Improving Head CT Scan Decisions for Pediatric Minor Head Trauma in General Emergency Departments: A Pragmatic Implementation Study.

STUDY OBJECTIVE: To measure the effectiveness of a multimodal strategy, including simultaneous implementation of a clinical decision support system, to sustain adherence to a clinical pathway for care of children with minor head trauma treated in general emergency departments (EDs). METHODS: Prospective, type III hybrid effectiveness-implementation cohort study with a nonrandomized stepped-wedge design and monthly repeated site measures. The study population included pediatric minor head trauma encounters from July 2018 to December 2020 at 21 urban and rural general ED sites in an integrated health care system. Sites received the intervention in 1 of 2 steps, with each site providing control and intervention observations. Measures included guideline adherence, the computed tomography (CT) scan rate, and 72-hour readmissions with clinically important traumatic brain injury. Analysis was performed using multilevel hierarchical modeling with random intercepts for the site and physician. RESULTS: During the study, 12,670 pediatric minor head trauma encounters were cared for by 339 clinicians. The implementation of the clinical pathway resulted in higher odds of guideline adherence (adjusted odds ratio 1.12 [95% confidence interval 1.03 to 1.22]) and lower odds of a CT scan (adjusted odds ratio 0.96 [95% confidence interval 0.93 to 0.98]) in intervention versus control months. Absolute risk difference was observed in both guideline adherence (site median: +2.3% improvement) and the CT scan rate (site median: -6.6% reduction). No 72-hour readmissions with confirmed clinically important traumatic brain injury were identified. CONCLUSION: Implementation of a minor head trauma clinical pathway using a multimodal approach, including a clinical decision support system, led to sustained improvements in adherence and a modest, yet safe, reduction in CT scans among generally low-risk patients in diverse general EDs.

The effects of musical stimulation on the level of consciousness among patients with head trauma hospitalized in intensive care units: A randomized control trial.

BACKGROUND: Improvement in the level of consciousness (LOC) is considered as an indicator of recovery among patients with head trauma (HT). musical stimulation is a simple noninvasive intervention with potential positive effects on LOC. This study evaluated the effects of musical stimulation on LOC among patients with HT hospitalized in intensive care unit. METHODS: This clinical trial was conducted in 2018-2019. Fifty-four patients with HT were purposively and consecutively recruited from two trauma intensive care units in Qazvin, Iran, and randomly allocated to a control (n = 27) and an intervention (n = 27) group. Participants in the intervention group received fifteen-minute musical stimulation once daily for seven consecutive days using an MP3 player and a headphone for their counterparts, the headphones were silent for 15 min without receiving any musical stimulation once daily for seven consecutive days. A demographic questionnaire, the Glasgow Coma Scale, and the Richmond Agitation-Sedation Scale were used for data collection. LOC was daily assessed before and after each musical stimulation session. The SPSS program (v. 23.0) was used for data analysis at a significance level of less than 0.05. FINDINGS: There were significant between-group differences respecting the posttest mean score of LOC in the third, fourth, fifth, sixth, and seventh days of the study intervention (P < 0.05)., the posttest mean score of LOC in the intervention group significantly increased in the intervention group (P < 0.0001), while it did not significantly change in the control group (P > 0.05). CONCLUSION: musical stimulation is effective in significantly improving LOC among hospitalized patients with HT. Therefore, it can be used as a non-expensive noninvasive intervention to improve treatment outcomes among these patients.

Therapeutic Effect of Enteral Nutrition Supplemented with Probiotics in the Treatment of Severe Craniocerebral Injury: A Systematic Review and Meta-Analysis.

BACKGROUND: Whether early enteral nutrition with probiotics can reduce the mortality and infection rate of patients with severe craniocerebral injury (SCI), improve their gastrointestinal function, and shorten the length of stay in the intensive care unit (ICU) has not been determined. METHODS: PubMed, China National Knowledge Infrastructure, and Embase were electronically searched for the purpose of identifying randomized controlled trials investigated the potential of early enteral nutrition supplemented with probiotics on patients with SCI from the establishment of databases to August 26, 2019. STATA software version 12.0 was used to perform meta-analysis. RESULTS: A total of 39 trials enrolling 3387 patients were included. Early enteral nutrition supplemented with probiotics was associated with decreased risk of infection (pooled risk ratio [RR], 0.486; 95% confidence interval [CI], 0.394-0.599), decreased risk of 7-, 14-, and 28-day mortality (pooled RRs, 0.415, 0.497, and 0.385; 95% CIs, 0.196-0.878, 0.297-0.833, and 0.197-0.751, respectively), and decreased risk of gastrointestinal complications (pooled RR, 0.363; 95% CI, 0.274-0.481). It also shortened the time course recovery of enteral function and shortened the length of stay in hospital and length of ICU stay (standardized mean differences, -3.327 and -1.461; 95% CIs, -6.213 to -0.440 and -2.111 to -0.811, respectively). CONCLUSIONS: Enteral nutrition supplemented with probiotics effectively decreases the risk of mortality, gastrointestinal complications, and infection, and shortens the stays in ICU; therefore, it should be extensively adopted to manage these given patients.

