***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 
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    Input: OBJECTIVE The options for abdominal coverage after damage control laparotomy or abdominal compartment syndrome vary by institution , surgeon preference , and type of patient . Some advocate polyglactin mesh ( MESH ) , while others favor vacuum-assisted closure ( VAC ) . We performed a single institution prospect i ve r and omized trial comparing morbidity and mortality differences between MESH and VAC . METHODS Patients expected to survive and requiring open abdomen management were prospect ively r and omized to either MESH or VAC .  After r and omization , an enteral feeding tube was inserted and the closure device placed . VAC patients returned to the operating room every 3 days for a total of three changes at which time polyglactin mesh was placed if closure was not possible . The MESH group had twice daily assessment s for the possibility of bedside mesh cinching and closure . Both groups underwent split thickness skin grafting when granulation tissue was evident , if delayed primary closure was not possible . RESULTS Fifty-one patients were r and omized . Both cohorts were matched for Injury Severity Scale score , gender , blunt/penetrating/abdominal compartment syndrome and age . Three patients died within 7 days and were excluded from closure rate calculation . There were no differences between delayed primary fascial closure rates in the VAC ( 31 % ) or MESH ( 26 % ) groups . The fistula rate in the VAC group was 21 % but not statistically different from the 5 % rate for MESH .  Intraabdominal rates were not statistically different . All VAC fistulas were related to feeding tubes and suture line areas ; the MESH fistula followed a retroperitoneal colon leak remote from the mesh . CONCLUSIONS MESH and VAC are both useful methods for abdominal coverage , and are equally likely to produce delayed primary closure . The fistula rate for VAC is most likely due to continued bowel manipulation with VAC changes with a feeding tube in place-enteral feeds should be administered via nasojejunal tube . Neither method precludes secondary abdominal wall reconstruction 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 Vacuum-assisted wound closure ( VAC ( ® ) ) therapy is considered to be superior to conventional dressings in the treatment of peri-vascular groin infections after vascular surgery at our department . Therefore , we performed an early interim analysis of the clinical outcomes in these seriously ill patients at risk of amputation and death . Patients were r and omised  to either VAC ( ® ) ( n = 5 ) or Sorbalgon ( ® ) ( n = 5 ; best alternative treatment ) therapy after surgical debridement . Non-invasive , laser Doppler perfusion imaging ( LDPI ) studies of the skin adjacent to the undressed wound were performed after 14 days of wound treatment . There was no difference in LDPI values  in VAC ( ® ) versus Sorbalgon ( ® ) treated patients ( P = 0·46 ) . One patient in the VAC ( ® ) group suffered from two re-bleeding episodes , leading to vascular resection and transfemoral amputation and in the Sorbalgon ( ® ) group two had a complete wound healing time of more than 4 months and one had a visible interposition bypass graft in the groin after 1 month of treatment . No patient died of the groin infection . Although not statistically proven , fewer wound treatment failures were recorded in the VAC ( ® ) group , justifying this early interim analysis . LDPI studies were feasible Purpose The purpose of this study was to evaluate the use of negative pressure wound therapy ( NPWT ) to improve  wound healing after total hip arthroplasty ( THA ) and its influence on the development of postoperative seromas in the wound area . Material sThe study is a prospect i ve r and omised evaluation of NPWT in patients with large surgical wounds after THA , r and omising patients to either a st and ard dressing ( group A ) or a NPWT ( group B ) over the wound area . The wound area was examined with ultrasound to measure the postoperative seromas in both groups on the fifth and tenth postoperative days . Results There were 19 patients r and omised in this study . Ten days after surgery , group A ( ten patients , 70.5 ± 11.01 years of age ) developed seromas with an average size of 5.08 ml and group B ( nine patients , 66.22 ± 17.83 years of age ) 1.97 ml . The difference was significant ( p = 0.021 ) . Conclusion NPWT has been used on many different types of traumatic and non traumatic wounds . This prospect i ve , r and omised study has demonstrated decreased development of postoperative seromas in the wound and improved wound healing Wound closure using topical negative pressure ( TNP ) has been reported to be effective , but equipment costs can be prohibitive in re source -challenged countries . Because nonhealing wounds are exceedingly common in developing countries such as India , the ability to optimize wound care with limited re sources is very important . To investigate the feasibility and efficacy of providing TNP in an Indian medical referral center , a r and omized controlled trial comparing a locally constructed TNP device ( treatment ) to wet-to-dry gauze dressings ( control ) was conducted . Eligible study participants ( N = 48 ) were recruited from the inpatient wards . Wound etiologies included diabetic foot ulcers ( 15 ) , pressure ulcers ( 11 ) , cellulitis/fasciitis ( 11 ) , and " other " ( 11 ) . Following enrollment , wound size was assessed using computer-aided measurements of digital photographs and block-r and omized to the study arms using a concealed allocation table . Wounds in both treatment groups were débrided before dressing application and patients were followed until wound closure or being lost to follow-up for an average of 26.3 days ( + /- 18.5 ) in the control and 33.1 days ( + /- 37.3 ) in the treatment group . No statistically significant differences in time to closure between the two treatment groups were observed except in a subset analysis of pressure ulcers ( mean 10 + /- 7.11 days for treatment and 27 + /- 10.6 days in control group , P = 0.05 ) . Direct costs to close a pressure ulcer also were lower in the TNP than in the control group . A review of the literature suggests the outcomes obtained using a locally constructed TNP device are similar to those obtained using commercially available devices . As a result of this study , a dedicated tissue viability team has been established to identify wounds suitable for TNP , over 
    Output:
    
AUTHORS ' CONCLUSIONS There is currently no rigorous RCT evidence available regarding the clinical effectiveness of NPWT in the treatment of surgical wounds healing by secondary intention as defined in this review .