title: Mechanical tissue resuscitation at the site of traumatic brain injuries reduces the volume of injury and hemorrhage in a swine model.
abstract: BACKGROUND
  Traumatic brain injuries (TBIs) continue to be a devastating problem with limited treatment options. Previous research applying controlled vacuum to TBI in a rat model resulted in smaller injuries and more rapid recovery.
  
  
  OBJECTIVE
  To examine the effects of the application of a controlled vacuum (mechanical tissue resuscitation) to TBI in a large-animal model. The magnitude of vacuum, length of application, and length of delay between injury and the application of mechanical tissue resuscitation were investigated.
  
  
  METHODS
  Localized, controlled cortical injuries were created in swine. Vacuums of -50 and -100 mm Hg were compared. Mechanical tissue resuscitation for 3 or 5 days was compared. Delays of 0, 3, or 6 hours between the creation of the TBI and the initiation of mechanical tissue resuscitation were examined. Analysis included histological assessments, computed tomographic perfusion, and magnetic resonance imaging (T2, proton magnetic spectra).
  
  
  RESULTS
  A -100 mm Hg vacuum resulted in significantly smaller mean contused brain and hemorrhage volumes compared with -50 mm Hg and controls. Magnetic resonance spectra of treated animals returned to near baseline values. All 10 animals with 5-day mechanical tissue resuscitation treatment survived. Three of 6 animals treated for 3 days died after the discontinuation of treatment. A 3-hour delay resulted in similar results as immediate treatment. A 6-hour delay produced significant, but lesser responses.
  
  
  CONCLUSIONS
  Application of mechanical tissue resuscitation to TBI was efficacious in the large-animal model. Application of -100 mm Hg for 5 days resulted in significantly improved outcomes. Delays of up to 3 hours between injury and the initiation of treatment did not diminish the efficacy of the mechanical tissue resuscitation treatment.
authors.affiliation: *Department of Plastic and Reconstructive Surgery, Wake Forest University Health Sciences, Winston-Salem, North Carolina; ‡Department of General Surgery, Wake Forest University Health Sciences, Winston-Salem, North Carolina; §Department of Neurosurgery, Wake Forest University Health Sciences, Winston-Salem, North Carolina.
authors.forename: Zhen-lin
authors.initials: ZL
authors.lastname: Zheng
authors.forename: Michael
authors.initials: M
authors.lastname: Morykwas
authors.forename: Douglas
authors.initials: D
authors.lastname: Campbell
authors.forename: Maria
authors.initials: M
authors.lastname: McGee
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hollingsworth
authors.forename: Farren
authors.initials: F
authors.lastname: Adams
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mays
authors.forename: Stephen
authors.initials: S
authors.lastname: Tatter
authors.forename: Louis
authors.initials: L
authors.lastname: Argenta
mesh_terms: D000818:Animals; D001921:Brain / Q000098:blood supply* / Q000473:pathology; D001930:Brain Injuries / Q000473:pathology / Q000628:therapy*; D004195:Disease Models, Animal; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D023421:Models, Animal; D054843:Negative-Pressure Wound Therapy; D013552:Swine