This document discusses local antibiotic delivery using Stimulan, a synthetic calcium sulfate hemihydrate. It begins by introducing Dr. Mangal Parihar and describing his credentials. It then discusses Stimulan's advantages over traditional calcium sulfate forms, including its purity, pH, and ability to elute antibiotics at high concentrations over an extended period. Studies showing Stimulan's ability to elute antibiotics like moxifloxacin, fusidic acid, and daptomycin at levels above the MIC for pathogens like MRSA are summarized. The document concludes by describing Stimulan's potential benefits for treating bone infections by providing sustained, high local antibiotic levels directly at the site of infection.
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
Hoffa's Fracture - coronal split fracture of distal femur, its diagnosis, management strategy, a new classification and tips and tricks of management. First described Hoffa, a new classification system by Bagaria et al helps plan the surgery for these tricky fracture. The most crucial step is not to miss these fractures in ER.
This video explains Lumbar Disc Replacement in Detail. When degenerative disc disease begins to affect the spine this is called degenerative disc disease. This video highlights the history, epidemiology, and treatment options both conservative and surgical. If you or someone you know needs to be seen in regards to Lumbar Disc Replacement feel free to look us up online www.beverlyspine.com or www.santamonicaspine.com OR call toll free 1-8SPINECAL-1
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
Hoffa's Fracture - coronal split fracture of distal femur, its diagnosis, management strategy, a new classification and tips and tricks of management. First described Hoffa, a new classification system by Bagaria et al helps plan the surgery for these tricky fracture. The most crucial step is not to miss these fractures in ER.
This video explains Lumbar Disc Replacement in Detail. When degenerative disc disease begins to affect the spine this is called degenerative disc disease. This video highlights the history, epidemiology, and treatment options both conservative and surgical. If you or someone you know needs to be seen in regards to Lumbar Disc Replacement feel free to look us up online www.beverlyspine.com or www.santamonicaspine.com OR call toll free 1-8SPINECAL-1
In Vitro Cell Tests for Functional FoodInstitut Kurz
The relationship between the food we eat and our health is
clear. In the constant search for healthier foods rich in
bioactive compounds that promote health and healthy
ageing, a wide variety of functional foods have appeared on
the market.
To know the real function of these functional foods
in our body, it is necessary to carry out different types of in
vitro cell tests.
Institut Kurz specializes in conducting in vitro cell tests for functional foods.
Contact us for more information:
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https://www.institut-kurz.com/
Royal jelly accelerates recovery from oral mucositisBee Healthy Farms
Great news for cancer patients who suffer from oral mucositis. However, individuals undergoing this type of intense therapy also need to consume large quantities of propolis to protect their weakened immune system.
Almost Exact Procedure is provided in each & every slide ..
Thanks & Best Regards
Anurag Pandey (B.Pharm)
Contact :- anurag.dmk05@gmail.com (Facebook & Gmail)
The long story of the treatment of CPT (congenital pseudarthrosis tibia) of a 2 year old child.
Despite the multiple problems that occurred during the treatment, the kid remained his usual smiling self, and the parents remained with us.
hats off to them for the successful treatment.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
NVBDCP.pptx Nation vector borne disease control program
Use of local antibiotic depot (stimulan)
1. Local Antibiotic Delivery by Stimulan
Dr Mangal Parihar
Hon Assistant Prof, Grant Medical College
& JJ Group of Hospitals
Orthopedic Surgeon
Mangal Anand Hospital,
Sir H N Hospital,
Fortis Hospital,
Police Hospital
Mumbai
Center for Limb Lengthening & Reconstruction, Mumbai
www.ilizarov.in
2. Fully setting paste with individual pelletizing kit
5, 10cc packs!
Mixed for 1-2 minutes to become paste!
Sets in-vivo in 15 minutes at body temperature
T!&!C!Apply!!!
5. Product summary
Key benefits over Competitor products
!
" Physiologic pH!
• Hydrophilic!
• No traces of potentially toxic impurities!
• Consistency in clinical performance!
Key Features
!
• Biocompatible!
• Fully resorbable – no nidus for bacteria!
