We employed vacuum-assisted closure (VAC) as a treatment modality for wound complications after cardiovasular surgery. Between March and December 2004, 9 patients were treated with VAC, 8 of whom were men, and the mean age was 69.6 years old. Seven patients underwent off-pump coronary artery bypass, and 2 underwent a valve replacement. Six of them had diabetes, 5 had renal dysfunction (4 were dialysis patients), and 2 had chronic obstructive lung disease. Six cases were classified as superficial sternal infection (Superficial) and 3 as a deep sternal infection (Deep). Superficial cases were healed with wound closure after a short period of VAC treatment. However, Deep cases required long duration of VAC treatment and wound closure with a myocutaneous flap in 2 cases, although all of them did not develop mediastinitis requiring closed irrigation and drainage. In 9 cases, with numerous risk factors for poor healing, we found that VAC treatment facilitated wound healing and reduced frequent painful wound care.

The paracolpium or paravaginal tissue is surrounded by the vaginal wall, the pubocervical fascia and the rectovaginal septum (Denonvilliers' fascia). To clarify the configuration of nerves and fasciae in and around the paracolpium, we examined histological sections of 10 elderly cadavers. The paracolpium contained the distal part of the pelvic autonomic nerve plexus and its branches: the cavernous nerve, the nerves to the urethra and the nerves to the internal anal sphincter (NIAS). The NIAS ran postero-inferiorly along the superior fascia of the levator ani muscle to reach the longitudinal muscle layer of the rectum. In two nulliparous and one multiparous women, the pubocervical fascia and the rectovaginal septum were distinct and connected with the superior fascia of the levator at the tendinous arch of the pelvic fasciae. In these three cadavers, the pelvic plexus and its distal branches were distributed almost evenly in the paracolpium and sandwiched by the pubocervical and Denonvilliers' fasciae. By contrast, in five multiparous women, these nerves were divided into the anterosuperior group (bladder detrusor nerves) and the postero-inferior group (NIAS, cavernous and urethral nerves) by the well-developed venous plexus in combination with the fragmented or unclear fasciae. Although the small number of specimens was a major limitation of this study, we hypothesized that, in combination with destruction of the basic fascial architecture due to vaginal delivery and aging, the pelvic plexus is likely to change from a sheet-like configuration to several bundles.
Aged* ; Aging ; Anal Canal ; Autonomic Pathways ; Cadaver* ; Fascia* ; Female ; Humans ; Hypogastric Plexus ; Muscles ; Rectum ; Urethra