BackgroundTraumatic brain injury (TBI) is a major cause of death and disability. TBI results in a prolonged secondary central neuro-inflammatory response. Previously, we have demonstrated that multiple doses (2 and 24 h after TBI) of multipotent adult progenitor cells (MAPC) delivered intravenously preserve the blood-brain barrier (BBB), improve spatial learning, and decrease activated microglia/macrophages in the dentate gyrus of the hippocampus. In order to determine if there is an optimum treatment window to preserve the BBB, improve cognitive behavior, and attenuate the activated microglia/macrophages, we administered MAPC at various clinically relevant intervals.MethodsWe administered two injections intravenously of MAPC treatment at hours 2 and 24 (2/24), 6 and 24 (6/24), 12 and 36 (12/36), or 36 and 72 (36/72) post cortical contusion injury (CCI) at a concentration of 10 million/kg. For BBB experiments, animals that received MAPC at 2/24, 6/24, and 12/36 were euthanized 72 h post injury. The 36/72 treated group was harvested at 96 h post injury.ResultsAdministration of MAPC resulted in a significant decrease in BBB permeability when administered at 2/24 h after TBI only. For behavior experiments, animals were harvested post behavior paradigm. There was a significant improvement in spatial learning (120 days post injury) when compared to cortical contusion injury (CCI) in groups when MAPC was administered at or before 24 h. In addition, there was a significant decrease in activated microglia/macrophages in the dentate gyrus of hippocampus of the treated group (2/24) only when compared to CCI.ConclusionsIntravenous injections of MAPC at or before 24 h after CCI resulted in improvement of the BBB, improved cognitive behavior, and attenuated activated microglia/macrophages in the dentate gyrus.

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Surgical site infection and other common surgical site complications (dehiscence, hematoma, and seroma formation) can lead to serious and often life-threatening complications. Gauze, adhesive dressings, and skin adhesives have traditionally been utilized for incision management. However, the application of negative pressure wound therapy over clean, closed surgical incisions (closed incision negative pressure therapy, ciNPT), has become a recent option for incision management. A brief review of ciNPT clinical evidence and health economic evidence are presented. A brief literature review was performed using available publication databases (PubMed, Ovid®, Embase®, and QUOSA™) for articles in English reporting on the use of ciNPT between October 1, 2016, to March 31, 2019. The successful application of ciNPT over clean, closed wounds has been reported in a broad spectrum of patients and operative interventions, resulting in favorable clinical results. Four of the five studies that examined health economics following the use of ciNPT reported a potential reduction in the cost of care. The authors' own experience and published results suggest that patients at high risk for developing a surgical site complication may benefit from the use of ciNPT during the immediate postoperative period. Additional studies are needed across various surgical disciplines to further assess the safety, and cost-effectiveness of ciNPT use in patient populations.

Traditionally, the surgical approach to managing abdominal injuries was to assess the extent of trauma, repair any damage and close the abdomen in one definitive procedure rather than leave the abdomen open. With advances in medicine, damage control surgery using temporary abdominal closure methods is being used to manage the open abdomen (OA) when closure is not possible. Although OA management is often observed in traumatic injuries, the extension of damage control surgery concepts, in conjunction with OA, for the management of the septic patient requires that the general surgeon who is faced with these challenges has a comprehensive knowledge of this complex subject. The purpose of this article is to provide guidance to the acute care and general surgeon on the use of OA negative pressure therapy (OA-NPT; ABTHERA™ Open Abdomen Negative Pressure Therapy System, KCI, an ACELITY Company, San Antonio, TX) for OA management. A literature review of published evidence, clinical recommendations on managing the OA and a case study demonstrating OA management using OA-NPT have been included.

Several published reviews and recommendations exist for the use of negative pressure wound therapy (NPWT) with instillation and a dwell time (NPWTi-d) in acute and chronic wounds. Specific dressings for use with NPWTi-d have also been developed, including a reticulated open cell foam dressing with through holes (ROCF-CC) that assists in removing thick wound exudate and infectious materials. ROCF-CC is especially helpful for wound cleansing when debridement is not possible or appropriate in patients.We report our initial experiences in using NPWTi-d with ROCF-CC in patients with pressure ulcers. An algorithmic approach was used to determine appropriate treatment to reach the goals of therapy (i.e., wound bed preparation, granulation tissue formation, and removal of infectious materials). Previous therapies included honey and gauze soaked in Dakin's solution. All patients received antibiotics and debridement when possible.Five patients (3 females and 2 males) received NPWTi-d with ROCF-CC (instillation of saline or a hypochlorous solution with a dwell time of 10 minutes, followed by 2-3 hours of -125 mmHg NPWT). Patient comorbidities included obesity, diabetes mellitus, hypertension, and peripheral artery disease. Mean age of patients was 65.2 years (range: 50-82 years). After an average of 6 days of therapy (range 2-9 days), all wounds treated with NPWTi-d with ROCF-CC showed rapid granulation tissue formation.We also noted improved removal of devitalized tissue and subsequent granulation tissue formation in patients receiving hypochlorous solution compared to patients receiving saline during NPWTi-d with ROCF-CC. All patients were eventually transferred to a skilled nursing facility. In our clinical practice, NPWTi-d with ROCF-CC provided effective and rapid removal of the thick exudate and infectious materials and promoted excellent development of underlying granulation tissue.