Longitudinal changes in optical coherence tomography angiography characteristics in normal-tension glaucoma with or without high myopia.

PURPOSE: To evaluate the structural, microvascular, and functional progression of normal tension glaucoma (NTG) with or without high myopia by examining longitudinal changes in optical coherence tomography angiography (OCTA) and visual field (VF) parameters. METHODS: We evaluated 61 NTG eyes and classified 25 of the eyes with axial lengths (ALs) of ≥26 mm as highly myopic. We assessed the rate of change in OCTA parameters, namely radial peripapillary capillary (RPC) vessel density (VD), parafovea VD, deep parafovea VD, retinal nerve fibre layer (RNFL) thickness, and ganglion cell complex thickness. We evaluated the correlation of the rate of change in OCTA parameters with VF loss and AL. RESULTS: Among the 61 NTG eyes, rates of loss of RPC VD, parafovea VD, deep parafovea VD, and RNFL thickness were significantly different from zero despite the nonsignificant rate of change in VF mean deviation (MD). Changes in these OCTA parameters did not differ significantly in highly myopic NTG eyes. The rate of change in VF MD was significantly correlated with the rate of change in parafovea VD in highly myopic and non-highly myopic NTG eyes. In highly myopic NTG eyes, AL was negatively correlated with the rates of loss of RNFL thickness, VF MD, and VF PSD. CONCLUSION: NTG eyes with a relatively stable VF exhibited loss of VD and RNFL thickness. VF progression in NTG was correlated with decreasing parafovea VD, indicating a structure-function correlation. Greater AL may indicate faster VF loss and RNFL thinning in highly myopic NTG eyes.

Association of Intraocular Pressure and Optical Coherence Tomography Angiography Parameters in Early Glaucoma Treatment.

This prospective study aimed to explore the effect of medical intraocular pressure (IOP) reduction on structural and capillary vessel density (VD) change by optical coherence tomography (OCT) angiography in early glaucoma. Patients with newly diagnosed glaucoma and a follow-up of ≥6 months were enrolled. An ocular examination that included slit-lamp bio-microscopy, pneumatic tonometry, gonioscopy, standard automated perimetry, and OCT angiography was performed. Quantitative OCT angiography parameters were assessed using a linear mixed model that was adjusted for inter-eye correlation. The correlations between IOP changes and OCT angiography parameter changes were analyzed using Spearman's correlation test. In total, 52 eyes of 36 participants, including 33 glaucoma eyes of 17 participants and 19 healthy eyes of 19 participants served as the case and control groups, respectively. The IOP of the case group decreased from a baseline mean of 20.4 ± 0.8 mmHg to 15.7 ± 0.5 mmHg at 3 months (p < 0.001) and to 16.1 ± 0.5 mmHg at 6 months (p < 0.001). For the subgroup with an IOP reduction of >20%, the deep macula VD was negatively correlated with baseline IOP and significantly decreased at 3 months follow-up. Additionally, change in retinal nerve fiber layer (RNFL) was positively correlated with a change in IOP at 6 months. In conclusion, the deep-layer macula VD was correlated with baseline IOP and influenced by the reduction in IOP in the short term. The changes in VD revealed the vulnerability of the deep vascular complex. The OCTA parameters provide in vivo monitoring information during medical treatment for early glaucoma.

Thinner Central Corneal Thickness is Associated with a Decreased Parapapillary Vessel Density in Normal Tension Glaucoma.

This retrospective cross-sectional study, which enrolled 124 normal tension glaucoma (NTG) eyes and 68 healthy eyes as the control, determined the association between central corneal thickness (CCT) and ocular parameters in NTG. CCT was measured using the Pentacam® system, optical coherence tomography angiography (OCT-A) was adopted to measure the peripapillary and macular area VDs, and spatial data were based on the Garway-Heath map as illustrated in OCT-A. Univariate and multivariate linear regressions were used to statistically analyze for associations between CCT and other factors. In this study, the mean age was similar for both the NTG and control groups. The mean CCT of the NTG group was significantly thinner than that of the control group (533.97 ± 33.11 µm vs. 546.78 ± 38.21 µm; p = .022). Considering all the factors, CCT negatively correlated with visual field (VF) pattern standard deviation (univariate, p = .045). To analyze structural and functional factors separately, we found a significant positive correlation between CCT and whole disc radial peripapillary capillary VD (VDRPC; multivariate, p = .019). To analyze the relationship between all factors and sectoral changes in VDRPC, a significant positive correlation was observed between CCT and inferior temporal VDRPC (univariate, p = .039) and inferior nasal VDRPC (VDRPC IN; univariate, p = .048). In conclusion, this novel study shows that among NTG participants, a thinner cornea correlated with weaker biomechanical properties susceptible to optic nerve tissue displacement, especially in response to mild transient elevation of IOP, leads to compromised ocular microcirculation.

