Please select the eligibility criteria that correspond to the clinical trial below.
Title: Use of Negative Pressure Wound Therapy for At Risk Surgical Closures
Brief Summary: In this study, the investigators propose using negative pressure wound therapy (NPWT) to aid in wound healing along the lines of closure for lower extremity amputation and complex abdominal wounds. This study is designed to be a prospective, randomized clinical trial to evaluate the effectiveness of NPWT versus accepted standard surgical dressings on these wounds. Study participants will be randomized to one of the two treatment groups (NPWT vs. standard dressing) prior to surgery, and will be followed in the post operative period to monitor the effects on their surgical closures. The experimental group will consist of participants receiving NPWT and will have a Vacuum Assisted Closure (V.A.C., KCI inc.) device placed intra-op along the line of closure. The control group will receive a standard surgical dry sterile dressing. The surgical closures will be assessed after three days of treatment as well as the first outpatient post-op visit and any subsequent visits through the following 6 months. By doing so, the investigators hope to demonstrate the utility of NPWT on difficult, at risk surgical closures. Additionally, the investigators hope to show a difference in clinical outcome of incisions treated by NPWT over our current standard technique.

All patients in the principal and co-investigators practice who are scheduled to undergo lower extremity amputation or complex abdominal closure will be eligible for enrollment in this prospective randomized study. There are no exclusion criteria. Informed consent will be obtained pre-operatively. Data collection will include basic demographic data, disease history, past medical and social history as well key data relating to wound healing (infection, wound dehiscence or breakdown) and hospital course (length of stay, operative complications). The investigators will use simple statistical methods (ANOVA and chi-squared analysis) to compare surgical wound healing between the two populations. The only deviation from current standard of care in these populations includes utilizing a V.A.C. system on the closure line of the experimental group versus the standard dry sterile dressing.


Options:
A: Inclusion Criteria:

* 30 total patients undergoing panniculectomy alone following massive weight loss
* 30 total patients undergoing formal abdominoplasty (including undermining of skin flaps, rectus fascia plication and liposuction) following massive weight loss
* 30 total non-massive weight loss patients undergoing formal lipo-abdominoplasty
* 30 total patients undergoing ventral hernia repair using acellular dermal matrix
* 30 total patients undergoing bilateral breast reconstruction using acellular dermal matrix with 30 breasts randomized to conventional closed suction (one breast left vs right) and 30 breasts randomized to continuous negative pressure devices (=60 breasts total)

Exclusion Criteria:

* presence of necrotic tissue
* untreated osteomyelitis
* malignancy (except terminal patients for quality of life issues)
* untreated malnutrition
* use on exposed arteries, veins, or organs
* use on non-enteric and unexplored fistulas Special precaution will be taken when using the NPWT device in patients on anticoagulants, exhibiting otherwise difficult hemostasis, or non-adherent patients.
B: Inclusion Criteria:

* Pregnant women with BMI \> 40 undergoing a cesarean delivery at Parkland Health and Hospital System.

Exclusion Criteria:

* Any patient not meeting inclusion criteria will be deemed ineligible.
* All HIV positive patients will be excluded due to the increased risk of infectious complications in these patients.
* Although patients on anticoagulants can use NPWT, they will be excluded as there may be an increased risk of bleeding in these patients.
* according to the wound therapy manufacturer's instructions patients with:

  * fragile skin
  * allergy to silver or acrylic adhesives
  * a malignancy in the wound bed or margins of the wound bed
  * non-enteric and unexplored fistulas
  * necrotic tissue with eschar present
  * exposed arteries, veins, nerves or organs, anastomotic sites, or surgical suction are not candidates for usage of the device.
C: Key inclusion criteria BMI greater than or equal to 30 kg/m2 at less than or equal to 22 weeks of gestation Subject is laboring Subject is having an unplanned cesarean section Subject will have Pfannenstiel Skin Incision Subject has the ability to take a picture and email it to a secure account Subject receives prenatal care in the University of Pennsylvania health system and plans to follow up postpartum in the system Subject is greater than or equal to 18 years of age

Key exclusion criteria Subject cannot read or speak English Subject is not 18 years of age Subject does not have ability to send a picture by email Subject has preexisting diabetes mellitus (Type 1 or Type 2) , is using chronic steroids or immune-suppressants, OR being actively treated for a malignancy Subject is undergoing a scheduled cesarean section Subject is allergic to silver
D: Inclusion Criteria:

* patients presenting to wound center undergoing wound treatment with expected closure of wounds including: Midfoot amputations, below knee amputations, knee disarticulations, above knee amputations, and trunk wounds
* wounds must be closed primarily without the use of grafts

Exclusion Criteria:

* any patient \<18 years old
* any patient whose wound is unable to be closed primarily

Answer: D