The effects of peppermint gel on prevention of pressure injury in hospitalized patients with head trauma in neurosurgical ICU: A double-blind randomized controlled trial.

OBJECTIVE: This study aimed to evaluate the effect of peppermint gel on the prevention of pressure injuries in patients with head trauma admitted to neurosurgical intensive care units. DESIGN: This double blind, randomized, controlled clinical trial study was conducted on 150 patients with head trauma admitted to the ICU. Using sealed envelopes, patients were assigned randomly into two intervention (n = 75) and control (n = 75) groups. SETTING: The study was conducted in the ICUs of a university hospital and a general hospital in Shiraz, Iran. INTERVENTION: The intervention group received peppermint gel three times a day up to 14 days during the skin care as a layer on the skin areas exposed to the risk of pressure injuries. The control group used a placebo gel. PRIMARY OUTCOMES: The expected outcome in this study was the incidence of pressure injuries stage I, which once daily was evaluated by pairs of observers with the National Pressure Ulcer Advisory Panel. RESULTS: The incidence rate of pressure injuries was 22.8% and 77% in the intervention and the control groups, respectively. The chi-square test result showed a significant deference between two groups (P < 0.001). Sacrum was the most common site for incidence of the pressure injuries. CONCLUSION: The findings showed that the peppermint gel has a positive effect in the prevention of pressure injuries in the patients with head trauma admitted to ICUs. So, the use of this gel is suggested as an easy and low-cost method for prevention of pressure injuries in the patients admitted to ICUs.

Wounds in the Head from Kitab al-Dhakhira fi 'Ilm al-Tibb by Thabit b. Qurra in the Ninth Century.

OBJECTIVE: Kitab al-Dhakhira fi 'Ilm al-Tibb is one of Thabit b. Qurra's most noteworthy books on medicine in Arabic in the ninth century. This study aims to present and discuss the section subtitled "wounds in the head" in the 24th chapter of Kitab al-Dhakhira considering the information in the literature. MATERIALS AND METHODS: This study is primarily based on a copy of Kitab al-Dhakhira edited by Dr. G. Sobhy and printed in al-Matba'at al-Amiriyya, Cairo in 1928. It is compared with the manuscript, which is in the Sehit Ali Pasa Collection, nr. 2028, in the Süleymaniye Manuscript Library in Istanbul, Turkey. The 24th chapter was first translated into English and then examined. The acquired knowledge from the chapter is discussed in this study by comparing it with that on this subject from the literature regarding the history of medicine. RESULTS: The 24th chapter, entitled "On Wounds and Wounds in the Head and Hemorrhage from Them and from Other Wounds and on Gently Drawing Arrowhead/Spearhead and Thorn," includes a section subtitled "wounds in the head." This section provides information regarding steps to be taken if the head is simply wounded or if there is an accompanying swelling, how to control hemorrhage, which medicines should be used for treatment, and how to bandage wounds in the head, but unfortunately, it specifies no details regarding surgical interventions for such wounds. CONCLUSIONS: Kitab al-Dhakhira presents interesting knowledge regarding wounds in the head, reflecting the medical paradigm of that era.

Early enteral nutrition supplemented with probiotics improved the clinical outcomes in severe head injury: Some promising findings from Chinese patients.