• Sets at body temperature !
• Pyrogen Free!
• FDA cleared for use in infected cases
6. Center for Limb Lengthening & Reconstruction, Mumbai www.ilizarov.in 6
7. Moxifloxacin Elution
P. Panagopoulos et al. / International Journal of Antimicrobial Agents 32 (2008) 485–487
ns of moxifloxacin were estimated by modifica-
• MICs
ously described method [4,5] using ciprofloxacin
standard. Briefly, 250 L of sample were diluted
• MRSA
displacing reagent and centrifuged for 5 min at
splacing reagent consisted of 0.5% sodium dodecyl
(Merck, Darmstadt, Germany) and 20% acetoni-
• (0.5 - 2 mcg/ml)
75 mM sodium phosphate buffer (pH 7.5). Ten
he supernatant were injected onto an Agilent 1100
formance liquid chromatography (HPLC) system
logies, Waldbronn, Germany) with the following
eristics: Nucleosil® 100-5 C18 (4.6 mm × 250 mm,
under 37 ◦ C; mobile phase consisting of a buffer
sed of 25 mM Na3 PO4 and 10 mM SDS and acetoni-
5/65 ratio with a flow rate of 1 mL/min; ultraviolet
at 293 nm. Ciprofloxacin (Bayer) was added to all
ncentration of 2 g/mL. The retention time of mox-
8 min and its concentration was estimated by a
reated with known concentrations of moxifloxacin.
tion limit was 0.03 g/mL and the interday coeffi-
n of the assay was 0.1%. All determinations were
uplicate.
ns of fusidic for Limb Lengthening & Reconstruction, Mumbaiby
Center
acid were determined in duplicate www.ilizarov.in 7
8. The calcium sulphate (Stimulan ) commonly used as a bone graft to
of systems for local delivery of moxifloxacin. Collagen shields have
fill bone cavities resulting from disease, trauma or surgery. Its main
the
characteristics are 100% purity and its been applied for its intraocular administration in humans, deliver-
ability for biodegradation.
Moxifloxacin is a fourth-generation quinolone with similar activ- below those described here for StimulanTM
ing concentrations well
Fusidic Acid Elution
ity to that of ciprofloxacin and pefloxacin against Gram-negative repair system was also evaluated as an in
[14,15]. Norian skeletal
bacteria but with enhanced activity against carrier[9]. A recent
vitro MRSA for moxifloxacin by our group [16]. Release lasted for
After almost 400 days but the eluted concentrations were lower than
uted those achieved with StimulanTM as a carrier.
evel The applied carrier in the present study allowed for continuous
d on [
release of fusidic acid lasting for 14 days (Fig. 2). Eluted concentra-
S.D.
was tions over the first 6 days were >100 g/mL and remained above
50 g/mL over most of the period of release. The MIC90 for MRSA [
After is reported to be 0.5 g/mL [17], which makes the developed sys-
uted [
tem of release promising for the eradication of MRSA osteomyelitis.
alue
However, fusidic acid is not a popular candidate for local release
d on [
S.D. systems. Only one study has recently been published where it was
was incorporated in microspheres of poly(lactide-co-glycolide), where [
it proved effective for the management of experimental osteomyeli-
tis caused by MRSA in rats [18].
[
Calcium sulphate has been applied as a carrier in various stud-
ies for the in vitro elution of a variety of antimicrobials, including
cul- vancomycin, teicoplanin, clindamycin, gentamicin and daptomycin
ssue [
[3,19]. Peak elution of all the tested agents was found within the
ents.
has first 2 days. Elution of vancomycin, teicoplanin, clindamycin and
cor- gentamicin lasted only for 10 days, whereas that of daptomycin
[
bone lasted for 28 days. However, released concentrations of daptomycin
TM
d as Fig. 2. Elution of fusidic acid by Stimulan . S.D., standard deviation.
ranged between 5 g/mL and 7 g/mL after Day 4 [19], which are
Center for Limb Lengthening & Reconstruction, Mumbai www.ilizarov.in 8 [
10. Antibiotic Elution
• High Initial Peak
• Sustained High Local Levels
• Effectively Sterilise the area upto 3 cm
• Higher Initial Concentration -
Higher Peaks and longer period of elution
Center for Limb Lengthening & Reconstruction, Mumbai www.ilizarov.in 10
11. Advantages
• Completely Resorbed in 6 weeks
• 2nd surgery for removal not needed
• No biofilm / membrane produced
• No Low Level antibiotic release
(resistance?)
