Identification of the furanose ring conformations and the factors driving their adoption.

Three groups of furanoses with restricted freedom of rotation on the C3-C4, C2-C3, and C1-C2 bonds, respectively, are presented. Conformational analysis of these furanoses is conducted based on the proton nuclear magnetic resonance (1H NMR) spectroscopy, density functional theory (DFT) calculations, and X-ray analysis. It is shown that the particular group of the presented furanoses is locked in the specific conformation. These are the 1T2-like, the 0E-like, and the 3T4-like conformation, respectively. Characteristic 1H NMR spectra of these three conformations are presented and the factors influencing the conformational preferences of the analyzed furanoses are discussed.

Characteristic 1H NMR spectra of ß-d-ribofuranosides and ribonucleosides: factors driving furanose ring conformations.

A series of ß-d-ribofuranosides and ribonucleosides fused with 2,3-O-isopropylidene ring was synthesized and studied in terms of their conformational preferences. Based on the 1H NMR spectra, DFT calculations, and X-ray analysis the E 0-like and E 4-like conformations adopted by these furanosides are identified. The 3 E-like and 2 E-like conformations are assigned to ribonucleosides without the 2,3-O-isopropylidene group. The studies are supported by analysis of the structural data of ß-d-ribofuranosides and ribonucleosides deposited in the Cambridge Crystallographic Data Center (CCDC) database. Finally, the factors influencing the conformational preferences of the furanose ring with the ß-d-ribo configuration are indicated. These are the unfavorable ecliptic orientation of the 2-OH and 3-OH groups, the 1,3-pseudodiaxial interaction of the aglycone and terminal hydroxymethyl group and the endo-anomeric effect. It is also proved that the exo-anomeric effect acts in ß-d-ribofuranosides.

Risk factors for long-term survival in patients with ypN+ M0 rectal cancer after radical anterior resection.

BACKGROUND: Regional lymph node metastases are the main adverse prognostic factor in patients with rectal cancer without distant metastases. There are discrepancies, however, regarding additional risk factors in the group of ypN + M0 patients. The purpose of the study was to assess clinical and pathological factors affecting long-term oncological outcomes in the group of ypN + M0 patients after radical rectal anterior resection. METHODS: 112 patients with ypN + M0 rectal cancer after neoadjuvant therapy and radical anterior resection were subject to a retrospective analysis. The effect of potential factors on survival was assessed with the use of Kaplan-Meier curves together with a log-rank test and multiple factor Cox proportional hazards model. RESULTS: In the multiple factor Cox analysis, adverse factors affecting disease-free survival (DFS) were: the use of angiotensin-converting enzyme inhibitors (ACEIs) (hazard ratio HR: 3.11, 95% CI 1.01-9.56, p = 0.047), presence of perineural invasion (HR: 7.27, 95% CI 2.74-19.3, p < 0.001) and occurrence of postoperative complications (HR: 6.79, 95% CI 2.09-22.11, p = 0.001), while a positive factor was the negative lymph node (NLN) count > 7 (HR: 0.33, 95% CI 0.12-0.88, p = 0.026). In the disease-specific survival (DSS) analysis, an adverse factor was the use of ACEIs (HR: 4.275, 95% CI 1.44-12.694, p = 0.009), while a positive effect was caused by NLN > 5 (HR: 0.22, 95% CI 0.082-0.586, p = 0.002). CONCLUSIONS: The use of ACEIs may have a negative effect on long-term treatment outcomes in patients with ypN + M0 rectal cancer. In this group of patients, the NLN count seems to be an important prognostic factor, as well.

In Situ Micro-Observation of Surface Roughness and Fracture Mechanism in Metal Microforming of Thin Copper Sheets with Newly Developed Compact Testing Apparatus.

