Introduktion: Olika typer av sår skapar stort lidande för den drabbade och Negative Pressure Wound Therapy (NPWT) är en behandlingsmetod som utvecklats för att effektivisera sårläkningsprocessen. Livskvaliteten och hälsan påverkas av såret och dess utveckling, vilket gör omvårdnaden vid sårbehandling grundläggande för patientens välmående. Syfte: Syftet var att belysa hur Negative Pressure Wound Therapy påverkar patientens livskvalitet och hälsa. Metod: Polit och Beck (2012) niostegsmodell användes för litteraturstudien. Artikelsökningarna gjordes i två olika databaser samt manuella sökningar och resultatet grundades på tolv artiklar som genomgick en kvalitetsgranskning. Resultat: Fem teman identifierades påverka patientens upplevelse av behandlingen. Behandlingen påverkar den fysiska förmågan att leva ett dagligt liv och tenderar att framkalla smärta vid omläggning. Behandlingen tenderar även att på ett psykiskt påfrestande sätt påverka både det allmänna välmåendet och det sociala livet. Kunskap och information, hos både personal och patient, visades ha en inverkan på patientens livskvalitet och hälsa. Slutsats: Denna avancerade sårbehandling påverkar patientens livskvalitet och hälsa. Behandlingen innebär en fysisk påfrestning där patienten behöver bära runt på en behandlingsmaskin samt uppleva smärta. Det innebär också en psykisk påfrestning som ger utryck i stress, oro och rädsla samt en risk för isolering i det sociala livet. Det är därför av största vikt att vårdpersonal införskaffar sig och tillgodoser patientens behov av information och kunskap för att förutsättningar för en optimal omvårdnad ska kunna skapas.

Doctor of Philosophy / Department of Kinesiology / Carl Ade / During exercise, muscle blood flow (Q ̇m) increases to match metabolic demand of the active skeletal muscle. In order for this matching to take place, ‘competition’ between local vasodilating metabolites and sympathetically mediated vasoconstriction, termed “functional sympatholysis,” must take place. A key feature of functional sympatholysis is that it is driven largely by metabolic rate (i.e., a higher work rates lead to greater sympatholysis), but may also be largely dependent on nitric oxide bioavailability and oxidative stress in certain disease states (e.g., hypertension). Thus, evaluation of these factors may provide valuable insight into the vascular control mechanisms during exercise in both health and disease. Therefore, the purpose of this dissertation was to 1) determine the role metabolic rate and blood flow on mediating functional sympatholysis, 2) determine the role of nitric oxide bioavailability on functional sympatholysis with high salt intake, a risk factor for primary hypertension, and 3) determine the effect of increases in nitric oxide bioavailability on functional sympatholysis in primary hypertension patients. In the first investigation (Chapter 1), we increased the relaxation phase of the contraction-relaxation cycle to increase active skeletal muscle blood flow (Q ̇m) and see if this would impact vasoconstriction of the active skeletal muscle. We showed that a decreased relaxation time led to greater functional sympatholysis. Interestingly, despite a lower metabolic rate (15% and 20% MVC), we showed that there was no difference in vasoconstriction between the increased relaxation times. These results may show that increases in Q ̇m play a role in functional sympatholysis when mechanical compression is minimized. In the second investigation (Chapter 2), we sought to determine if high dietary sodium (HS) intake would impact functional sympatholysis. We showed that HS intake (15g/day for 7 days) did not impact functional sympatholysis during exercise. Importantly, we show a significant increase in mean arterial pressure (i.e., pressor response) during handgrip exercise. These findings show the deleterious changes in blood pressure, but further work is needed to pinpoint specific mechanisms causing the responses. In the final investigation (Chapter 3), we used an acute nitrate rich (NR) supplement to improve NO bioavailability in hypertensive post-menopausal women (PMW), and observe the impact on functional sympatholysis. We provide novel evidence that functional sympatholysis is improved (~50%) with a NR supplement. The finding that a NR supplement can attenuate vasoconstriction in hypertensive PMW sheds light on the complexities of hypertension, functional sympatholysis and NO bioavailability. The current results indicate that the ‘competition’ between vasodilating metabolites and sympathetically mediated vasoconstriction can be independently modified in health and disease. In individuals with impairment to local vasodilation (e.g., hypertension), the ability to increase functional sympatholysis and muscle blood flow may lead to improvements in cardiovascular health. Taken together, the present results suggest that modifying duty cycle, sodium intake, and NO bioavailability are important factors to be considered with regard to overall cardiovascular health.

