A modified free muscle transfer technique to effectively treat chronic and persistent calcaneal osteomyelitis.

UNLABELLED: Successful management of chronic calcaneal osteomyelitis presents a major challenge for the plastic and reconstructive surgeon, especially in cases involving soft-tissue defects. This article describes a modified free muscle transfer technique to effectively eradicate chronic and persistent calcaneal osteomyelitis. METHODS: Between February 2009 and September 2009, 3 male patients with persistent calcaneal osteomyelitis were treated in our clinic. All 3 had purulent drainage for a minimum of 6 months and a maximum of 23 years. Multiple surgical debridements and vacuum-assisted closure had been used in the past, but the infection remained. We used a therapeutic protocol of repeated and radical surgical debridement with removal of nearly all cancellous bone and preservation of the cortical shell of the calcaneus. After the final debridement, the bone cavity was plugged by a free gracilis muscle flap from the contralateral side. A meshed split thickness skin graft was applied. Culture-specific antibiotics were administered for 2 weeks. RESULTS: All flaps healed uneventfully except for a minor hematoma that was treated conservatively. All 3 patients were able to return to ambulatory status with regular foot apparel. At last follow-up evaluation, they had no clinical, laboratory, or radiologic signs of osteomyelitis. CONCLUSION: This modified free muscle transfer technique seems to be successful in managing chronic and persistent calcaneal osteomyelitis. Infected and healthy cancellous bone of the calcaneus is removed to eradicate all possible foci that maintain inflammation. The resulting bony defect after the aggressive surgical debridement is sufficiently filled with a well-vascularized muscle that ensures a good wound healing. We consider this method to be a promising treatment option, which needs to be supported by further cases.

"The Maestro": a pioneering plastic surgeon--Sir Archibald McIndoe and his innovating work on patients with burn injury during World War II.

This article describes McIndoe's revolutionary methods of burn treatment and rehabilitation of patients with burn injury and outlines his personality traits that made him one of the most important plastic surgeons of the twentieth century. As a consultant plastic surgeon to the Royal Air Force, he set up a plastic surgery unit in the Queen Victoria Hospital in East Grinstead. By using biographical data and photography, McIndoe's work on burns treatment and the challenges he faced are presented. Before World War II, little was known about the treatment of severe burns and their complications, and even less was done about the rehabilitation and social reintegration of patients with burn injury. McIndoe changed all that by developing new techniques for the management and reconstruction of burn injuries. He helped his patients become and get accepted as a normal part of society again. The patients with burn injury treated by him formed the Guinea Pig Club. Sir Archibald Hector McIndoe, a charismatic plastic surgeon with an uncanny instinctive knowledge of psychology, recognized early that the rehabilitation of a burned patient was as important as the reconstruction of his physical body. His therapeutic approach to patients with burn injury was mental and physical.

Intravital monitoring of microcirculatory and angiogenic response to lactocapromer terpolymer matrix in a wound model.

The aim of this study was to assess the impact of an epidermal substitute, a lactocapromer terpolymer matrix, on microcirculation in wounds. Lactocapromer terpolymer matrices were placed into the dorsal skinfold chamber of mice (n = 10). Untreated chamber preparations served as controls (n = 10). The microcirculation in tissue adjacent to the implant was observed by intravital fluorescence microscopy. Alongside the stable microhaemodynamics, a strong induction of angiogenesis adjacent to the implants was observed. A progressive increase in the functional vessel density was detected throughout the observation time of 10 days. Additionally, a stable and increasing perfusion within the newly developed vascular network in the outer circumference of the matrix was noted. The lactocapromer terpolymer matrix showed no adverse effect on the microcirculation in the host tissue. In contrast, as detected by intravital microscopy, the biomaterial protected the microcirculation and induced angiogenesis.

Monstrous aneurysm of the deep femoral artery.

Deep femoral artery aneurysms are a rarity among arterial aneurysms. Based on a selected case of a patient who was treated at our clinic, clinical images are presented and treatment options are discussed.

The influence of different food and drink on tics in Tourette syndrome.

AIM: Tourette syndrome (TS) is characterized by waxing and waning motor and vocal tics. Because standard medication often remains unsatisfactory, many patients seek alternative medicine. The aim of this study was to increase experience about the influence of food and drinks in TS. METHODS: A standardized questionnaire was sent to 887 people recruited from our Tourette outpatient clinic and the German TS self-aid group. Respondents should assess whether 32 different foods influenced their tics. RESULTS: Two hundred twenty-four questionnaires could be used for analyses. A significant positive correlation (tic deterioration) was found for caffeine- and theine-containing drinks such as coke (p<0.001), coffee (p<0.001) and black tea (p<0.001) as well as for preserving agents (p<0.001), refined sugar (p<0.001) and sweeteners (p<0.001). A significant negative correlation (tic improvement) was not found. CONCLUSIONS: Results from this first survey investigating the influence of special foods and drinks on tics demonstrated that 34% and 47% of responders, respectively, assessed that coffee and coke deteriorate tics. It, therefore, can be speculated that caffeine may further stimulate an already overactive dopaminergic system in TS and thus increases tics. However, from these preliminary data, no further general recommendations regarding special diets and food restrictions can be made.