The treatment of chronic osteomyelitis with clindamycin

Clindamycin was given orally over prolonged periods to 12 patients with chronic osteomyelitis. It was well tolerated with only minor side effects and no major toxicity. Clinical and bacteriological cure occurred in five patients and improvement was noted in another five. It appears less effective than either lincomycin or cloxacillin but, because of the complex nature of both the disease and its treatment, strict comparisons are very difficult.     

The use of anterolateral thigh perforator flaps in chronic osteomyelitis of the lower extremity

From April of 2000 to May of 2003, 28 consecutive patients with chronic osteomyelitis of the lower extremity underwent surgical debridement and reconstruction with anterolateral thigh perforator flaps (six cases were combined with vastus lateralis muscle flaps). All wounds were open for a minimum period of 6 weeks (average, 24.7 months; range, 6 weeks to 52 months). The average patient age was 42.8 years (range, 18 to 71 years), there were 21 male and seven female patients, and the average follow-up period was 18.2 months (range, 5 to 41 months). The cause of injury was an open fracture in 10 cases, secondary wound complications after reduction in eight cases, and diabetic foot in 10 cases. The surface defects ranged from 50 to 153 cm. The wounds were debrided an average of 2.5 times and then reconstructed with flap and treated with antibiotics for 6 weeks. Antibiotic beads were used in six cases and secondary bone graft procedures were performed in seven cases 3 months after the flap coverage. All 28 flaps were successful without any signs of recurrences or persistent osteomyelitis, but partial wound dehiscence was observed during early rehabilitation in two cases suspected of delayed healing caused by diabetes. These wounds healed spontaneously. All patients achieved acceptable gait function after rehabilitation. No debulking procedure was necessary in any case. Although the muscle flap is known to provide superior vascular supply, the type of flap used for coverage seems to be less critical in the final outcome, provided that total debridement and obliteration of dead spaces are achieved. A well-vascularized anterolateral thigh perforator flap was successfully used to combat infection and bring stability to wounds with chronic osteomyelitis.     

The office treatment of tattoos: a simple and effective method

A simplified method for the treatment of tattoos is described. The method is based on an older method called the "French method" known to tattoo artists. The treatment consists of superficial dermabrasion of the skin followed by application of a tannic acid solution which is then "rubbed" into the skin by the dermabrasion wheel. The treatment site is then "painted" with a silver nitrate stick. A heavy eschar forms which separates in approximately 2 to 3 weeks. The method incorporates the use of equipment that is present in the usual plastic surgical office. The method has produced excellent improvement in tattoos, with obliteration of the tattoo in the majority of cases. This report covers 85 patients with 207 tattoos treated over an 11-year period. The method is presented as a treatment of tattoos that are too large for simple excision. Details of the treatment are presented.     

Muscle flaps in osteomyelitis of the lower extremity: a 20-year account

Between 1977 and 1993, 64 patients had local muscle flap transposition as an integral portion of treatment for lower-extremity osteomyelitis. All muscle flaps were performed by a single surgeon. There were 54 men and 10 women with an average age of 45 years (range, 16 to 87 years). Median follow-up period was 9.3 years (range, 5 to 21 years). The muscles used included medial gastrocnemius (n = 28), soleus (n = 19), lateral gastrocnemius (n = 13), and peroneus tertius (n = 1). At final follow-up, the recurrence free rates at 5, 10, and 15 years were 94, 92.5, and 86 percent, respectively. These long-term results support the use of local muscle flap transposition as an important management method in the treatment of lower extremity osteomyelitis; however, the risk of treatment failure may arise after extended periods of time.     

Use of prodigioza in the overall treatment of chronic osteomyelitis]

Treatment of 188 patients suffering from chronic osteomyelitis of various etiology and localization with prodigiosan, a bacterial lipopolysaccharide favoured an increase in the nonspecific immunobiological reactivity: the phagocytic activity and leucocytic intensity increased, the average titers of iso- and heteroagglutinins, as well as the complementary activity of the serum became higher. The results of the clinico-laboratory studies are indicative of advisable use of prodigiosan in complex therapy of cases with chronic osteomyelitis.     

The muscle flap in the treatment of chronic lower extremity osteomyelitis: results in patients over 5 years after treatment.

Preliminary reports have indicated that debridement of the bony sequestrum followed by muscle-flap coverage allows successful treatment of chronic osteomyelitis. To determine the long-term effectiveness of this procedure, 34 consecutive patients with chronic osteomyelitis of the distal lower extremity treated with debridement, a 10- to 14-day course of culture-specific antibiotics, and immediate muscle-flap coverage were evaluated. Patients were treated from 1979 through 1984, and long-term (greater than 5 years) follow-up was available for 27 (79 percent). Twenty-three (85 percent) of these patients underwent microvascular muscle transplantation (gracilis or latissimus dorsi), and four underwent local muscle flaps (gastrocnemius or soleus) for immediate wound coverage. Twenty-four patients (89 percent) healed and were without recurrence over long-term (greater than 5 years, mean 7.4 years) follow-up. Of the three with recurrence, two were cured (greater than 5 years follow-up) after additional muscle-flap procedures. Thus the overall success rate was 96 percent, with a minimum 5-year follow-up. Guidelines for muscle-flap selection and treatment techniques in current use are presented. Debridement and immediate muscle-flap coverage provide effective, single-stage treatment of chronic osteomyelitic wounds and allow antibiotics to be restricted to short-term use. Furthermore, muscle flaps covered with skin grafts provide durable coverage while allowing subsequent ancillary procedures (i.e., bone grafts) to be performed under the flaps.     

A simple and effective SuperBuffer for DNA agarose electrophoresis

In the paper, we describe a unique effective electrophoresis buffer for DNA agarose electrophoresis, called SuperBuffer. Using this buffer, electrophoresis could be performed within 10 min at voltages as high as 25 V/cm. In addition, DNA fragments of different lengths could be isolated clearly even at lower agarose gel concentrations and the DNA recovery efficiency was higher than that of the TAE/TBE running buffers. The SuperBuffer still retained its electrophoretic effect even after several uses.     

Choice and context: testing a simple short-term choice rule

Psychological studies of animal choice show that the immediate consequences of choice strongly influence preference. In contrast, evolutionary models emphasize the longer-term fitness consequences of choice. Building on recent work by Stephens & Anderson (2001, Behavioral Ecology12, 330-339), this study presents two experiments that address this conflict. Stephens & Anderson developed an alternative choice situation based on patch-leaving decisions and compared this to the binary choice, or self-control, situation typically used in psychological studies. They hypothesized that the same short-term choice rule could account for choice in both situations, maximizing long-term gains in the patch situation, but typically producing shortsighted results in the self-control case. Experiment 1 used captive blue jays, Cyanocitta cristata, to test this ‘same rule’ hypothesis. The results do not support this hypothesis, suggesting that if a single rule applies, it is probably a more complex rule. Stephens & Anderson also hypothesized that a rule based on the delay to the next meal could explain why the intertrial interval has little effect in binary choice studies, even though the analogous travel time strongly affects patch-leaving decisions. When an animal leaves a patch, it experiences a delay consisting of the travel time plus time spent searching in the patch until food is obtained. Experiment 2 tested the hypothesis that travel time and search time combine additively, behaving like a single delay. Using treatments that created the same combined delay via different combinations of travel and search time, we found no evidence of nonadditivity, suggesting that these two components may indeed be treated as a single delay. Copyright 2003 Published by Elsevier Ltd on behalf of The Association for the Study of Animal Behaviour.