Because of the high cost of some wound management regimens, payors may require that moist wound therapies be used before other treatment approaches, such as negative pressure wound therapy (NPWT), are implemented but few studies have investigated the effect of delayed initiation of NPWT on patient outcomes. To examine the impact of early versus late initiation of NPWT on patient length of stay in home health care, a nonrandomized, retrospective analysis was performed on the Outcome and Assessment Information Set (OASIS) information for home care patients with NPWT-treated Stage III or Stage IV pressure ulcers (N = 98) or surgical wounds (N = 464) gathered between July 2002 and September 2004. Early initiation of NPWT following the start of home care was defined as <30 days for pressure ulcers and <7 days for surgical wound patients. Median duration of NPWT was 31 days (range 3 to 169) for pressure ulcers and 27 days (range 5 to 119) for the surgical wound group. Median lengths of stay in the early treatment groups were 85 days (range 11 to 239) for pressure ulcers and 57 days (range 7 to 119) for the surgical group versus 166 days (range 60 to 657) and 87 days (range 31 to 328), respectively, for the late treatment pressure ulcer and surgical groups (P <0.0001). After controlling demographic patient variables, regression analysis indicated that for each day NPWT initiation was delayed, almost 1 day was added to the total length of stay (β = 0.96, P <0.0001 [pressure ulcers]; β = 0.97, P <0.0001 [surgical wounds]). Early initiation of NPWT may be associated with shorter length of stay for patients receiving home care for Stage III or Stage IV pressure ulcers or surgical wounds. Additional studies to ascertain the cost-effectiveness of treatments and treatment approaches in home care patients are needed.

Introduktion/Bakgrund: Negative Pressure Wound Therapy är en sårbehandling som är vanlig vid sekundär sårläkning och kan användas på många olika typer av sår. Undertryck skapas med ett specifikt skumförband som placeras i sårhålan och kopplas till en vakuumpump. Syfte: Syftet med litteraturstudien var att beskriva patienters erfarenhet av Negative Pressure Wound Therapy (NPWT). Metod: Litteraturstudien utformades utifrån Polit och Becks (2021) nio steg. I databaserna Cinahl och PubMed genomfördes litteratursökning, samt en kompletterande manuell sökning. Totalt elva artiklar var relevanta för studiens syfte och granskades utifrån granskningsmallarna ”Guide to a Focused Critical Appraisal of Evidence Quality in an Qualitative Research Report” samt “Guide to a Focused Critical Appraisal of Evidence Quality in a Quantitative Research Report. Resultat: Artiklar som belyste patienters erfarenhet av Negative Pressure Wound Therapy resulterade i tre teman: ”Sjuksköterskans kompetens vid NPWT”, ”Påverkan på livssituationen vid NPWT”, samt ”Oro och smärta”. Slutsats: Sjuksköterskans kompetens inom sårbehandling samt Negative Pressure Wound Therapy visade sig ha en stor betydelse för patienters negativa och positiva erfarenheter av Negative Pressure Wound Therapy. Därav finns ett behov av adekvat kompetens hos sjuksköterskor för att patienters behov ska tillgodoses samt för att styrka patientsäkerheten.