Prospective evaluation of the comorbidity of obstructive sleep apnea in patients with glaucoma.

STUDY OBJECTIVES: This study aimed to identify prospectively the correlation between obstructive sleep apnea (OSA) severity, ocular microcirculation changes, and visual function changes in patients with glaucoma. METHODS: We prospectively enrolled patients with glaucoma who were willing to undergo overnight polysomnography. The enrolled patients were further divided into normal tension glaucoma, high-tension glaucoma, and control. Visual field progression was analyzed using sequential standard automated perimetry. Peripapillary and macular vessel density were assessed through optical coherence tomography angiography (OCT-angiography). The associations between polysomnography parameters, OCT-angiography parameters, and visual field progression were analyzed. RESULTS: A total of 22 patients with normal tension glaucoma, 30 patients with high-tension glaucoma, and 24 control patients were enrolled. Through regression analysis, glaucoma was found to be an independent predictor of moderate-to-severe OSA (P = .035); furthermore, moderate-to-severe OSA was significantly associated with visual field progression (P = .008 in the high-tension glaucoma subgroup and P = .008 in the overall glaucoma). Additionally, OSA severity was negatively correlated with the ganglion cell complex thinning rate in the normal tension glaucoma subgroup. CONCLUSIONS: Presence of glaucoma increased the risk of moderate-to-severe OSA compared with the control group. OSA severity was related to visual field deterioration in patients with glaucoma and further associated with structural progression in the normal tension glaucoma subgroup. Careful monitoring of the comorbid OSA status of patients with glaucoma is essential to prevent disease progression. CITATION: Chan Y-H, Chuang L-H, Yu C-C, et al. Prospective evaluation of the comorbidity of obstructive sleep apnea in patients with glaucoma. J Clin Sleep Med. 2022;18(1):47-56.

Optic disc hemorrhage in nonglaucomatous eyes: A cross-sectional study with average 8-year follow-up.

PURPOSE: To characterize changes in the retinal nerve fiber layer (RNFL) and peripapillary vessel density (VD) at the site of disc hemorrhage (DH) in nonglaucomatous eyes. MATERIALS AND METHODS: This retrospective cross-sectional study included nonglaucomatous eyes diagnosed with unilateral DH. The change of DH was recorded using disc photography. Both anatomical data and functional visual field (VF) data were collected using optical coherence tomography angiography and Humphrey VF examination. RESULTS: Sixteen patients were included with average follow-up duration of 95 months. Almost half of DH episodes was initially presented at the inferotemporal area of the optic disc. Pigment formation at the previous DH site after resolution was noted in 12.5% of eyes. Sectoral radial peripapillary VD at the DH site was significantly lower in DH eyes than in the control group; however, the sectoral RNFL thickness at the DH site was not significantly decreased. Progression of the VF defect corresponding to the DH site was found in 81.3% of eyes despite regular use of antiglaucoma agents. The mean change in the VF mean deviation was -0.64 dB/year in DH eyes. CONCLUSION: During long follow-up periods, decreased peripapillary VD at the DH site and progression of the VF defect corresponding to the DH site were detected in nonglaucomatous eyes. Retinal pigmentation with an RNFL defect is a clue for DH, although RNFL showed no significant change. Antiglaucoma treatment may not prevent the deterioration of visual function.

Normal tension glaucoma in obstructive sleep apnea syndrome: A structural and functional study.