Center for Limb Lengthening & Reconstruction, Mumbai www.ilizarov.in 11
12. Advantages
• Any Antibiotic
Thermostable/Thermolabile
Powder/Liquid
Combination of 2 or 3 antibiotics
• Pyrogen Free
• Pellet form – greater surface area – better
elution
Center for Limb Lengthening & Reconstruction, Mumbai www.ilizarov.in
13. In contrast, hemi-hydrate calcium sulphate powder has successfully been mixed with either the mixing solution and/or an
antibiotic to achieve full hydration. When the calcium sulphate powder is mixed with a solution or an antibiotic it will become
a paste-like material that will set to a completely hard material. When mixed with the correct quantity of water, it will set
Setting Times and ABs
hard within 8-12 minutes. Between the initial mixing and the complete setting of the paste, the calcium sulphate can be
injected directly into the site or simply moulded by hand into the desired shape.
The effects of commonly used antibiotics on the setting of calcium sulphate
Table 1 - The effects of antibiotics on the setting of calcium sulphate
Amount of calcium sulphate Total Liquid Antibiotic used Mix Mixing Time Setting Time
hemi-hydrate used used / ml and quantity Consistency ± / minutes ± / minutes
10cc 5.6 None Wet 5 9
10cc 5.7 Briklin 1.0g Wet 30 40
10cc 5.6 Gentamycin 0.9g Wet 16 22
10cc 5.9 Zinacef* 1.1g Wet 4 6
10cc 6.2 Flucloxacillin 0.6g Dry 4 6
10cc 5.8 Cefuroxime 3.6ml** Wet 9 13
10cc 6.5 Teicoplanin 400mg† Wet 2 12
10cc 6.5 Vancomycin, 1g Wet 2 12
* Zinacef – 750mg powder + 3ml water ** Cefuroxime – 1.5g powder + 20ml water † Teicoplanin – 400mg powder + 6.5ml water
± All times are approximate, and quantities of antibiotic used do not represent the correct dosage. Dosage of prescription
drugs is the sole responsibility of the operating surgeon.
N.B. for Limb application should be cautious, limiting the total antibiotic load. Dosage should be no higher than one that would
Center Clinical Lengthening & Reconstruction, Mumbai www.ilizarov.in 13
14. Center for Limb Lengthening & Reconstruction, Mumbai www.ilizarov.in 14
15. Center for Limb Lengthening & Reconstruction, Mumbai www.ilizarov.in 15
16. My Experience
• 18 Cases
• FU 6 - 18 months
• No continuing infection
• Single Organism 13
• Two Organism 5
• Parenteral Antibiotic - 5 days
2 cases - 2 weeks
• Oral Antibiotic 2 weeks
Center for Limb Lengthening & Reconstruction, Mumbai www.ilizarov.in 16
17. My Experience
• Osteomyelitis
• Compound Fractures
• Bone Void Filling
• Soft tissue Infections
• ? Stimulates bone healing
Center for Limb Lengthening & Reconstruction, Mumbai www.ilizarov.in
18. Compound Fracture
• 40 year male
• Grade II Compound Fracture
• Delayed presentation
(24 hrs)
Center for Limb Lengthening & Reconstruction, Mumbai www.ilizarov.in
25. Story So Far…..
• 66 years
• Discharging sinuses
• Shortening – 5cm
• 8 years since injury
• 8 surgeries
Center for Limb Lengthening & Reconstruction, Mumbai www.ilizarov.in
69. Inadequate Debridement
• PRINCIPLES rather than TOOLS
• Ilizarov ≠ healing
• Flap & Vascularity ≠ control of infection
Center for Limb Lengthening & Reconstruction, Mumbai