Our objective was to compare cefazolin concentrations in biopsied tissue samples collected from surgically created wounds treated with negative pressure wound therapy to those collected from surgically created wounds treated with nonadherent dressings. The study design was a prospective, controlled, experimental study. The animal population included 12 female spayed beagles. We hypothesized there would be a difference between the cefazolin concentrations of wounds treated with negative pressure wound therapy when compared to the cefazolin concentrations of wounds treated with nonadherent dressings. Surgical methods were as follows: Full thickness cutaneous wounds were created on each antebrachium (n=24). Following surgery, cefazolin (22 mg/kg) was administered intravenously to each of the dogs and continued every 8 hours during the study. The right wound was randomly assigned to group I or group II while the wound on the contralateral antebrachium was assigned to the other group. Group I wounds were treated with negative pressure wound therapy (NPWT) and group II wounds were treated with nonadherent dressings for 3 days. Dressings were changed and tissue biopsies obtained from wound beds at 24-hour intervals for both groups. Cefazolin wound tissue and plasma concentrations were measured by liquid chromatography mass spectrometry (LC-MS/MS). Blood samples for measuring plasma cefazolin concentrations were collected prior to biopsy sampling. At the time of surgery and at each bandage change, wound beds were swabbed and submitted for aerobic and anaerobic culture. Our results revealed that after initiating cefazolin treatment, wound tissue antibiotic concentrations between treatment groups were not significantly different at any sampling time. Similarly, after initiating cefazolin treatment, plasma cefazolin concentrations were not significantly different at any sampling time for individual dogs. We concluded that using a canine experimental model, NPWT treatment of surgically created wounds does not statistically impact cefazolin tissue concentrations when compared to conventional nonadherent bandage therapy / Master of Science

Submitted by Jorge Silva (jorgelmsilva@ufrrj.br) on 2017-04-10T18:18:36Z No. of bitstreams: 1 2012 - Marcus Andr? Ferreira S?.pdf: 393876 bytes, checksum: 9d184a085854acf9828da371a7e2b732 (MD5) / Made available in DSpace on 2017-04-10T18:18:36Z (GMT). No. of bitstreams: 1 2012 - Marcus Andr? Ferreira S?.pdf: 393876 bytes, checksum: 9d184a085854acf9828da371a7e2b732 (MD5) Previous issue date: 2012-07-17 / CAPES / The present experiment aimed to verify if different vacuum pump negative pressures (150, 280 e 400 mmHg) can influence the oocyte recovery rate per preovulatory follicle aspirated. Hence, 21 estrous cycles from regularly cycling mares were subject to OPU. The estrous cycles were sorted in three groups (G150=150 mmHg; G280=280 mmHg; G400=400 mmHg) in the following sequence: G150= 150mmHg (n=6); G280= 280mmHg (n=7); G400= 400mmHg (n=6). During the estrus, the ovarian activity of the mares was daily monitored using the transrectal ultrasound technique until the largest follicle reached at least a diameter of 35mm and endometrial edema secore 2.5 was identified on ultrasonographic evaluation, when 1000UI of hCG administered intravenuous. Approximately 24 hours after the hCG administered, the mares were monitored by rectal palpation and ultrasonography every six hours to follicle evaluation. In the case of imminent indication of ovulation or formation of hemorrhagic follicle, the follicle would be immediately aspirate. The aspirations occurred in 32,45?1,92h after the hCG administration. The transvaginal aspirations were performed with ultrasound apparatus equipped with a convex transducer of 5,0mHz with polyethylene guide containing a double lumen needle of 12G. The follicular fluid collected from each follicle was frozen and the aspirated content was transferred to a Petri Dishes and thoroughly examined on the stereomicroscope to identify the oocytes presence. In order to statistically evaluate the influence of different pressures on the oocyte recovery, were used Chi-Squared test (a 5% significance) and Fisher Exact Test, when recommended. The recovery rate was 31,57% (6/19), being 16,66 % (1/6) in G150, 42,85 % (3/7) in G280 and 33,33 % (2/6) in G400. There was no difference among groups (p>0,05). From the results of the current study, it is possible to conclude that the negative pressure of the vacuum pump is not a determining factor to increase the oocyte recovery and other aspects