This study characterized and evaluated normal tension glaucoma (NTG) in obstructive sleep apnea syndrome (OSAS).In this retrospective, cross-sectional study, all participants were examined with polysomnography (PSG). Functional parameters of standard automated perimetry (SAP) were recorded. Structural parameters in optical coherence tomography angiography (OCTA) included peripapillary superficial vessel density (VD RPC), peripapillary whole-layer (VD NH), and superficial and deep macular area VD. Participants were categorized into perimetric and nonperimetric groups by SAP result. Low reliability of SAP and signal strength index <50 in OCTA were excluded.Severity of OSAS was graded by apnea-hypopnea index (AHI) in PSG. Those with moderate/severe OSAS (AHI ≥ 15, n = 39) had longer neck circumference and shorter ocular axial length than mild OSAS (AHI < 15, n = 14). Furthermore, there was significantly higher AHI and larger neck circumference in the NTG perimetric group (n = 27) than in the control group (n = 26; p < 0.001 and p = 0.047, respectively). Superficial and deep-layer peripapillary and macular area VD significantly decreased in the perimetric group. Overall, structural and functional parameters show that VF PSD was negatively correlated with VD NH and VD RPC (p = 0.007, p = 0.015); and VF MD was positively correlated with VD NH (p = 0.029), but not significantly to VD RPC (p = 0.106).OSAS is a risk factor of NTG. With aid of OCTA, whole-layer retinal capillary dropout supports that the vascular dysregulation of OSAS leads to NTG.

Archeometric studies in the Franciscan Convent of "Santo Antônio" (Recife, PE).

The purpose of this paper is to characterize the tiles placed on the walls of the Franciscan convent of "Santo Antônio" (Recife-PE) and to obtain information about the several expansions and structural reforms performed on the convent by dating the bricks. For this purpose, a portable energy dispersive x-ray fluorescence (EDXRF) was used to characterize the tiles. The dating of the bricks was performed using the Thermoluminescence (TL) technique. The results of the EDXRF analysis show that the dominant component of the white pigment is lead [2PbCO(3)·Pb(OH)(2)], used since the ancient times until the 20th century, while the dominant element of the blue pigment is cobalt (CoO·Al(2)O(3)), that has been used from 1807 until nowadays. The TL dating of bricks indicate that there were walls with different periods of construction, being one built around 1765, with a deviation of 28 years, whereas other was built later, around 1874, with a deviation of 15 years. These results provide new data towards understanding how and when the Recife Franciscan convent of "Santo Antônio" was designed and built, contributing to other research works presently underway on site.

Novel mode of resistance to Fusarium infection by a mild dose pre-exposure of cadmium in wheat.

Exposure of healthy wheat seeds (Triticum aestivum var Sonalika) to mild dose of cadmium (Cd(2+)) given as 50 microM CdCl(2) for 48 h and then washed off Cd(2+) offered resistance to the subsequent infection by Fusarium oxysporum inoculum. Seven days old seedlings having two primary leaves were aseptically inoculated with fungus, F. oxysporum (1 x 10(6)) spores. The seedlings pre-exposed to low level of Cd(2+) survived the Fusarium infection, while plantlets without Cd(2+) stress wilted and then perished due to Fusarium infection. The stress associated proteins induced by Cd(2+) (50 microM), F. oxysporum and by the co-stress (50 microM Cd(2+) and then with F. oxysporum) treatments were observed to be of same molecular weight (51 kDa). Antibody was raised against the purified Cd(2+)-stress associated protein (CSAP). Immuno-gold labeling of wheat seedling root tissue showed the presence of this CSAP in Cd(2+) pre-exposed and in co-stressed tissues and to be located predominantly on the inner linings of the cell membranes. We also observed that the anti-CSAP-antibody also labeled the root tissue of only Fusarium inoculated seedlings and the gold labeling was intensely located on the membrane. This cross-reaction of anti-CSAP suggests that Fusarium-induced stress protein (FISP) possibly has close homology to CSAP. We thus show for the first time the over expression of a high molecular mass protein by mild dose of Cd(2+) pre-exposure to wheat seeds which subsequently provided protection against Fusarium infection. This mode of resistance developed by an abiotic stress-causing agent against pathogen infection is novel.

Activity of commercial enzymes on settlement and adhesion of cypris larvae of the barnacle Balanus amphitrite, spores of the green alga Ulva linza, and the diatom Navicula perminuta.

