Feasibility of collecting wound fluid during ongoing negative pressure wound therapy by the use of an additional container - A prospective observational study.

Negative-pressure-wound-therapy is commonly used in clinical routine for wound management. Aim of the present study was to assess the feasibility and safety of using an additional container to collect wound fluid during ongoing negative-pressure-wound-therapy. In this present prospective observational study, patients with negative-pressure-wound-therapy were included. An additional container was inserted in the connecting tube between the wound and the vacuum generating device. The following 3 days, the container was changed daily and replaced by a new one. Further safety outcome parameters were assessed. A questionnaire was answered by the responsible surgeon. Twenty-two patients with negative-pressure-wound-therapy with a median (IQR) age of 58.5 (53.0-70.0) years were included in the present study. In median, the duration of negative-pressure-wound-therapy was 5.0 (4.6-5.5) days. In mean ± SD the collected volume of the wound fluid in millilitres (mL) was on day one 7 ± 4 on day two 8 ± 7 and 10 ± 11 on day three. In one patient, there was <0.1 mL of clear water in the additional container. No safety concerns due to the additional container were observed. This study demonstrates that collecting wound fluid during ongoing negative-pressure-wound-therapy over a time period of 3 days is feasible and safe. No safety concerns were observed.

Anatomy of the Vascularized Lateral Femoral Condyle Flap.

BACKGROUND: The perforators of the free lateral femoral condyle flap have yet to be adequately described in humans. Therefore, the authors investigated the perforator vessels of the lateral femoral condyle flap in an anatomical study and discussed potential clinical applications with a particular interest in its indication with vascularized bone and/or iliotibial band for tendon repair surgery. METHODS: The authors dissected thighs of 28 cadavers to evaluate the anatomical properties of perforator vessels that branch from the superior lateral genicular artery and supply bone, cartilage, subcutaneous tissue, and the iliotibial band of the lateral femoral condyle. RESULTS: In each dissected thigh, the superior lateral genicular artery was present and the average pedicle length was 38 ± 10 mm. The average diameter of the superior lateral genicular artery, proximal to its distribution into the deep articular and superficial patellar branches, was 2 ± 0.5 mm. A communication between deep articular and superficial patellar branches was seen in 96 percent of the dissected thighs. In 24 cases (86 percent), the authors were able to show the iliotibial band perforating vessel and harvest a free lateral femoral condyle flap as an osteochondral fasciocutaneous bone flap with vascularized tendon. CONCLUSIONS: Altogether, the authors' results indicate that the blood supply of the lateral femoral condyle flap is consistent and the lateral femoral condyle flap could serve as a free composite flap for complex indications in hand or limb reconstructive surgery. Clinical studies to compare the lateral femoral condyle to other well-established microsurgical free flaps are warranted.

The past 25 years of pediatric burn treatment in Graz and important lessons been learned. An overview.

INTRODUCTION: The aim of this study was to characterize the epidemiology of pediatric and adolescent burns admitted to the Children's Burns Unit at the Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Austria, between January 1st 1988 and December 31st 2012. METHODS: This is a retrospective review over the past 25-years and describes admission rate by gender and age groups, causes of burns, anatomical sites of burns, extent and depth of injury, length of hospital stay, child abuse and in-hospital mortality. RESULTS: In the studied 25 year-period, 1586 pediatric burn patients were admitted. 1451 patients were "acute" admissions, 64 "secondary" admissions and 71 patients did not fulfill the inclusion criteria. Of the 1451 patients, 930 (64%) were male and 521 (36%) female. The majority of patients - 880 or 60.6% - were children from 1 to 5 years of age. Domestic burns occurring at home resulted in 1164 (80.2%) of injuries and scalds were the most common type of thermal trauma with 945 (65.1%) patients. According to the extent of injury 1106 (76.2%) patients suffered burns of <10% with an median length of hospital stay of 3 days. 14 children (0.98%) - 8 girls and 6 boys - were confirmed victims of abuse and 4 patients (0.3%) died. CONCLUSION: The study provides a good opportunity to review changes in burn care over a long time period, at a single center, including children and adolescents, with stable surgical and rehabilitation staff. The data is also important for the design of prevention programs and establishment of burn care capacities, since the analysis showed no change in the incidence of burn related admissions over the time period studied.

Linezolid concentrations in infected soft tissue and bone following repetitive doses in diabetic patients with bacterial foot infections.

The present study aimed at assessing unbound extracellular concentrations of linezolid in inflamed soft tissue and bone of diabetic patients suffering from severe bacterial foot infections. Linezolid was administered intravenously twice daily at a dosage of 600 mg. At steady-state conditions, the microdialysis technique was utilised to sample serially interstitial space fluid from inflamed subcutaneous adipose tissue and metatarsal bone from 0-8h post dose in three representative patients. Mean peak concentrations of free linezolid in plasma, healthy subcutis, inflamed subcutis and cancellous bone were 16.6+/-3.0, 15.5+/-2.5, 15.8+/-2.8 and 15.1+/-4.1mg/L, respectively. The degree of tissue penetration as expressed by the ratio of the area under the concentration-time curve of free linezolid from 0-12h (fAUC(0-12)) in tissue to the fAUC(0-12) in plasma was 1.32+/-0.09, 1.12+/-0.22 and 1.09+/-0.11 for healthy subcutis, inflamed subcutis and bone, respectively. Based on currently available pharmacokinetic/pharmacodynamic targets, we conclude that linezolid administered at 600 mg twice daily may be considered an effective treatment in diabetic patients suffering from bacterial foot infection complicated by osteomyelitis.