would possibly have more significant influence . / O presente experimento visou investigar se diferentes press?es negativas da bomba de v?cuo (150, 280 e 400mmHg) podem influenciar a taxa de recupera??o oocit?ria por fol?culo preovulat?rio aspirado. Para tanto, foram submetidos a ovum pick up 21 ciclos estrais de ?guas ciclando regularmente, distribu?dos em tr?s grupos (G150= 150 mmHg; G280= 280 mmHg; G400= 400 mmHg), na seguinte ordem: G150= 150 mmHg (n=6); G280= 280 mmHg (n=7); G400= 400 mmHg (n=6), definida por meio de sorteio. Durante estro, a atividade ovariana das ?guas foi monitorada diariamente atrav?s da t?cnica ultrassonogr?fica transretal at? que o maior fol?culos atingisse pelo menos 35mm de di?metro e edema endometrial grau 2,5 durante a avalia??o ultrassonogr?fica, quando ent?o administrou-se 1000UI de hCG, por via endovenosa. Aproximadamente 24 horas ap?s a administra??o de hCG as ?guas foram submetidas a exame ultrassonogr?fico a cada seis horas para avalia??o folicular. Caso houvesse indica??o iminente de ovula??o ou forma??o de fol?culo hemorr?gico, o mesmo seria imediatamente aspirado. As aspira??es ocorreram em 32,45?1,92h ap?s a aplica??o do hCG fazendo uso de ultrassom equipado com um transdutor convexo de 5,0mHz com guia de polietileno contendo uma agulha de duplo l?men de 12G. O fluido folicular coletado de cada fol?culo foi congelado e o conte?do aspirado transferido para uma Placa de Petri e examinado minuciosamente ao estereomicrosc?pio para localiza??o dos o?citos. Para avaliar estatisticamente o efeito das diferentes press?es sobre a recupera??o oocit?ria, foi utilizado o teste Qui-Quadrado (a 5% de signific?ncia) e Fisher Exato, quando recomendado. A taxa de recupera??o foi de 31,57% (6/19), sendo 16,66 % (1/6) no G150, 42,85 % (3/7) no G280 e 33,33 % (2/6) no G400. N?o houve diferen?a entre os grupos (p>0,05). Atrav?s dos resultados obtidos no presente estudo ? poss?vel concluir que a press?o negativa da bomba de v?cuo utilizada n?o ? o determinante para elevar a recupera??o oocit?ria, possivelmente havendo outros fatores atuando de modo mais importante.

Störungen der Schluckfunktion werden im Alter zunehmend diagnostiziert und beeinträchtigen die Lebensqualität der betroffenen Patienten sehr. Ein abnormes Schluckmuster bei Kindern und Jugendlichen kann eine pathologische Wirkung auf die Entwicklung der Zahnstellung haben. In dieser Studie wurde bei einem gesunden Probandenkollektiv von 52 Teilnehmern (40 w; 12 m) im Alter von 20 - 45 (MW: 25.48; SD:4.68) Jahren die orale Phase des Schluckaktes untersucht. Für diese Zwecke, wurde ein intraorales Mundstück angewendet (Silencos®, Bredent, Senden, Deutschland), das aufgrund der Einbringung einer Silikonschlaufe die intraorale Bolusapplikation und Druckmessung erlaubte. Extraoral wurde das Mundstück einerseits an einer mit Flüssigkeit gefüllten Spritze zur Bolusapplikation und andererseits an ein digitales Manometer (GDUSB 1000®, Greisinger electronics, Regenstauf Deutschland) angeschlossen. Das genutzte Messgerät besaß die Fähigkeit, mit einer Frequenz von 1kHz Messungen in einem Bereich von 2000 bis -1000 mbar durchzuführen. Zum Schutz der Probanden und zur Sicherung der Messung wurde am Schlauchsystem ein Bakterienfilter und ein Wasserabscheider angebracht. Mit dieser Versuchsanordnung wurden drei Schluckmodalitäten untersucht. Jede Modalität beinhaltete 10 Schluckvorgänge. Die erste Untersuchung bezog sich auf die aktive Einnahme eines Bolus aus Wasser. Die Probanden führten Saugimpulse aus, indem sie Flüssigkeit aus einer Spritze zogen und diese anschließend schluckten. Die zweite und dritte Untersuchung basierte auf der passiven Gabe eines Bolus, der in einem Volumen von 2 ml appliziert wurde. In diesem Versuch wurde jeweils ein 2-ml-Bolus aus Wasser und aus Gel verabreicht. Bei den erhobenen Daten konnten hauptsächlich negative Druckamplituden beobachtet werden. Dabei wurde ein Mittelwert von -290 mbar bei der aktiven Bolus-Einnahme, -31 mbar während der passiven Gabe eines Bolus aus Wasser und -37 mbar bei der passiven Gabe eines Bolus aus Gel gemessen. Auch die Dauer der Schluckereignisse wurde gemessen. Hierbei ergab sich ein Mittelwert von 5.1 s bei der aktiven Bolus-Einnahme, 1.8 s bei der passiven Gabe eines Bolus aus Wasser und 1.5 s bei der passiven Gabe eines Bolus aus Gel. In Abhängigkeit von der Art der Bolusapplikation und der Boluskonsistenz konnten signifikante Differenzen zwischen den erhobenen Druckamplituden und Druckverläufen beobachtet werden. Die aktive Einnahme eines Bolus zeigte höhere negative Druckverläufe