Salvage of a Below Knee Amputation Utilizing Rotationplasty Principles in a Patient with Chronic Tibial Osteomyelitis.

INTRODUCTION: Chronic osteomyelitis is a disease that requires fastidious treatment to eliminate. However, when eradication is unable to be achieved through exhaustive modalities of antibiotic therapy and multiple debridements, significant resection of the infected bone and soft tissue must be considered, including amputation. Here we report of a salvage procedure for chronic osteomyelitis of the left tibia by employing a rotationplasty to avoid an above knee amputation and instead provide the patient with a below knee amputation. CASE REPORT: A 51-year-old male presented to the emergency department after noticing dehiscence of an operative wound with exposure of an implant in the left lower extremity. Two years prior to presentation, the patient was involved in a motorcycle accident and underwent four surgeries in the Dominican Republic for an open fracture of the left tibia and fibula, including a procedure that involved the placement of an implant in the left proximal tibia. Tissue biopsies from the wound confirmed that the patient had osteomyelitis of the left proximal tibia. After extensive surgical and antibiotic intervention to eradicate the patient's osteomyeltis, it was eventually determined that an amputation would be necessary. In order to avoid an above knee amputation, a salvage procedure was conducted by employing a rotationplasty to provide the patient with a below knee amputation. CONCLUSION: When amputation is deemed necessary, sparing the knee joint is associated with decreased energy expenditures, increased patient satisfaction and overall better postoperative outcomes. As part of a multi-disciplinary team, orthopaedics, plastic surgery, infectious disease, and medical services successfully treated this case of chronic osteomyelitis of the left proximal tibia by employing a rotationplasty to avoid an above knee amputation and achieve a below knee amputation.

IL-10 suppresses mast cell IgE receptor expression and signaling in vitro and in vivo.

Mast cells are known for their roles in allergy, asthma, systemic anaphylaxis, and inflammatory disease. IL-10 can regulate inflammatory responses and may serve as a natural regulator of mast cell function. We examined the effects of IL-10 on in vitro-cultured mouse and human mast cells, and evaluated the effects of IL-10 on FcepsilonRI in vivo using mouse models. IgE receptor signaling events were also assessed in the presence or absence of IL-10. IL-10 inhibited mouse mast cell FcepsilonRI expression in vitro through a Stat3-dependent process. This down-regulation was consistent in mice tested in vivo, and also on cultured human mast cells. IL-10 diminished expression of the signaling molecules Syk, Fyn, Akt, and Stat5, which could explain its ability to inhibit IgE-mediated activation. Studies of passive systemic anaphylaxis in IL-10-transgenic mice showed that IL-10 overexpression reduced the IgE-mediated anaphylactic response. These data suggest an important regulatory role for IL-10 in dampening mast cell FcepsilonRI expression and function. IL-10 may hence serve as a mediator of mast cell homeostasis, preventing excessive activation and the development of chronic inflammation.