Soft tissue and bone penetration abilities of daptomycin in diabetic patients with bacterial foot infections.

OBJECTIVES: In the attempt to overcome increasing glycopeptide- and methicillin-resistant soft tissue infections, daptomycin is presently considered as an attractive alternative to the class of glycopeptides. However, daptomycin dosing and its ability to penetrate into inflamed target tissues are still a matter of controversy. Thus, in the present investigation, we set out to evaluate daptomycin's ability to penetrate into inflamed subcutaneous adipose tissue and bone in diabetic patients presenting with severe bacterial foot infection. PATIENTS AND METHODS: The microdialysis technique was utilized to collect interstitial space fluid from inflamed subcutaneous adipose tissue and metatarsal bone. Plasma and unaffected subcutaneous adipose tissue served as reference compartments. Serial sampling of specimens at steady-state was performed from 0 to 8 h post-dose in five patients (Group A) and from 8 to 16 h after study drug administration in another group of four patients (Group B). In all subjects, daptomycin was administered intravenously once daily at a dosage of 6 mg/kg body weight for 4 consecutive days at minimum. RESULTS: Equilibrium between free tissue and plasma concentrations was achieved approximately 2 h post-infusion. Under steady-state conditions, the degree of tissue penetration was assessed by the calculation of the ratio of free (f) AUC of daptomycin in plasma to the fAUC in tissues. The mean ratios of the fAUC0-16 tissue to the fAUC0-16 plasma were 1.44, 0.98 and 1.08 for healthy tissue, inflamed subcutaneous adipose tissue and bone, respectively. The corresponding ratios of the fAUCs from 0 to 24 h were 1.54, 1.06 and 1.17, respectively. CONCLUSIONS: With the reservation that pharmacokinetic-pharmacodynamic targets for daptomycin in tissues are currently not established, we conclude that daptomycin given at intravenous doses of 6 mg/kg body weight once daily may be considered an effective treatment regimen in diabetic patients suffering from bacterial foot infection and osteomyelitis.

Management of an unfortunate triad after breast reconstruction: pyoderma gangrenosum, full-thickness chest wall defect and Acinetobacter Baumannii Infection.

If diagnosed late, post-surgical pyoderma gangrenosum (PSPG) is a rare, tricky and potentially life-threatening complication. Once diagnosed, immunosuppressive agents may provoke further complications. Well-intentioned extensive serial debridement may cause deep skin and soft-tissue defects, requiring skin grafting and possible flap surgery. The combination of necessary immunosuppressive treatment, protracted hospital stay and broad-spectrum systemic antimicrobial therapy may encourage serious acquired multidrug resistance (MDR). We report an unfortunate triad following breast reconstruction of PSPG, full-thickness chest wall defect and MDR with Acinetobacter baumannii infection. Interdisciplinary treatment using free flap surgery and negative-pressure wound therapy with instillation therapy (V.A.C.Instill(R) Wound Therapy) enabled survival and complete wound closure.

High fosfomycin concentrations in bone and peripheral soft tissue in diabetic patients presenting with bacterial foot infection.

OBJECTIVES: Appropriate antimicrobial therapy and surgical intervention may be required in diabetic patients presenting with severe bacterial foot infection. Methicillin-resistant Staphylococcus aureus (MRSA) agents such as fosfomycin are increasingly in demand because of recent concern regarding vancomycin and daptomycin efficacy and constant use. Intravenous fosfomycin is approved for the therapy of severe soft tissue infections and is highly active against methicillin-susceptible S. aureus and MRSA. in the present study we investigated fosfomycin's ability to penetrate bone tissue in diabetic patients suffering from severe bacterial foot infection. PATIENTS AND METHODS: The well established microdialysis technique was utilized to determine fosfomycin concentrations in metatarsal bone in nine patients scheduled for partial bone resection due to bacterial foot infection and osteomyelitis. Plasma and unaffected subcutaneous adipose tissue served as reference compartments. RESULTS: After a single intravenous dose of approximately 100 mg of fosfomycin per kg of body weight, the mean C(max), T(max) and AUC(0-6) for bone were 96.4 mg/L, 3.9 h and 330.0 mg x h/L, respectively. The degree of tissue penetration as determined by the ratios of the AUC(0-6) for bone to plasma and for subcutaneous adipose tissue to plasma were 0.43 +/- 0.04 and 0.76 +/- 0.05, respectively. CONCLUSIONS: On the basis of relevant pharmacokinetic-pharmacodynamic indices, it seems that fosfomycin is an effective antibiotic for the treatment of deep-seated diabetic foot infections with osseous matrix involvement.

Treatment of spider leg veins with the KTP (532 nm) laser--a prospective study.

BACKGROUND AND OBJECTIVES: Spider leg veins are telangiectasias located intracutaneously. This condition poses a cosmetic problem. STUDY DESIGN/PATIENTS AND METHODS: The purpose of this study was to determine what influence the KTP (532 nm) laser has on spider leg veins dependent on the vascular diameter and to what extent the skin has been affected. Seventy female patients were treated in three laser sessions. Analysis was done 30 weeks after the last laser treatment session. RESULTS: Fifty-six patients completed the study. In group 1 (vascular diameter < or = 0.6 mm), spider leg veins were no longer visible in 33%; in 40%, a decrease in vascular diameter could be observed; in 27%, no change in size occurred. In group 2 (vascular diameter 0.7-1.0 mm), laser-treated spider leg veins were visible in all patients. Hyperpigmentation occurred in 13 patients. CONCLUSIONS: The KTP (532 nm) laser is an effective for treating spider leg veins having a vascular diameter under 0.7 mm.