BACKGROUND: The role of early enteral nutrition (ENN) supplemented with probiotics (<48 hours) in improving clinical outcomes of patients with severe head injury (SHI) remains controversial. We performed this meta-analysis to investigate the efficacy of EEN supplemented with probiotics on clinical outcomes in these patients. METHODS: Systematic searches were performed in PubMed, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang database, and Chinese Biomedical Literature to identify potential studies. Two investigators checked citations, extracted data, appraised risk of bias, and then STATA 12.0 was used to perform statistical analysis. RESULTS: A total of 18 trials were eventually included in the present study. Meta-analysis indicated that EEN supplemented with probiotics was associated with decreased risk of infection (risk ratio [RR], 0.53; 95% confidence interval [CI], 0.44-0.65), decreased risk of mortality (RR, 0.56; 95% CI, 0.38-0.82), decreased risk of gastrointestinal complications (RR, 0.19; 95% CI, 0.13-0.25), and shortened stays in intensive care unit (ICU) (mean difference [MD], -4.55; 96% CI, -5.91 to -3.19). CONCLUSION: EEN supplemented with probiotics may be a promising alternative for patients with SHI because it effectively decreased the risk of infection, mortality, and gastrointestinal complications, as well as shortened the stays in ICU.

Alternative Therapies to Fat Grafting in the Craniofacial Region.

Autologous fat grafting is a technique with various applications in the craniofacial region ranging from the treatment of wounds, scars, keloids, and soft tissue deformities. In this review, alternative therapies to fat grafting are discussed. These are composed of established therapies like silicone gel or sheeting, corticosteroids, cryotherapy, and laser therapy. Novel applications of negative pressure wound therapy, botulinum toxin A injection, and biologic agents are also reviewed.

[Antimicrobial anti-inflammatory photodynamic and light-emitting-diode phototherapy of the consequences of the gunshot and mine-blast injury to the face, head, and neck including damage to the ENT organs]. / Antimikrobnaia protivovospalitel'naia fotodinamicheskaia i svetodiodnaia fototerapiia posledstvii ognestrel'noi i minno-vzryvnoi travmy golovy i shei.

The objective of the present study was the enhancement of the effectiveness of the treatment of the consequences of the gunshot wounds and mine-blast injuries inflicted to the face, head, and neck encountered in the otolaryngological practice as well as the prevention of the formation of the large demarcation areas in the injured tissues and the preparation of these tissues for the further restorative treatment. Anti-microbial and anti-inflammatory photodynamic therapy (PDT) as well as light-emitting-diode (LED) phototherapy were carried out in 20 patients who suffered gunshot wounds and mine-blast injuries to the face, head, and neck. The photodynamic therapy was performed with the use of an aqueous solution of methylene blue at a concentration of 0.1%, the 'Alod-1' infrared laser ('Granat' modification, Russia), and the 'AFS-Solaris' light-emitting diode-based phototherapeutic apparatus (Russia). The analysis of the results of the study has demonstrated the high efficiency of the proposed approach that made it possible to prevent the development of severe septic complications, reduce the amount of drug therapy, significantly shorten duration of the treatment, and create the conditions for the earlier rehabilitation and further plastic and cosmetic restoration of the tissue structures.

Impact of Zinc Supplementation on the Clinical Outcomes of Patients with Severe Head Trauma: A Double-Blind Randomized Clinical Trial.

To determine the effects of zinc supplementation on clinical outcomes of patients with severe head trauma, this double-blind clinical trial randomly allocated 100 patients with severe head trauma, aged between 18 to 65 years, to receive placebo or 120 mg zinc via a nasogastric tube for 15 days. Plasma zinc and copper, 24-hour urinary zinc excretion, Sequential Organ Failure Assessment (SOFA) were assessed on days 1, 7, and 16. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cell (WBC) count were measured on days 1 and 16. Glasgow outcome score (GOS), mortality rate on day 28, and length of stay (LOS) were compared between groups. There were no significant differences in baseline data between groups (all p > .05). Mean plasma zinc concentration was significantly higher in the zinc group than the placebo group on day 7 (119.5 vs. 81.7 µg/dl, p < .001) and day 16 (124.1 vs. 101.1 µg/dl, p < .001). The SOFA, GOS, and inflammation factors were significantly better in the zinc-supplemented group by day 16 (all p < .05). The LOS was shorter (52 vs. 65 days, p = .043) and mortality rate on day 28 was borderline lower (17% vs. 22%, p = .507) in zinc versus placebo groups. Zinc supplementation in the study had favorable effects on GOS, SOFA score, and inflammatory markers in patients with severe head injury.

Pediatric Headache: An Overview.

