The Keystone perforator island flap (Keystone flap), is a Type A fasciocutaneous advancement flap, consisting of two V to Y advancement flaps. Skin cancer excision around joints presents a number of reconstructive challenges. Owing to the mobile nature of joints, the optimal periarticular reconstructive option should possess the ability to provide adequate tissue coverage and withstand regional changes in tensile pressures. We report a single-surgeon series of five cases of periarticular keystone flap between 2014 and 2017. Data were collected from operation notes, clinical photography, histopathology, and outpatient clinic records. The indication for keystone flap was skin cancer in all cases (n = 5). The largest defect size post-excision in was 75 mm × 40 mm × 15 mm. All keystone flaps demonstrate a color and cosmetic appearance comparable to adjacent tissue. There were no major postoperative complications including flap failure or impaired range of joint movement in the follow up period. Superficial wound infection occurred postoperatively in one case. This is the first case series to discuss the use of keystone flaps in periarticular wound closure. Locoregional fasciocutaneous wound coverage offered by keystone flaps may alleviate the risks of graft failure, contour defects, and donor site morbidity associated with alternative reconstructive options, with good functional and cosmetic outcomes. We advocate their use as a robust reconstructive option in periarticular areas.

We have previously reported that platelet concentrates (PC) may be irradiated with ultraviolet light (UVL) in a cryostorage pack such that mixed lymphocyte reactions (MLR) are abolished whilst satisfactory platelet function is retained during subsequent storage using Fenwal PL-1240 containers. We have now studied both platelet structure and function after irradiation in DuPont Stericell bags which are both UV-permeable and biocompatible. The irradiation dosage was 3000 Joules/m2 of UVL at a mean wavelength of 310 nm; a dose previously shown to abolish MLR. No detriment to platelet function was observed when compared to control as measured by aggregation responses to adenosine diphosphate (ADP), collagen and ristocetin, hypotonic shock response and pH during 5 d of storage. Lactate levels were significantly higher (P less than 0.01) and glucose levels lower (P less than 0.01) in UV-treated PC, although in the majority the lactate level did not exceed 20 mmol/l. Betathromboglobulin and platelet factor 4 levels were higher during storage in the UV group, the latter reaching significance (P less than 0.05). When whole platelets and platelet membranes were stained with Coomassie blue or Periodic Acid-Schiff's reagent after electrophoresis in polyacrylamide gels no obvious alterations to major membrane constituents were observed on days 1 and 5 of storage. Paired in vivo autologous studies in healthy volunteers using 111Indium-labelling were performed at the end of 5 d of storage. The UV-treated platelets gave satisfactory and equivalent results for recovery, half life and survival when compared to controls. We conclude that PC irradiated with UVL and stored for 5 d in DuPont Stericell containers appear suitable for transfusion and may prove to be nonimmunogenic. Further in vivo studies of haemostatic efficacy and recipient alloimmunization are now warranted.

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Six patients with newly diagnosed haematological malignancy were treated with ciprofloxacin 500 mg orally, as chemoprophylaxis during neutropenia. The mean serum ciprofloxacin concentrations, measured 1, 2, 3 and 4 h after dosage were reduced for up to ten days after the start of chemotherapy. The mean maximum serum concentration and AUC 0-4 h were reduced from 3.7 (95% confidence limits, 2.3-5.1) mg/l and 10.7 (6.2-15.2) mg/l.h pre-chemotherapy to 2.0 (1.4-2.6) mg/l and 5.7 (4.4-7.0) mg/l.h, 13 days after chemotherapy. Absorption of ciprofloxacin is reduced after cytotoxic chemotherapy, and this may have implications for the use of oral ciprofloxacin in this group of patients.

Serial capillary blood glucose levels from insulin treated patients were recorded over 24 hour periods at fortnightly intervals for three months. Total glycosylated haemoglobin as % of HbA was measured at the end of this period by the Flückiger method, and % HbA1 by column chromatography. There were highly significant correlations between mean blood glucose levels over the three months and % HbA1 (r = 0.93, 95% confidence limits 0.84-0.98), and with total glycosylated haemoglobin (r = 0.88, 95% confidence limits 0.75-0.94). There was also a good correlation between results obtained by the two methods (r = 0.81, p less than 0.0001). There were less strong correlations between % HbA1 and blood glucose levels during each of the three months before the estimation, with percentage of glucose levels greater than 10 mmol/l and with mean fasting blood glucose. These data support the hypothesis that % HbA1 and total glycosylated haemoglobin are satisfactory measurements of short term diabetic control.