A better understanding of material deformation behaviours with changes in size is crucial to the design and operation of metal microforming processes. In order to facilitate the investigation of size effects, material deformation behaviours needed to be determined directly from material characterizations. This study was aimed at the design and manufacture of a compact universal testing machine (UTM) compatible with a 3D laser-confocal microscope to observe the deformation behaviour of materials in real-time. In this study, uniaxial micro tensile testing was conducted on three different thin (0.05 mm, 0.1 mm, and 0.3 mm) copper specimens with characteristic dimensions at micro scales. Micro tensile experimental runs were carried out on copper specimens with varying grain sizes on the newly developed apparatus under a 3D laser-confocal microscope. Microscale experiments under 3D laser-confocal microscope provided not only a method to observe the microstructure of materials, but also a novel way to observe the early stages of fracture mechanisms. From real-time examination using the newly developed compact testing apparatus, we discovered that fracture behaviour was mostly brought about by the concave surface formed by free surface roughening. Findings with high stability were discovered while moving with the sample grasped along the drive screw in the graphical plot of a crosshead's displacement against time. Our results also showed very low mechanical noise (detected during the displacement of the crosshead), which indicated that there were no additional effects on the machine, such as vibrations or shifts in speed that could influence performance. The engineering stress-strain plots of the pure copper-tests with various thicknesses or samples depicted a level of stress necessary to initiate plastic flowing inside the material. From these results, we observed that strength and ductility declined with decreasing thickness. The influence of thickness on fracture-strain, observed during tensile testing, made it clear that the elongation-at-break of the pure-copper foils intensely decreased with decreases in thickness. The relative average surface-roughness Ra was evaluated, which showed us that the surface-roughness escalated with the increasing trend of plasticity deformation (plastic strain) ε. For better understanding of the effects of plastic strain on surface roughness prior to material fractures, micro tensile tests were performed on the newly developed machine under a 3D laser-confocal-microscope. We observed that homogeneous surface roughness was caused by plastic strain, which further formed the concave surface that led to the fracture points. Finally, we concluded that surface roughness was one of the crucial factors influencing the fracture behaviour of metallic sheet-strips in metal microforming. We found that this type of testing apparatus could be designed and manufactured within a manageable budget.

Fibular Free Flap and Iliac Crest Free Flap Mandibular Reconstruction In Patients With Mandibular Ameloblastomas.

ABSTRACT: Ameloblastoma (AM) is the most common, locally aggressive odontogenic tumor. It comprises about 1% of all head and neck neoplasms. It occurs mainly in young adults in their 3rd and 4th decade of life. It localizes in the mandible in about 80% of the cases. According to the 2017 WHO classification, 4 types of ameloblastoma can be distinguished: ameloblastoma (previously referred to as solid/multicystic-SMA; the "conventional type" AM), unicystic (AM-UA), extraosseous/peripheral (AM-PA), and malignant/metastatic (AM-MA). Solid, multicystic is the most common type. It is characteristic for its aggressiveness and high risk of recurrence. Radical resection with consecutive reconstruction is the treatment of choice of mandibular ameloblastomas.In this study, the authors present their experience in the surgical treatment of mandibular ameloblastomas with vascularized free flap reconstructions. They discuss new technological possibilities that could improve the precision of the reconstructive procedure and therefore result in the better aesthetic outcome.The retrospective study of a group of 21 patients suffering from mandibular ameloblastoma who underwent segmental man-dibulectomy with simultaneous microvascular free flap reconstruction was conducted. A thorough clinical analysis with various aspects was performed. Tumors resected before 2017 were double checked patomorphologically and assigned to the corrected subtype group.Seven patients were admitted to the department due to recurrent ameloblastoma. The most common localization of the tumor was the mandibular body ( n = 6) andbodywith ramus of the mandible ( n = 6). A total amount of 10 iliac crest free flaps and 12 fibular free flaps were performed. Complications were reported in 4 patients. A purulent oro-cutaneus fistula occurred in 3 patients. There was a flap failure in each reconstructive group. The virtual surgical planning with intraoperative cone-beam computed tomography was used in 3 patients. Dentition implantation was conducted in 4 patients (3 simultaneously, 1 postponed). The mean follow-up was 5 years and 8 months.Radical resection that covers radical segmental mandibulect-omy with immediate microvascular free flap reconstruction is a first-line and only effective treatment of mandibular ameloblas-tomas, that eliminates the risk of recurrence. The extent of surgical margins seems not to influence the recurrence rate, yet further investigation with statistical analysis should be performed. The choice of the adequate free flap must be adapted to dimensions and localization of the tumor and to each patient individually.New technologies such as virtual surgical planning with 3D models and intraoperative cone-beam computed tomography can make the reconstruction more accurate, improving patient's quality of life.

Productivity Enhancement by Prediction of Liquid Steel Breakout during Continuous Casting Process in Manufacturing of Steel Slabs in Steel Plant Using Artificial Neural Network with Backpropagation Algorithms.