Headache represents the most common neurologic disorder in the general population including children and is increasingly being recognized as a major source of morbidity in youth related to missed school days and activities. In this article, we take a holistic approach to the child presenting with headache with a focus on the detailed headache history, physical and neurologic examinations, and diagnostic evaluation of these patients. Clinical presentations and classification schema of multiple primary and secondary headache types in children are discussed using the International Headache Criteria (IHCD-3) as a guide, and a summary provided of the various treatment modalities employed for pediatric headache including lifestyle modifications, behavioral techniques, and abortive and preventive medications.

[Hyperbaric oxygen therapy at different pressure levels for aphasia following craniocerebral injury: efficacy, safety and patient adherence to therapy].

OBJECTIVE: To observe the clinical effect of hyperbaric oxygen (HBO) therapy at different pressure levels on aphasia after craniocerebral injury and assess the patient adherence to the therapies. METHODS: Thirty-one patients with aphasia after craniocerebral injury receiving 30 sessions of HBO therapy at the pressure level of 0.175 MPa and another 31 patients receiving 0.2 MPa therapy were recruited as the treatment groups 1 and 2, respectively; 31 patients who refused to have HBO therapy served as the control group. All the patients received routine therapy. The therapeutic effects were assessed using Western Aphasia Battery (WAB) before and after the therapy. The WAB item and AQ scores, curative effect, and recovery time of aphasia were compared between the 3 groups. RESULTS: The total response rate was significantly lower in the control group as compared with those in treatment groups 1 and 2 (58.06% vs 83.87% and 87.1%). WAB item scores and AQ scores, curative effect, and recovery time of aphasia all showed significant differences between the control group and the two treatment groups (P<0.05), but not between the latter 2 groups (P>0.05). Compared with 0.20 MPa HBO therapy, 0.175 MPa HBO therapy showed a better patient adherence with a significantly lowered non-adherence rate (by 31.37%) an increased partial and total adherence rates (by 13.86% and 17.51%, respectively). CONCLUSION: HBO therapy at the pressure level of 0.175 MPa is more appropriate for treatment of aphasia after craniocerebral injury to ensure the safety, efficacy and patient compliance.

[Maintenance effects of acupoint catgut embedding at early time on gastrointestinal function in patients with craniocerebral injury].

OBJECTIVE: To explore the maintenance effects of acupoint catgut embedding at early time on gastrointestinal function in patients with craniocerebral injury. METHODS: Sixty craniocerebral injury patients with 5 to 12 points of Glasgow coma scale (GCS), according to treatment order, were alternately divided into an observation group and a control group, 30 cases in each one. Patients in the control group were treated with regular treatment and nursing care. Based on this, patients in the observation group, according to different pathogenesis and symptoms presented within 24 h into hospitalization, were additionally treated with acupoint catgut embedding. The recovery time of borborygmus, time of first anal aerofluxus, time of first defecation, abdominal pressure at different time points, the occurrence rate of complications (upper gastrointestinal hemorrhage, diarrhea, vomiting), time of enteral nutrition tolerance rate reaching 30 kcal/kg x d were observed and recorded. RESULTS: The recovery time of borborygmus, time of first anal aerofluxus, time of first defecation and time of enteral nutrition tolerance rate reaching 30 kcal/kg x d in the observation group were all earlier to those in the control group (all P<0.01). At 48 h, 4 d and 7 d into hospitalization, the abdominal pressures in the observation group were all lower than those in the control group [(11.10 +/- 1.47) mmHg vs. (13.50 +/- 1.43) mmHg, (8.40 +/- 1.25) mmHg vs. (11.90 +/- 1.56) mmHg, (6.73 +/- 0.74) mmHg vs. (10.80 +/- 1.30) mmHg, all P<0.01]. There were 8 cases with complications of gastrointestinal hemorrhage, diarrhea and vomiting in the observation group with the occurrence rate o 27% (8/30), which was lower than those in the control group (70.0% (21/30), P<0.01. CONCLUSION: The acupoint catgut embedding at early time in craniocerebral injury patients could improve the recovery of gastrointestinal function, reduce intolerance of enteral nutrition and occurrence rate of various complications.

Current topics in sports-related head injuries: a review.