sowie eine längere Dauer als bei der passiven Gabe eines Bolus. Auch signifikante Unterschiede zwischen den Konsistenzen konnten beobachtet werden: die Gabe eines Bolus aus Gel wies polyphasische Kurven auf. Im Vergleich dazu zeigten sich vorwiegend monophasische Kurven beim Schlucken von Wasser. Der vorgeschlagene Schlucktest zeigte eine einfache Anwendbarkeit und konnte bei allen Probanden problemlos durchgeführt werden. Der technische Aufwand war gering und die Untersuchung brachte keine Nebenwirkungen für die Probanden mit sich. Anhand dieses Tests wurden Datensätze zur Schluckfunktion erzeugt, welche qualitativ und quantitativ ausgewertet wurden und als Normwert für zukünftige Untersuchungen dienen. Die Interpretation der erhobenen Daten anhand des biofunktionellen Modells ermöglicht eine methodische Erfassung der Schluckphysiologie. Eine klinische Anwendung bietet sich als diagnostischer Test sowie auch in der Übungstherapie an. Die durchgeführten Untersuchungen konnten die funktionelle Ähnlichkeit der Funktionen Saugen und Schlucken belegen und zeigten, dass das vom biofunktionellen Modell ausgewiesene Kompartiment 2 offensichtlich zum Transport von Flüssigkeiten einen Saugmechanismus und nicht einen Propulsionsmechanismus durch Verdrängen des Bolus bevorzugt.

Magnetic Resonance Imaging (MRI) was used to determine changes in the size of the Inferior Vena Cava (IVC) as a result of blood pooling induced by lower body negative pressure (LBNP). Images of the IVC of supine human subjects (10 males, 10 females) were obtained under four conditions: 1) steady-state 0 mmHg LBNP, 2) steady-state –35 mmHg LBNP, 3) ramping from 0 to –35 mmHg LBNP, 4) ramping from –35 to 0 mmHg LBNP. Volumes for a given IVC segment were obtained under the first two conditions during both end inspiration and end expiration breath-holds. Inferior Vena Cava widths were measured under all four conditions at the levels of portal entry and portal exit. The IVC volume for men and women combined decreased 41% due to LBNP (p andlt; 1.02 x 10-9). The IVC was 64.4% wider at portal exit than at portal entry in men (p andlt; 0.0003). Lower Body Negative Pressure induced a decrease in men's vena cava width up to 46% at portal exit and up to 62% at portal entry. Supported by NASA EPSCoR WKU 522611 and NIH GCRC MO1 RR262.

Les liquides sont capables, comme les solides, de supporter des forces de traction. Ils sont alors à pression négative (c'est-à-dire en tension), dans un état qui est métastable. Le retour vers un état stable à pression positive peut se faire par la nucléation d'une bulle, un processus appelé cavitation. Dans cette thèse nous nous intéressons aux propriétés de la cavitation en milieu confiné, avec un accent particulier sur la dynamique des bulles. Ce sujet est motivé par l'étude du transport de l'eau dans les arbres dont une partie (la sève montante) se fait sous tension, dans des canaux micrométriques. La cavitation entraîne alors l'embolie des éléments conducteurs de sève, c'est-à-dire leur remplissage par du gaz. Une grande partie du manuscrit est consacrée à l'étude de la cavitation dans un milieu modèle, où de l'eau est confinée dans des inclusions sphériques micrométriques au sein d'un hydrogel. L'évaporation passive de l'eau à travers le gel permet de générer des pressions négatives, et la cavitation peut se produire spontanément ou être déclenchée à l'aide d'un laser. Nous résolvons la dynamique subséquente de la bulle à l'aide de diverses méthodes (caméra time-lapse ou caméra rapide, diffusion de la lumière, strobophotographie laser ...) et montrons qu'après une séquence inertielle ultra-rapide, la bulle atteint un état d'équilibre temporaire, puis grossit de manière quasi-statique sous l'effet des flux d'eau dans l'hydrogel, provoquant "l'embolie" de l'inclusion. Une place importante est accordée à un chapitre de théorie qui explore d'une part les propriétés thermodynamiques d'un liquide confiné à pression négative, et d'autre part la dynamique aux temps courts de bulles de cavitation dans de tels systèmes. Nous proposons ainsi une équation de Rayleigh-Plesset modifiée qui rend compte de l'accélération importante des oscillations radiales des bulles que nous avons observée expérimentalement. La compressibilité du liquide et l'élasticité du confinement sont des éléments-clés de ce modèle. Enfin, nous discutons l'application des résultats précédents dans le contexte des arbres, tout en proposant une nouvelle méthode expérimentale qui permet un suivi optique du processus d'embolie. Nous présentons quelques résultats obtenus sur