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Background A commonly used treatment for open wounds, negative pressure wound therapy (NPWT) has recently been used to optimize wound healing in the setting of surgically closed wounds; however, the specific mechanisms of action by which NPWT may benefit patients after surgery remain unknown. Using a swine wound healing model, the current study investigates angiogenesis as a candidate mechanism. Methods Multiple excisional wounds were created on the dorsa of 10 male Yorkshire pigs and closed by primary suture. The closed wounds underwent treatment with either NPWT dressing or control dressings in the absence of negative pressure. Dressings were maintained for 8 days followed by euthanasia of the animal. Scar evaluation of the wounds by photographic analysis was performed, and wounds were analyzed for angiogenesis markers by enzyme-linked immunosorbent assay and immunohistochemistry. Results Scar evaluation scores were observed to be significantly higher for the NPWT-treated sites compared with the control sites (P < 0.05). The enzyme-linked immunosorbent assay results demonstrated increases for vascular endothelial growth factor (VEGF) staining at the incision site treated with NPWT compared with other treatment groups (P < 0.05). In addition, an approximately 3-fold elevation in VEGF expression was observed at the NPWT-treated sites (2.8% vs. 1%, respectively; P < 0.0001).). However, there was no significant difference in immunohistochemistry staining. Conclusions The use of NPWT improves the appearance of wounds and appears to increase VEGF expression after 8 days in the setting of a closed excisional wound model, suggesting that improved angiogenesis is one mechanism by which NPWT optimizes wound healing when applied to closed surgical wound sites.

Although the rate of ENDO continues to rise nationally, it still has not surpassed OPEN revascularization in the face of AMI. Patients treated endovascularly demonstrated one-third the rate of in-hospital mortality (odds ratio, 3.0; 97.5% CI, 2.2-4.1), an increased hazard ratio for discharge alive (hazard ratio, 2.27; 97.5% CI, 2.00-2.58), and a cost saving of $9196 (97.5% CI, $3797-$14,595) per hospitalization. Furthermore, they were less likely to develop AKI and to be discharged home after hospitalization.

Methods: Participants underwent a 1.5-day course covering open and endovascular procedures on high-fidelity simulators and cadavers. Before and after the course, participants completed a written test that assessed procedural knowledge concerning index open vascular and endovascular procedures. Participants also assessed their own procedural competence in both open and endovascular procedures on a 5-point Likert scale (1: no ability to perform, 5: performs independently). Postcourse and precourse scores were compared among postgraduate year (PGY) 1 and 2 and PGY 3 to 7 trainees. Participants used a survey to rate the relevance and realism of open and endovascular simulations.Results: Twenty-four vascular integrated residents and vascular fellows (PGY1-7) completed the course and all assessments. After course participation, procedural knowledge scores were significantly improved among PGY1-2 residents (precourse: 51% correct vs postcourse: 63%; P ¼ .002) but not among PGY3-7 residents (precourse: 62% correct vs postcourse: 67%; P ¼ .2). Self-rated procedural competence was significantly improved between PGY 1-2 (precourse: 2.5 6 .2 vs postcourse: 3.4 6 .2; P < .0001) and PGY 3-7 (precourse: 3.2 6 .3 vs postcourse: 4.0 6 .2; P ¼ .003) participants. Self-rated procedural competence significantly improved for both endovascular (precourse: 2.3 6 .2 vs postcourse: 3.3 6 .1; P < .0001) and open procedures (precourse: 2.7 6 .2 vs postcourse: 3.6 6 .1; P ¼ .002). Greater than 90% of participants reported they were "satisfied" or "very satisfied" with the relevance and realism of both open and endovascular simulations. All participants reported they would recommend the course to other trainees.Conclusions: This intensive simulation and surgical skills course improved procedural knowledge concerning index open vascular and endovascular procedures among PGY 1-2 trainees and improved self-rated procedural competence across all levels of training for both open and endovascular procedures. Trainees rated the simulation experience highly. These data support the implementation of similar intensive simulation and surgical skills courses with ongoing objective assessment of their educational effect.