We review the current topic in sports-related head injuries including acute subdural hematoma (ASDH), concussion, and chronic traumatic encephalopathy (CTE). Sports-related ASDH is a leading cause of death and severe morbidity in popular contact sports like American football in the USA and judo in Japan. It is thought that rotational acceleration is most likely to produce not only cerebral concussion but also ASDH due to the rupture of a parasagittal bridging vein, depending on the severity of the rotational acceleration injury. Repeated sports head injuries increase the risk for future concussion, cerebral swelling, ASDH or CTE. To avoid fatal consequences or CTE resulting from repeated concussions, an understanding of the criteria for a safe post-concussion return to play (RTP) is essential. Once diagnosed with a concussion, the athlete must not be allowed to RTP the same day and should not resume play before the concussion symptoms have completely resolved. If brain damage has been confirmed or a subdural hematoma is present, the athlete should not be allowed to participate in any contact sports. As much remains unknown regarding the pathogenesis and pathophysiology of sports-related concussion, ASDH, and CTE, basic and clinical studies are necessary to elucidate the crucial issues in sports-related head injuries.

[Comparative analysis of gerontologic prophylaxis efficiency and membranotropic action of various gas therapy].

The research was executed on 320 male patients aged 35-92 years with various polyorgan pathology in a compensation stage. The treatment by gases was used: hyperbaric oxygenation, dry carbonic acid baths, ozon therapy, hypo oxygen therapy and their combinations. On indicators of biological age various age-dependent geroprophylactics effect of gas therapy was established. On indicators of resistance of erythrocytes various safety of used modes was found.

Catastrophic head and neck injuries in judo players in Japan from 2003 to 2010.

BACKGROUND: Few studies have documented catastrophic head and neck injuries in judo, but these injuries deserve greater attention. PURPOSE: To determine the features of catastrophic head and neck injuries in judo. STUDY DESIGN: Descriptive epidemiological study. METHODS: This study was based on the accident reports submitted to the All Japan Judo Federation's System for Compensation for Loss or Damage. A total of 72 judo injuries (30 head, 19 neck, and 23 other injuries) were reported between 2003 and 2010. The investigated parameters were mechanism of injury, age at time of injury, length of judo experience, diagnosis, and outcome. RESULTS: Among head injuries, 27 of 30 (90%) occurred in players younger than 20 years of age. The relationship between age, mechanism, and location of injury was more relevant when players younger than 20 years incurred head injury while being thrown (P = .0026). Among neck injuries, 13 of 19 (68%) occurred in players with more than 36 months of experience. The relationship between experience, mechanism, and location of injury was more relevant when experienced players incurred neck injury while executing an offensive maneuver (P = .0294). Acute subdural hematoma was diagnosed in 94% of head injuries. The outcomes of head injury were as follows: 15 players died; 5 were in a persistent vegetative state; 6 required assistance because of higher brain dysfunction, hemiplegia, or aphasia; and 4 had full recovery. Among neck injuries, 18 players were diagnosed with cervical spine injury, 11 of whom had fracture-dislocation of the cervical vertebra; there was also 1 case of atlantoaxial subluxation. The outcomes of neck injury were as follows: 7 players had complete paralysis, 7 had incomplete paralysis, and 5 had full recovery. CONCLUSION: Neck injuries were associated with having more experience and executing offensive maneuvers, whereas head injuries were associated with age younger than 20 years and with being thrown.

Emergency physicians' knowledge and attitudes of clinical decision support in the electronic health record: a survey-based study.

OBJECTIVES: The objective was to investigate clinician knowledge of and attitudes toward clinical decision support (CDS) and its incorporation into the electronic health record (EHR). METHODS: This was an electronic survey of emergency physicians (EPs) within an integrated health care delivery system that uses a complete EHR. Randomly assigned respondents completed one of two questionnaires, both including a hypothetical vignette and self-reported knowledge of and attitudes about CDS. One vignette version included CDS, and the other did not (NCDS). The vignette described a scenario in which a cranial computed tomography (CCT) is not recommended by validated prediction rules (the Pediatric Emergency Care Applied Research Network [PECARN] rules). In both survey versions, subjects responded first with their likely approach to evaluation and then again after receiving either CDS (the PECARN prediction rules) or no additional support. Descriptive statistics were used for self-reported responses and multivariate logistic regression was used to identify predictors of self-reported knowledge and use of the PECARN rules, as well as use of vignette responses. RESULTS: There were 339 respondents (68% response rate), with 172 of 339 (51%) randomized to the CDS version. Initially, 25% of respondents to each version indicated they would order CCTs. After CDS, 30 of 43 (70%) of respondents who initially would order CCTs changed their management decisions to no CCT versus two of 41 (5%) with the NCDS version (chi-square, p = 0.003). In response to self-report questions, 81 of 338 respondents (24%) reported having never heard of the PECARN prediction rules, 122 of 338 (36%) were aware of the rules but not their specifics, and 135 of 338 (40%) reported knowing the rules and their specifics. Respondents agreed with favorable statements about CDS (75% to 96% agreement across seven statements) and approaches to its implementation into the EHR (60% to 93% agreement across seven statements). In multivariable analyses, EPs with tenure of 5 to 14 years (odds ratio [AOR] = 0.51, 95% confidence interval [CI] = 0.30 to 0.86) and for 15 years or more (AOR = 0.37, 95% CI = 0.20 to 0.70) were significantly less likely to report knowing the specifics of the PECARN prediction rules compared with EPs who practiced for fewer than 5 years. In addition, in the initial vignette responses (across both versions), physicians with ≥15 years of ED tenure compared to those with fewer than 5 years of experience (AOR = 0.30, 95% CI = 0.13 to 0.69), and those reporting knowing the specifics of the PECARN prediction rules were less likely to order CCTs (AOR = 0.53, 95% CI = 0.30 to 0.92). CONCLUSIONS: EPs incorporated pediatric head trauma CDS via the EHR into their clinical judgment in a hypothetical scenario and reported favorable opinions of CDS in general and their inclusion into the EHR.