des échantillons de pin sylvestre. / Liquids can sustain traction forces, as solids do. In this case, they are at negative pressure (that is, under tension), in a metastable state. Nucleation of a bubble can occur, leading the system back to a stable state : this process is called cavitation. In this PhD work, we are interested in the properties of cavitation in a confined liquid, with a particular emphasis on bubble dynamics. This study is motivated by the context of water transport in plants : ascending sap is indeed under tension, in natural micro-channels. Cavitation then leads to embolism, i. e. the gas-filling of these channels. A significant part of the manuscript is devoted to the study of cavitation in a model system : spherical inclusions of water are embedded in a hydrogel, and passive evaporation of water through the gel allows the generation of negative pressures. Cavitation can then happen spontaneously or be triggered with a laser. We resolve the subsequent dynamics of the bubble, using several methods (fast or time-lapse camera, light scattering, laser strobe photography ...), showing that after a first ultra-fast inertial step, the bubble reaches a temporary equilibrium. Then, it slowly grows due to fluxes in the hydrogel, leading to full embolism of the inclusion. A theoretical chapter follows. First, the thermodynamical properties of a confined liquid under negative pressure are investigated. In a second part, we focus on the dynamics of cavitation bubbles in such systems, at short time scales. We derive a modified Rayleigh-Plesset equation which accounts for the experimentally observed ultra-fast radial oscillations of the bubbles. Liquid compressibility and confinement elasticity are key ingredients in this model. Last, the applicability of the previous results in the context of trees is discussed. A new method to directly study embolism in trees by optical means is also presented, and applied to Scots pine samples.

The purpose of this study was to examine the clinical outcomes of negative pressure wound therapy (NPWT) using reticulated open-cell foam (ROCF) in the adjunctive management of abdominal wounds with exposed and known infected synthetic mesh. A non randomised, retrospective review of medical records for 21 consecutive patients with infected abdominal wounds treated with NPWT was conducted. All abdominal wounds contained exposed synthetic mesh [composite, polypropylene (PP), or knitted polyglactin 910 (PG) mesh]. Demographic and bacteriological data, wound history, pre-NPWT and comparative post-NPWT, operative procedures and complications, hospital length of stay (LOS) and wound healing outcomes were all analysed. Primary endpoints measured were (1) hospital LOS prior to initiation of NPWT, (2) total time on NPWT, (3) hospital LOS from NPWT initiation to discharge and (4) wound closure status at discharge. A total of 21 patients with abdominal wounds with exposed, infected mesh were treated with NPWT. Aetiology of the wounds was ventral hernia repair (n = 11) and acute abdominal wall defect (n = 10). Prior to NPWT initiation, the mean hospital LOS for the composite, PP and PG meshes were 76 days (range: 21-171 days), 51 days (range: 32-62 days) and 19 days (range: 12-39 days), respectively. The mean hospital LOS following initiation of NPWT for wounds with exposed composite, PP and PG mesh were 28, 31 and 32 days, respectively. Eighteen of the 21 wounds (86%) reached full closure after a mean time of 26 days of NPWT and a mean hospital LOS of 30 days postinitiation of NPWT. Three wounds, all with composite mesh left in situ, did not reach full closure, although all exhibited decreased wound dimensions, granulating beds and decreased surface area exposure of mesh. During NPWT/ROCF, one hypoalbuminemic patient with exposed PP mesh developed an enterocutaneous fistula over a prior enterotomy site. This patient subsequently underwent total mesh extraction, takedown of the fistula and PP mesh replacement followed by reinstitution of NPWT and flap closure. In addition to appropriate systemic antibiotics and nutritional optimisation, the adjunctive use of NPWT resulted in successful closure of 86% of infected abdominal wounds with exposed prosthetic mesh. Patient hospital LOS (except those with PG mesh), operative procedures and readmissions were decreased during NPWT compared with treatment prior to NPWT. Future multi-site prospective, controlled studies would provide a strong evidence base from which treatment decisions could be made in the management of these challenging and costly cases.