It has long been realized that NPWT does not make its greatest impact by bioburden reduction. Other work has demonstrated that debridement alone does not reduce wound bioburden by more than 1 Log. Wounds treated with NPWTi (in this case with quarter strength bleach instillation solution) had a statistically significant reduction in bioburden, while wounds treated with NPWT had an increase in bioburden over the 7 days.

No abstract

The incidence of appendiceal neoplasms may have been underreported in the past. Patients undergoing incidental appendectomies or appendectomies for chronic appendicitis may be at higher risk for an incidental appendiceal neoplasm. To determine the incidence of occult appendiceal neoplasms and identify risk factors associated with this pathology, a retrospective review of a pathology specimen database was conducted from November 2007 to December 2011, in a single tertiary care hospital center. All patients with appendectomies were included for analysis (n = 1793). Pathology specimens were grouped based on the indication for appendectomy, and the incidence of appendiceal neoplasms, and patient variables among the groups were compared using χ2 test and Student's t test. A total of 1793 appendectomy specimens met criteria for evaluation. The total number of appendiceal neoplasms was 31 (1.7%). There were 14 neoplasms in 1337 (1.0%) cases of acute appendicitis with 2 in 41 (4.9%) cases of chronic and 15 in 415 (3.6%) cases, where an incidental appendectomy was performed (P < 0.001). Patients with carcinoid tumors were significantly younger than patients with noncarcinoid tumors (P = 0.0001). Indication for operation was the only significant factor for predicting an appendiceal tumor on final pathology. Patients who undergo interval or incidental appendectomies may be at higher risk of appendiceal neoplasm compared with those performed for other indications. Younger patients may be at a higher risk of occult appendiceal carcinoid neoplasms than other age groups. Pathologic diagnosis in specific high-risk patient groups may be the only way to effectively capture these tumors for optimal treatment.

The senior author receives research grant support from Healthpoint Biotherapeutics; KCI; Manuka Honey; Smith & Nephew; Medline Ind., Macrocure; CODA. In addition the senior author is a consultant for: Smith & Nephew and KCI and medical consultant and reviewer for Macrocure. While the study as presented evaluates in part the efficacy of a commercial product from Smith & Nephew, no industry support for this study was sought or provided.

Disparities are evident in breast cancer diagnosis, treatment, and outcomes. This study examines multiple socioeconomic and geographic regions across the US to determine if disparities exist in the type of reconstruction obtained after mastectomy. This is a retrospective study evaluating socioeconomic and geographic variables of 14,764 women who underwent mastectomy in 2008 using the Nationwide Inpatient Sample (NIS). Statistical analysis was performed on three groups of women: patients without reconstruction (NR), patients who underwent breast implant/tissue expander reconstruction (TE), and patients with autologous reconstruction such as free or pedicled flaps (FLAP). The majority of patients (63.9%) had NR, while 23.9% had TE and 12.2% underwent FLAP. Compared to patients with NR, women with TE or FLAP were younger (64.9 years versus 51.3 and 51.1 years, p < 0.001), had fewer chronic conditions (2.60 and 2.54 chronic conditions for TE and FLAP respectively versus 3.85 for NR, p < 0.001) and higher mean hospital charges ($42,850 TE and $48,680 FLAP versus $22,300 NR, p < 0.001). Both Medicare and Medicaid insurance carriers had a higher proportion of women that did not get reconstructed compared to other insurance types (p < 0.001). Compared to NR, reconstructed women more often lived in urban areas and zip codes with higher average incomes (p < 0.001). This is the first national study analyzing insurance type and geographic variations to show statistically significant disparities in rate and type of immediate reconstruction after mastectomy. These inequalities need to be addressed to extend immediate reconstruction options to all women undergoing mastectomy.