Fouling species produce adhesive polymers during the settlement, adhesion and colonization of new surfaces in the marine environment. The present paper tests the hypothesis that enzymes of the appropriate specificity may prevent biofouling by hydrolysing these adhesive polymers. Seventeen commercially available enzyme preparations designed originally for bulk use in a range of end-use applications were tested for their effects on the settlement and/or adhesion of three major fouling species, viz. the green alga Ulva linza, the diatom Navicula perminuta and the barnacle Balanus amphitrite. The serine-proteases were found to have the broadest antifouling potential reducing the adhesion strength of spores and sporelings of U. linza, cells of N. perminuta and inhibiting settlement of cypris larvae of B. amphitrite. Mode-of-action studies on the serine-protease, Alcalase, indicated that this enzyme reduced adhesion of U. linza in a concentration-dependent manner, that spores of the species could recover their adhesive strength if the enzyme was removed and that the adhesive of U. linza and juvenile cement of B. amphitrite became progressively less sensitive to hydrolysis as they cured.

Mid-term follow-up of Nd:YAG laser iridotomy in Asian eyes.

BACKGROUND AND OBJECTIVE: To assess the long-term results of Nd:YAG laser iridotomy in the treatment of patients with primary angle-closure glaucoma and occludable angles to evaluate the risk-benefit ratio and the role of gonioscopy in predicting the outcome after Nd:YAG laser iridotomy. PATIENTS AND METHODS: The records of 138 consecutive patients (231 eyes) who underwent Nd:YAG laser iridotomy in one hospital during 3 years (from 1989 to 1991) were reviewed. The mean follow-up period was 51 months. RESULTS: Of all eyes, 25.1% were treated for chronic angle-closure glaucoma and 10.8% were treated for acute angle-closure glaucoma; most eyes (64.1%) underwent prophylactic iridotomy for occludable angles. Decreased intraocular pressure (IOP) was noted in most eyes after Nd:YAG laser iridotomy; only 10 eyes required further filtration surgery. Visual acuity was unchanged or improved in 97.9% of all eyes at the 6-month visit. Cataract progression was primarily responsible for those eyes with decreased acuity. Ninety-seven percent of eyes had quantitatively wider angles after laser treatment; 8 of 14 eyes with peripheral anterior synechiae of more than 270 degrees underwent further surgery to control IOP. Transient elevated IOP and iris bleeding occurred in 23.5% and 12.2% of the eyes, respectively; other complications were rare. CONCLUSION: Nd:YAG laser iridotomy is a safe and effective procedure for the treatment and prevention of angle-closure glaucoma. Gonioscopy is useful to predict the outcome after Nd:YAG laser iridotomy.

Supracondylar femur fractures treated percutaneously.

One hundred twenty-five supracondylar fractures in 118 patients treated with the Green-Seligson-Henry supracondylar intramedullary nail were evaluated. One hundred four patients (111 fractures) were followed up to fracture union. The percutaneous technique was compared with open reduction and internal fixation using the same device. The mean operative time was greater for the open reduction technique when compared with the percutaneous technique (176 minutes versus 76.6 minutes, respectively), as was the mean estimated blood loss (229 cc versus 96.2 cc). The incidence of delayed union was approximately the same for patients who were treated with both techniques. However, the nonunion rate was significantly higher in the patients treated with open reduction and internal fixation than the patients treated with the percutaneous technique (5.6% versus 2.6%). Twenty-nine (39%) patients who were treated with open reduction and internal fixation required bone grafting versus only three (7%) patients who were treated with the percutaneous technique. Additionally, the percutaneous technique did not produce a higher incidence of malalignment and resulted in a greater postoperative range of motion than the open technique. The current study shows that percutaneous treatment of supracondylar femur fractures is possible and can decrease operative times, blood loss, the need for bone grafting, increase rates of union, and improve functional outcomes.

Role of genotypic analysis of the thymidine kinase gene of herpes simplex virus for determination of neurovirulence and resistance to acyclovir.

Mutations in the thymidine kinase (TK) gene of herpes simplex virus (HSV) have been associated with resistance to acyclovir (ACY) and possible recognition of neurotropic strains. We sequenced a 335-bp segment of the TK gene to determine the frequency of mutations in HSV strains recovered from dermal, genital, and cerebrospinal fluid (CSF) specimens (n = 200; 102 HSV type 1 [HSV-1] 98 HSV-2 strains). Four polymorphic sites were detected in HSV-1 strains; C513T, A528G, C575T, and C672T. Among the polymorphisms, only C575T resulted in a change of amino acid sequence (residue 192, Ala-->Val). For HSV-2 strains, only one polymorphism (G420T) which resulted in an amino acid substitution (residue 139, Leu-->Phe) was detected. Phenotypic determination of resistance to ACY by a plaque reduction assay of 48 HSV isolates was not correlated with the sequence results of 11 strains in that 7 of these with genotypic polymorphisms were susceptible to the drug in vitro. In addition, of 32 ACY-resistant HSV strains, 28 (87.5%) had no polymorphisms detected in the 335-bp amplicon of the TK gene. There was no statistical difference in the frequency of polymorphisms according to the source of the specimens. We conclude that the detection of nucleic acid polymorphisms in a previously implicated 335-bp segment of the TK gene cannot be interpreted as indicative of either ACY resistance or neurotropism of HSV strains from dermal, genital, and CSF sources.