Breakout is one of the major accidents that often arise in the continuous casting shops of steel slabs in Bokaro Steel Plant, Jharkhand, India. Breakouts cause huge capital loss, reduced productivity, and create safety hazards. The existing system is not capable of predicting breakout accurately, as it considers only one process parameter, i.e., thermocouple temperature. The system also generates false alarms. Several other process parameters must also be considered to predict breakout accurately. This work has considered multiple process parameters (casting speed, mold level, thermocouple temperature, and taper/mold) and developed a breakout prediction system (BOPS) for continuous casting of steel slabs. The BOPS is modeled using an artificial neural network with a backpropagation algorithm, which further has been validated by using the Keras format and TensorFlow-based machine learning platforms. This work used the Adam optimizer and binary cross-entropy loss function to predict the liquid breakout in the caster and avoid operator intervention. The experimental results show that the developed model has 100% accuracy for generating an alarm during the actual breakout and thus, completely reduces the false alarm. Apart from the simulation-based validation findings, the investigators have also carried out the field application-based validation test results. This validation further unveiled that this breakout prediction method has a detection ratio of 100%, the frequency of false alarms is 0.113%, and a prediction accuracy ratio of 100%, which was found to be more effective than the existing system used in continuous casting of steel slab. Hence, this methodology enhanced the productivity and quality of the steel slabs and reduced substantial capital loss during the continuous casting of steel slabs. As a result, the presented hybrid algorithm of artificial neural network with backpropagation in breakout prediction does seem to be a more viable, efficient, and cost-effective method, which could also be utilized in the more advanced automated steel-manufacturing plants.

Effect of closed incision negative pressure wound therapy on incidence rate of surgical site infection after stoma reversal: a pilot study.

INTRODUCTION: The stoma reversal (SR) procedure is associated with a relatively high risk of perioperative complications with surgical site infection (SSI) as the most common. Recently closed incision negative pressure wound therapy (ciNPWT) was applied widely to prevent SSI. AIM: To investigate the efficiency of ciNPWT in terms of the incidence rate of SSI after SR surgery. MATERIAL AND METHODS: As an exploratory observational cohort study patients were treated either with ciNPWT (n = 15) or standard sterile dressing (SSD) (n = 15). CiNPWT was applied every 3 days whereas SSD was changed every day. Clinical evaluation for SSI signs, C-reactive protein level and pain assessment using the visual analogue scale (VAS) were analyzed. RESULTS: The incidence rate of SSI was in 13% (2/15) in the ciNPWT group and 26% (4/15) in the SSD group (p = 0.651, OR = 0.44, 95% CI: 0.03-3.73). All patients in the SSD group who developed SSI presented both local and generalized signs of infection. Pain-VAS levels assessed on the 1st (MdnciNPWT = 4, MdnSSD = 5, p = 0.027, W = 51.5) and 3rd postoperative day (MdnciNPWT = 2, MdnSSD = 4, p = 0.014, W = 45.5) were significantly lower in the ciNPWT group than in the SSD group. CONCLUSIONS: CiNPWT seems not to have a benefit to reduce SSI after the SR procedure. Further investigation is needed to establish firmly the benefit of using ciNPWT in this group of patients.

Concurrent Synthesis and Immobilization of Ag Nanoparticles over TiO2 via Plasma Reduction for Photocatalytic Treatment of Methyl Blue in Water.

Pure TiO2 nanoparticles (TiO2NPs) were produced via the sol-gel method and then coated with silver nanoparticles (AgNPs) to reduce their optical band gap. The concurrent synthesis and immobilization of AgNPs over TiO2NPs was achieved through the interaction of an open-air argon plasma jet with a solution of silver nitrate/stabilizer/TiO2NPs. The one-pot plasma synthesis and coating of AgNPs over TiO2NPs is a more straightforward and environmentally friendly method than others. The plasma-produced Ag/TiO2 nanocomposites were characterized and tested for their photocatalytic potential by degrading different concentrations of methyl blue (MB) in water. The dye concentration, oxidant dose, catalyst dose, and reaction time were also optimized for MB degradation. XRD results revealed the formation of pure AgNPs, pure TiO2NPs, and Ag/TiO2 nanocomposites with an average grain size of 12.36 nm, 18.09 nm, and 15.66 nm, respectively. The immobilization of AgNPs over TiO2NPs was also checked by producing SEM and TEM images. The band gap of AgNPs, TiO2NPs, and Ag/TiO2 nanoparticles was measured about 2.58 eV, 3.36 eV, and 2.86 eV, respectively. The ultraviolet (UV) results of the nanocomposites were supportive of the degradation of synthetic dyes in the visible light spectrum. The AgNPs in the composite not only lowered the band gap but also obstructed the electron-hole recombinations. The Ag/TiO2 composite catalyst showed 90.9% degradation efficiency with a 5 ppm dye concentration after 120 min of light exposure.

