgical therapy ' were calculated . RESULTS Fifty-four patients admitted to a department of plastic and reconstructive surgery were recruited into the trial . Cost analysis showed significantly higher mean material expenses for wounds treated with TNP ( 414euros+/-229euros [ SD ] ) compared with conventional therapy ( 15euros+/-11euros ; p<0.0001 ) , but significantly lower mean nursing expenses ( 33euros+/-31 euros and 83euros+/-58euros forTNP and conventional therapy respectively ; p<0.0001 ) . Hospitalisation costs were lower in theTNP group ( 1788euros+/-1060euros ) than in the conventional treatment group ( 2467euros+/-1336euros ; p<0.043 ) due to an on average shorter duration until they were'ready for surgical therapy ' . There was no significant difference in total costs per patient between the two therapies ( 2235euros+/-1301euros for TNP versus 2565euros+/-1384euros for conventional therapy ) . CONCLUSION TNP had higher material costs . However , these were compensated by the lower number of time-consuming dressing changes and the shorter duration until they were ' ready for surgical therapy ' , result ing in the therapy being equally as expensive as conventional moist gauze . DECLARATION OF INTEREST This work was partly supported by the Plastic and Reconstructive Surgery Esser Foundation , and KCI Medical , Houten , The Netherl and s. The authors have no conflicts of interest Topical negative pressure has been demonstrated to improve graft take in a number of noncomparative studies . This study aim ed to assess whether split-thickness skin graft take is improved qualitatively or quantitatively with topical negative pressure therapy compared with st and ard bolster dressings . A blinded , prospect i ve , r and omized trial was conducted of 22 adult in patients of Liverpool Hospital between July of 2001 and July of 2002 who had wounds requiring skin grafting . After grafting , each wound half was r and omized to receive either a st and ard bolster dressing or a topical negative pressure dressing .  Skin graft assessment was performed at 2 weeks by a single observer blinded to the r and omization . Two patients were lost to follow-up and were excluded from the study . There were 20 patients ( 12 men and eight women ) in the study group . The median patient age was 64 years ( range , 27 to 88 years ) , and the mean wound size was 128 cm2 ( range , 35 to 450 cm2 ) . The wound exposed subcutaneous fat in eight patients , muscle in six patients , paratenon in four patients , and deep fascia in two patients . At 2 weeks , wounds that received a topical negative pressure dressing had a greater degree of epithelialization in six cases ( 30 percent ) , the same degree of epithelialization in nine cases ( 45 percent ) , and less epithelialization in five cases ( 25 percent ) compared with their respective control wounds . Graft quality following topical negative pressure therapy was subjectively determined to be better in 10 cases ( 50 percent ) , equivalent in seven cases ( 35 percent ) , and worse in three cases ( 15 percent ) . Although the quantitative graft take was not significant , the qualitative graft take was found to be significantly better with the use of topical negative pressure therapy ( p < 0.05 ) . Topical negative pressure significantly improved the qualitative appearance of split-thickness skin grafts as compared with st and ard bolster dressings Objectives : To evaluate the impact of negative pressure wound therapy ( NPWT ) after severe open fractures on deep infection . Design : Prospect i ve r and omized study . Setting : Academic level I trauma center . Patients / Participants : Fifty-nine patients with 63 severe high-energy open fractures were enrolled in this study , with data available on 58 patients with 62 open fractures . Intervention : Twenty-three patients with 25 fractures r and omized to the control group and underwent initial irrigation and debridement followed by st and ard fine mesh gauze dressing , with repeat irrigation and debridement every 48 - 72 hours until wound closure .  Thirty-five patients r and omized to the NPWT group and had identical treatment except that NPWT was applied to the wounds between irrigation and debridement procedures until closure . Main Outcome Measurements : The presence or absence of deep wound infection or osteomyelitis , wound dehiscence , and fracture union were primary outcome measures . Results and Conclusions : Control patients developed 2 acute infections ( 8 % ) and 5 delayed infections ( 20 % ) , for a total of 7 deep infections ( 28 % ) , whereas NPWT patients developed 0 acute infections , 2 delayed infections ( 5.4 % ) , for a total of 2 deep infections ( 5.4 % ) . There is a significant difference between the groups for total infections ( P = 0.024 ) . The relative risk ratio is 0.199 ( 95 % confidence interval : 0.045 - 0.874 ) , suggesting that patients treated with NPWT were only one-fifth as likely to have an infection compared with patients r and omized to the control group . NPWT represents a promising new therapy for severe open fractures after high-energy trauma Objectives : To investigate negative pressure wound therapy ( NPWT ) to prevent wound dehiscence and infection after high-risk lower extremity trauma . Design : Prospect i ve r and omized multicenter clinical trial . Setting : Four Level I trauma centers . Patients / Participants : Blunt trauma patients with one of three high-risk fracture types ( tibial plateau , pilon , calcaneus ) requiring surgical stabilization . Intervention : Incisional NPWT ( Group B ) was applied to the closed surgical incisions of patients r and omized to the study arm of this trial , whereas st and ard postoperative dressings ( Group A ) were applied to the control patients . Main Outcome Measures : Acute and chronic wound dehiscence and infection . Results : Two hundred forty-nine patients with 263 fractures have enrolled in this study with 122 r and omized to Group A ( controls ) and 141 to Group B ( NPWT ) . There was no difference between the groups in the distribution of calcaneus ( 39 % ) , pilon ( 17 % ) , or tibial plateau ( 44 % ) fractures . There were a total of 23 infections in Group A and 14 in Group B , which represented a significant difference in favor of NPWT ( P = 0.049 ) . The relative risk of developing an infection was 1.9 times higher in control patients than in patients treated with NPWT ( 95 % confidence interval , 1.03–3.55 ) . Conclusions : There have been no studies evaluating incisional NPWT as a prophylactic treatment to prevent infection and wound dehiscence of high-risk surgical incisions . Our data demonstrate that there is a decreased incidence of wound dehiscence and total infections after high-risk fractures when patients have NPWT applied to their surgical incisions after closure . There is also a strong trend for decreases in acute infections after NPWT . Based on our data in this multicenter prospect i ve r and omized clinical trial , NPWT should be considered for high-risk wounds after severe skeletal trauma INTRODUCTION Open tibial fractures are associated with a high incidence of mainly osteomyelitis .  Negative pressure wound therapy ( NPWT ) is a novel form of treatment that uses subatmospheric pressure to effect early wound healing . OBJECTIVES AND STUDY DESIGN To determine the effect of NPWT on incidence of deep infections/osteomyelitis  after open tibial fractures using a prospect i ve r and omized study design . MATERIAL S AND METHODS Ninety-three open tibial f 
    Output:
    
There is moderate-certainty evidence for no clear difference between NPWT and st and ard care on the proportion of wounds healed at six weeks for open fracture wounds .
There is moderate-certainty evidence that NPWT is not a cost-effective treatment for open fracture wounds .
It is uncertain whether there is a difference in risk of wound infection , adverse events , time to closure or coverage surgery , pain or health-related quality of life between NPWT and st and ard care for any type of open traumatic wound