Functional outcome of patients with salvageable limbs with grades III-B and III-C open fractures of the tibia.

Numerous reports list predictive criteria to determine whether Gustilio-type tibial III-B and III-C fractures of the tibia are salvageable. What is lacking are long-term reports of comprehensive functional outcome of these severe injuries. We evaluated the functional outcome of patients with our own seven-scale score. Fifty-four patients with 57 types III-B (n = 41) and III-C (n = 16) open tibial fractures sustained between 1980 and 1989 were recalled for evaluation. There were 45 men and 9 women (average age, 28.4 years; range, 4-68 years). Follow-up periods averaged 48.2 months (range, 12-116 months). Salvage rate for the III-B fractures was 75% (n = 31) and for the III-C fractures 37% (n = 6). We conclude that the functional score is a simple and complete method for assessing the functional outcome of patients undergoing limb salvage procedures.

[Treatment concept and results of grade 3 open fractures with arterial injuries requiring reconstruction]. / Behandlungskonzept und Ergebnisse von drittgradig offenen Frakturen mit rekonstruktionspflichtigen Arterienverletzungen.

Ninety-one open fractures associated with arterial injury requiring vascular repair (type IIIC injuries) were treated at the University of Louisville between May 1983 and January 1994. Involved anatomical areas were the humerus (6x), the forearm (11x), the femur (16x), the tibia (36x), the ankle (11x) and the foot (11x). Fracture management consisted of meticulous radical debridement, copious wound irrigation, fasciotomy and fracture stabilization. Additionally, 49 wounds (53.8%) were treated with the supplemental local use of antibiotics (tobramycin-PMMA-beads). Thirty-four patients underwent primary amputation whereas 57 repairs of the injured vessels were performed. There were 7 secondary amputations due to infection or poor revascularization resulting in an overall amputation rate of 45.1%. The wound infection rate was 12.1% (11/91) and the rate for osteomyelitis was 3.3% (3/91). The local use of the antibiotic beads was of significant benefit to lower infectious complications. Primary coverage of the soft tissue defect with free tissue transfer was associated with a high infection rate (2/3) and is not recommended for this type of injury. Temporary wound coverage with the "antibiotic bead pouch" technique until wound closure can be obtained in a sterile and viable environment leads to more satisfying results.

Pathological gambling: Etiologic considerations and treatment efficacy of eye movement desensitization/reprocessing.

This study of 22 subjects who meet DSM IV criteria for Pathological Gambling (PG) tests a theory that the development of PG lies in the existence of unresolved trauma-related anxiety, similar to Post Traumatic Stress Disorder, and predicts that reduction of that anxiety will result in reduced pathological gambling behavior. The study compares the effect on gambling event frequency of Eye Movement Desensitization and Reprocessing (EMDR) therapy with cognitive therapy to that of cognitive therapy alone for subjects with and without reported trauma history. Results are significant for pre- vs post-EMDR (p =.04), for those with reported trauma history, (p=.01) and when controlled for frequency of sessions and time in therapy prior to the treatment (p=.04). Findings support an anxiety based model for the etiology of PG behavior.

Management of supracondylar fractures proximal to total knee arthroplasty with the GSH supracondylar nail.

The management of a supracondylar fracture above a total knee arthroplasty requires a cautious surgical approach. Currently, the standard method of plate/screw internal fixation of this type of fracture has yielded only fair results. A new technique of retrograde intramedullary nailing through the femoral component using the GSH supracondylar nail is described in this report. A review of four series in which more than 50 patients were treated using the GSH nail indicates a significant difference in bone grafting (10% versus 75%), delayed union (7.2% versus 50%), nonunion (1.9% versus 10%), and surgical revision (0 versus 10%) compared to plate/screw fixation of similar fractures. The findings in this review indicate that the GSH supracondylar nail provides excellent biomechanical stability in these complex fractures, resulting in minimal complications and allowing early return of the patient to functional activities.