Management of minor head injury in patients receiving oral anticoagulant therapy: a prospective study of a 24-hour observation protocol.

STUDY OBJECTIVE: Patients receiving warfarin who experience minor head injury are at risk of intracranial hemorrhage, and optimal management after a single head computed tomography (CT) scan is unclear. We evaluate a protocol of 24-hour observation followed by a second head CT scan. METHODS: In this prospective case series, we enrolled consecutive patients receiving warfarin and showing no intracranial lesions on a first CT scan after minor head injury treated at a Level II trauma center. We implemented a structured clinical pathway, including 24-hour observation and a CT scan performed before discharge. We then evaluated the frequency of death, admission, neurosurgery, and delayed intracranial hemorrhage. RESULTS: We enrolled and observed 97 consecutive patients. Ten refused the second CT scan and were well during 30-day follow-up. Repeated CT scanning in the remaining 87 patients revealed a new hemorrhage lesion in 5 (6%), with 3 subsequently hospitalized and 1 receiving craniotomy. Two patients discharged after completing the study protocol with 2 negative CT scan results were admitted 2 and 8 days later with symptomatic subdural hematomas; neither received surgery. Two of the 5 patients with delayed bleeding at 24 hours had an initial international normalized ratio greater than 3.0, as did both patients with delayed bleeding beyond 24 hours. The relative risk of delayed hemorrhage with an initial international normalized ratio greater than 3.0 was 14 (95% confidence interval 4 to 49). CONCLUSION: For patients receiving warfarin who experience minor head injury and have a negative initial head CT scan result, a protocol of 24-hour observation followed by a second CT scan will identify most occurrences of delayed bleeding. An initial international normalized ratio greater than 3 suggests higher risk.

[Vacuum-assisted closure of head and neck wounds]. / Vakuumversiegelungstherapie im Kopf-Hals-Bereich.

OBJECTIVE: Since the early 1990s, vacuum-assisted closure (VAC) therapy has been used to treat acute and chronic wounds in almost all disciplines of surgery in Germany. Taking this into consideration, the use of vacuum therapy in the area of head and neck surgery was examined. METHODS: A literature review using MEDLINE (with PubMed) and EMBASE as well as a Cochrane search was performed on 15 December 2010. Search terms included "vacuum therapy", "vacuum-assisted closure", "V.A.C.", "VAC", "(topical) negative pressure (wound therapy)". RESULTS: There were 1,502 peer-reviewed articles about "vacuum therapy" concerning all medical fields in literature. There were a total of 37 publications from the discipline of head and neck surgery (538 patients). Although benefits for the patients are consistently reported, these results are usually presented only in case reports or case series (evidence level IV and V). Positive results are mainly observed for the treatment of lifting defects in reconstructive surgery and for the treatment of acute and chronic soft tissue defects of the neck. Only little experience exists in the vacuum therapy of war wounds in the head and neck region. CONCLUSION: Due to its advantages (i.e., hygienic temporary wound care with support of the continuous decontamination, wound drainage, promotion of granulation tissue formation, and effective wound conditioning), VAC is an integral and indispensable part of modern wound treatment. Analogous to this general experience, a benefit must also be assumed for head and neck wounds. High-quality and reliable studies on the use of VAC must be performed to verify this observation and the future reimbursement of in- and outpatient wound VAC treatment.