The UQ Flap: A Novel Modification of the Keystone Flap.

Wound closure following excisions on the leg (between the knee and ankle), including the distal leg, is challenged by limited skin laxity. The keystone flap, first described by Behan in 2003, was proposed as one solution, but with a significant complication rate on the distal leg. This pilot study introduces a novel modification of the keystone flap, named the UQ flap, differing from other modifications, with an un-incised portion on one flap border and a unique curved leading-edge to absorb tension and distribute shearing forces in different directions, providing improved flap security and vascularization. The UQ flap was performed on 10 patients in two formats of "U" and "Q" also with two different orientations as base-proximal and base-distal. Other variations including minor deviation from the longitudinal axis, and double flap, were also performed. Except for one case with minor infection, there were no complications, and the results were favorable. No fasciotomy or undermining was required. The UQ flap proved to be a safe and convenient method of wound closure on the leg, including the distal leg. Compared with the keystone flap, there were reduced incisions leading to improved vascularity and less healthy tissue trimming. Its unique shape provided flap flexibility facilitating easy adjustment to the defects. The order and direction of wound closure after the excision of the lesion and incision of the flap are critical.

A comparison between doxycycline-rifampin and ciprofloxacin-rifampin regimens in the treatment of acute Brucellosis.

INTRODUCTION: Brucellosis, a serious zoonosis, is a widespread disease in many countries, especially the developing ones, with an annual report of 500,000 new cases to the World Health Organization (WHO). Although successful results have been achieved by the combination therapies recommended by the WHO, their relapse rates have been high, and therefore, the most effective agents with least side-effects are still undetermined. MATERIALS AND METHODS: An observational study has been prospectively carried out from 2007 to 2010 in the Infectious Clinics of Hashemi-nejad and Imam Reza Hospitals, Mashhad, Iran. In this study, among the patients of brucellosis, whose diseases were recently diagnosed, 50 patients, receiving one of the two common authentic regimens of doxycycline plus rifampin for eight weeks or ciprofloxacin plus rifampin for six weeks, were selected. The diagnosis was based on the presence of signs and symptoms compatible with brucellosis, including a positive Wright and 2ME tests, with titers equal to or more than 1/160 and 1/40 respectively. RESULTS: The cure rate was the same for the groups (P=0.55). However, the relapse rate was much more for the latter (P= 0.02). CONCLUSION: Doxycycline plus rifampin was considered better than ciprofloxacin plus rifampin for the treatment of acute brucellosis.