title: Percutaneous re-circulating isolated limb perfusion of gentamicin in a large animal model: targeted delivery of gentamicin to limb.
abstract: OBJECTIVE
  We have developed a percutaneous recirculation system (V-Vascular, V-V) to enable delivery of high levels of antibiotic to the limb in an isolated and targeted manner for the treatment of limb infection.
  
  
  BACKGROUND
  Chronic and acute limb infections are relatively commonplace in a variety of wound types. Infection can become refractory to existing treatment strategies and can cause complications associated with wound healing, lead to amputation and even death.
  
  
  METHODS
  Gentamicin was delivered to the ovine hind limb (4 mg/kg) using the V-V system, a 'closed' recirculatory catheter system that draws blood from the venous system and returns it to the artery via an oxygenator, or via intra-venous (IV) infusion. Samples of muscle, bone and synovial fluid of the limb were collected at 30 and 60 min post administration of gentamicin.
  
  
  RESULTS
  There was a significantly greater concentration of gentamicin observed in the bone and skeletal muscle of limbs receiving the antibiotic via V-V at 30 min post administration compared to IV delivery, (bone V-V 0.05 ± 0.04, I.V 0.004 ± 0.001 mg/L p<0.05; muscle V-V 0.005 ± 0.001, I.V 0.002 ± 0.0005 mg/L p<0.05) and bone and synovial fluid at 60 min post administration (bone V-V 0.06 ± 0.02, I.V 0.005 ± 0.001 mg/L p<0.05; synovial fluid V-V 34.58 ± 14.9, I.V 3.03 ± 0.59 mg/L p<0.05).
  
  
  CONCLUSIONS
  These results suggest that the use of percutaneous recirculation is a safe and effective method for delivering a greater concentration of antibiotic to the limb without systemic implications.
authors: Heart Failure Research Group, BakerIDI Heart & Diabetes Institute Melbourne, Victoria, Australia.
authors: Melissa J
authors: MJ
authors: Byrne
authors: Rejhan
authors: R
authors: Idrizi
authors: John M
authors: JM
authors: Power
authors: David M
authors: DM
authors: Kaye
keywords: Wound infection; gentamicin; limb; percutaneous delivery
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