Do surgeons use double gloves during surgery? Results of a survey.

<b>Introduction:</b> The perforation of gloves during surgical procedures is quite common. A cheap and quite effective method of reducing the risk of blood-borne infections is wearing two pairs of gloves. Unfortunately, some surgeons are reluctant to it, and they report decreased dexterity and sensation. The aim of the study was to evaluate surgeons' double-gloving practices to determine the factors related to compliance. <br><b>Material and methods:</b> An anonymous, 21-question survey in Polish was sent by post to 41 surgical departments. The questions concerned: demographic data, type of surgical gloves used, allergy to latex, number of surgeries performed, frequency of using double gloves and negative impressions from using them and finally, the frequency of needlestick injuries during surgical procedures. <br><b>Results:</b> We received 179 questionnaires back. More than 62% of the surgeons believe that double gloves provide better protection than a single pair, 24% do not believe in this, and 14% have no opinion. Only 0.6% of respondents always use double gloves during surgery, 19% double glove in at least 25% of cases and 68% do it occasionally. 13% of the surgeons declared that they had never worn double gloves. During high-risk procedures, 86% of respondents wear double gloves. About half of respondents (50.3%) report discomfort while wearing double gloves; 45% - decreased dexterity; about 30% complain of numbness and tingling; and 64% - decreased sensation. <br><b>Conclusion:</b> Due to the high number of surgical glove perforations and relatively high prevalence of needlestick injuries, it is necessary to use methods that reduce the risk of transmission of pathogens. The habit of using a double pair of gloves should be implemented especially among young surgeons starting to train in their specialities. Consequently, the period of initial discomfort will be combined with the acquisition of surgical skills, which will allow for gradual acclimatization.

The first homemade colonoscopy trainer.

Introduction Colonoscopy trainers have gained recognition for improving endoscopy skills and preparing for real procedures on humans. Unfortunately, due to their high price, commercial simulators are hard to obtain, especially for small medical centers. However, a solution might be to construct a device for themselves. Aim Our goal was to build a relatively cheap and easy-to-construct simulator for residents who want to start learning colonoscopy. Materials and methods The box model colonoscopy trainer was designed and constructed. The artificial colon was made from 2 layers of fabric and rubber rings between them. Velcro attached to the artificial colon and to the box, and the tarp straps that simulate peritoneal adhesions allow the bowel to be arranged in many different configurations. Moreover, some aspects of polypectomy training have been incorporated in the colonoscopy simulator. Results The self-constructed simulator was found to be an effective training device, with the total cost of parts not exceeding $30. Conclusions In this paper, we present the first homemade simulator for colonoscopy training. It offers the opportunity for skills acquisition in a preclinical setting.

Conformational studies of N-(α-d-glucofuranurono-6,3-lactone)- and N-(methyl ß-d-glucopyranuronate)-p-nitroanilines.

N-(α-d-Glucofuranurono-6,3-lactone)-p-nitroaniline and N-(methyl ß-d-glucopyranuronate)-p-nitroaniline were obtained as crystalline solids. The single-crystal X-ray diffraction, NMR data and DFT calculations for N-(α-d-glucofuranurono-6,3-lactone)-p-nitroaniline indicate that this N-furanoside adopts a 3T2/3E-like conformation in the crystal lattice, solution and gas phase. Thus, the structure of recorded for N-furanoside 1H NMR spectrum is indicative of the 3T2/3E region of the pseudorotational itinerary for furanose derivatives with α-d-gluco, ß-L-ido and α-d-xylo configurations. Moreover, it is concluded that the 1T2/E2/3T2/3E region of the pseudorotational itinerary for furanose derivatives with d-gluco, L-ido and d-xylo configurations should be characterised by the lack of coupling between H2 and H3 protons, irrespective of the anomeric configuration. Such a lack of vicinal coupling is characteristic for some of the trans-oriented furanose ring protons. The single-crystal X-ray diffraction and NMR data for N-(methyl ß-d-glucopyranuronate)-p-nitroaniline indicate that this N-glucuronide adopts the 4C1 conformation, both in the crystal lattice and solution. The occurrence of anomeric effects in the presented N-glycosides is discussed. The crystal structure analysis of both N-glycosides gives evidence that the amine group in p-nitroaniline is planar due to the nitrogen sp2 hybridisation.