Local antibacterial therapy for the management of orthopaedic infections. Pharmacokinetic considerations.

Bone infection has long been a formidable foe of orthopaedic surgeons. The standard method of treating osteomyelitis generally consists of irrigation and debridement supplemented by pre- and postoperative antibiotics and intraoperative antimicrobial solutions. In the 1970s, Buchholz introduced the concept of local antibacterial therapy in the form of antibiotic impregnated bone cement to treated infected arthroplasties. From this, antibiotic impregnated beads were developed to treat local infections of bone and soft tissue. The advantage of these beads compared with parenteral therapy is that they deliver a high concentration of antibacterial locally while avoiding high systemic concentrations, thus avoiding adverse effects that are often associated with parenteral antibacterial therapy. Additionally, methylmethacrylate bone cement does not significantly affect the immune response of the body. This makes the use of antibiotic-impregnated polymethylmethacrylate (PMMA) beads highly effective either as an alternative to, or in conjunction with, systemic antibiotic treatment of infected arthroplasties, and localised bone and soft tissue infection. This article explores the indications for the use of local therapy as well as any advantages or disadvantages it may have over systemic antibacterial treatment. Additionally, there are important pharmacokinetic considerations for the optimal use of antibacterial agents in the treatment of osteomyelitis.

Tibial pilon fractures: a comparative clinical study of management techniques and results.

Thirty-eight consecutive pilon fractures were reviewed retrospectively to compare the radiographic and clinical results with the original injuries based on three different treatment options: external fixation only, external fixation with limited internal fixation, and internal fixation only. Dates of injury were from February 1985 to February 1989. Treatment method was the surgeon's preference. The mean follow-up time was 28 months. Results were tabulated by clinical and radiographic scores. In general, simple fracture types had good results; complex ones did less well. In this study, fracture severity appeared to be the key variable in outcome.

Local antibiotic therapy for severe open fractures. A review of 1085 consecutive cases.

We reviewed 1085 consecutive compound limb fractures treated in 914 patients at the University of Louisville over a nine-year period. Of these fractures, 240 (group 1) received only systemic antibiotic prophylaxis and 845 (group 2) were managed by the supplementary local use of aminoglycoside-polymethylmethacrylate (PMMA) beads. There were no significant differences in age, gender, fracture type, fracture location or follow-up between the two groups. All had copious wound irrigation, meticulous debridement and skeletal stabilisation, but wound management and the use of local antibiotic depended on the surgeon's individual preference and there was no randomisation. In group 1 there was an overall infection rate of 12% as against 3.7% in group 2 (p < 0.001). Both acute infection and local osteomyelitis showed a decreased incidence in group 2, but this was statistically significant only in Gustilo type-IIIB and type-IIIC fractures for acute infection, and only in type-II and type-IIIB fractures for chronic osteomyelitis. Our review suggests that the adjuvant use of local antibiotic-laden PMMA beads may reduce the incidence of infection in severe compound fractures.

The management of open fractures associated with arterial injury requiring vascular repair.

Seventy-two open fractures associated with arterial injury requiring vascular repair (Gustilo type IIIC injuries) were treated at the University of Louisville from May 1983 and through 1992. The involved anatomic areas were the humerus (four), forearm (ten), femur (eight), tibia (31), ankle (ten), and foot (nine). Fracture management consisted of careful débridement, wound irrigation, fasciotomy, and fracture stabilization. Additionally, 40 wounds (55.6%) were treated with the supplemental use of local antibiotics (tobramycin-PMMA bead chains). Twenty-three patients (32.1%) underwent primary amputation, and 49 (67.99%) of the injured vessels were repaired. There were seven secondary amputations because of infection or poor revascularization, resulting in an overall amputation rate of 41.6%. The wound infection rate was 13.9% (10 of 72) and the rate for osteomyelitis was 4.2% (3 of 72). The local use of the antibiotic bead chains was of significant benefit in lowering infectious complications. Primary coverage of soft-tissue defects with free tissue transfer had an infection rate of 66%; temporary wound coverage with the "antibiotic bead pouch" technique until wound closure can be obtained in a sterile and viable environment appears to be a better option.