First Complex Allotransplantation of Neck Organs: Larynx, Trachea, Pharynx, Esophagus, Thyroid, Parathyroid Glands, and Anterior Cervical Wall: A Case Report.

OBJECTIVE: Evaluate the possibility of performing a complex vascular allotransplant of all neck organs including skin. SUMMARY BACKGROUND DATA: There are 2 previous attempts described in the literature, none of them being that complex. The first one is nonfunctional due to chronic rejection, the second one is viable yet considerably limited in complexity (no parathyroids, no skin). METHODS: The allotransplantation was performed simultaneously on 2 adjacent operating rooms, using microsurgical techniques. RESULTS: The patient's voice, breathing through mouth, swallowing, and endocrinal functions have been fully restored. CONCLUSIONS: Achieved results show clearly that such operations performed in selected patients can nearly fully restore functional and aesthetic effects in 1 single procedure.

Hyaluronic acid and phospholipid interactions useful for repaired articular cartilage surfaces-a mini review toward tribological surgical adjuvants.

This mini review is focused on the emerging nexus between the medical device and pharmaceutical industries toward the treatment of damaged articular cartilage. The physical rationale of hyaluronic acid and phospholipid preparations as tribological surgical adjuvants for repaired articular cartilage surfaces is explored, with directions for possible new research which have arisen due to the therapeutic advance of the physiochemical scalpel. Because synovial joint lubrication regimes become dysfunctional at articular cartilage lesion sites as a result of the regional absence of the surface active phospholipid layer and its inability to reform without surgical repair, hyaluronic acid and phospholipid intra-articular injections have yielded inconsistent efficacy outcomes and only short-term therapeutic benefits mostly due to non-tribological effects. Parameters for hydrophobic-polar type interactions as applied to the lubricating properties of normal and osteoarthritic synovial fluid useful for repaired articular cartilage surfaces are discussed.

Management of enteroatmospheric fistula with negative pressure wound therapy in open abdomen treatment: a multicentre observational study.

The management of enteroatmospheric fistula (EAF) in open abdomen (OA) therapy is challenging and associated with a high mortality rate. The introduction of negative pressure wound therapy (NPWT) in open abdomen management significantly improved the healing process and increased spontaneous fistula closure. Retrospectively, we analysed 16 patients with a total of 31 enteroatmospheric fistulas in open abdomen management who were treated using NPWT in four referral centres between 2004 and 2014. EAFs were diagnosed based on clinical examination and confirmed with imaging studies and classified into low (<200 ml/day), moderate (200-500 ml/day) and high (>500 ml/day) output fistulas. The study group consisted of five women and 11 men with the mean age of 52·6 years [standard deviation (SD) 11·9]. Since open abdomen management was implemented, the mean number of re-surgeries was 3·7 (SD 2·2). There were 24 EAFs located in the small bowel, while four were located in the colon. In three patients, EAF occurred at the anastomotic site. Thirteen fistulas were classified as low output (41·9%), two as moderate (6·5%) and 16 as high output fistulas (51·6%). The overall closure rate was 61·3%, with a mean time of 46·7 days (SD 43·4). In the remaining patients in whom fistula closure was not achieved (n = 12), a protruding mucosa was present. Analysing the cycle of negative pressure therapy, we surprisingly found that the spontaneous closure rate was 70% (7 of 10 EAFs) using intermittent setting of negative pressure, whereas in the group of patients treated with continuous pressure, 57% of EAFs closed spontaneously (12 of 21 EAFs). The mean number of NPWT dressing was 9 (SD 3·3; range 4-16). In two patients, we observed new fistulas that appeared during NPWT. Three patients died during therapy as a result of multi-organ failure. NPWT is a safe and efficient method characterised by a high spontaneous closure rate. However, in patients with mucosal protrusion of the EAFs, spontaneous closure appears to be impossible to achieve.

Classification, prevention and management of entero-atmospheric fistula: a state-of-the-art review.

BACKGROUND: Entero-atmospheric fistula (EAF) is an enteric fistula occurring in the setting of an open abdomen, thus creating a communication between the GI tract and the external atmosphere. Management and nursing of patients suffering EAF carries several challenges, and prevention of EAF should be the first and best treatment option. PURPOSE: Here, we present a novel modified classification of EAF and review the current state of the art in its prevention and management including nutritional issues and feeding strategies. We also provide an overview on surgical management principles, highlighting several surgical techniques for dealing with EAF that have been reported in the literature throughout the years. CONCLUSIONS: The treatment strategy for EAF should be multidisciplinary and multifaceted. Surgical treatment is most often multistep and should be tailored to the single patient, based on the type and characteristics of the EAF, following its correct identification and classification. The specific experience of surgeons and nursing staff in the management of EAF could be enhanced, applying distinct simulation-based ex vivo training models.

The Value of Scoring Systems for the Diagnosis of Acute Appendicitis.

UNLABELLED: Accurate diagnosis of acute appendicitis (AA) is still a problem and is not always easy, even for experienced surgeons. Studies have shown that 20 to 30% of the appendices removedwere normal. Therefore, various scoring systems have been developed to aid in the diagnosis of doubtful cases and reduce the number of unnecessary appendectomies. The aim of this study was to assess the diagnostic value of different scoring systems in acute appendicitis. MATERIAL AND METHODS: The study involved 94 patients who underwent laparotomy due to suspected acute appendicitis. Medical examination at hospital admission was performed by a resident and a general surgery specialist. The probability of AA was evaluated using six different scoring systems: Alvarado, Fenyo, Eskelinen, Ohman, Tzankis, and RIPASA. The resident calculated the results in individual systems. The decision to perform the operation was taken by a specialist surgeon who did not know the results. RESULTS: Normal appendix was removed in 26% of cases. Eskelinen, RIPASA and Alvarado systems showed highest sensitivity (99%, 88% and 85%, respectively). Tzankis and Fenyo systems showed highest specificity (62% and 50%, respectively). CONCLUSIONS: Our study has shown limited value of scoring systems for the diagnosis of acute appendicitis. The systems may improve diagnostic accuracy as they require obtaining a more detailed medical history, and making a more thorough and organized data analysis. However, the scoring systems should be treated only as an aid to diagnosis.

Video display during laparoscopy - where should it be placed?

INTRODUCTION: During laparoscopy, the monitor is usually placed near the operating table, at eye level, which significantly affects hand-eye coordination. First, it is impossible for the surgeon to simultaneously observe the operative field and hand movement. Second, the axis of view of the endoscope rarely matches the natural axis of the surgeon's sight: it resembles a direct view into the operative field. Finally, as the arms of the tools act as levers with a fulcrum at the site of the skin incision, the action of the tool handles is a mirror image of the movement of the tool tips seen on the monitor. Studies have shown that a neutral position with the head flexed at 15-45° is the most ergonomically suitable. AIM: To evaluate whether the level of monitor placement exerts an influence on laparoscopic performance. MATERIAL AND METHODS: A group of 52 students of medicine were asked to pass a thread through 9 holes of different sizes, placed at different levels and angles, using a self-made laparoscopic simulator. Each student performed the task four times in two monitor positions: at eye level, and placed on a simulator. The order of monitor placement was randomized. RESULTS: The task was performed more quickly when the monitor was placed on the simulator and the sight was forced downwards. Lower placement was also found to be more beneficial for students with experience in laparoscopy. CONCLUSIONS: New technologies which place the display on the patient, thus improving the ergonomics of the operation, should be developed.

Abdominal Cavity Eventration Treated by Means of the "Open Abdomen" Technique Using the Negative Pressure Therapy System--Case Report and Literature Review.

Wound dehiscence is a surgical complication in which the wound ruptures along the surgical suture with abdominal cavity bowel displacement. It is observed in 0.2-6% of operated patients. The extensive wound is a gateway for infection. Moreover, increased secretion of serous fluid induces a hygienic problem and may lead to secondary skin infections or bedsores. The negative pressure wound therapy (NPWT) system is an innovative therapeutic method. It perfectly executes the TIME strategy, receiving more and more recognition. The study presented a case of a 62-year old male patient after several consecutive wound dehiscence episodes who was primarily treated for rectal cancer by means of low anterior resection of the rectum. Due to acute respiratory insufficiency after several operations, wound necrosis with dehiscence was observed. Considering the high risk of perioperative death we abandoned surgical treatment and introduced conservative management using negative pressure wound therapy until the patient's health improved. Literature regarding the above-mentioned issue was also reviewed.