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Am J Transl Res 2013;5(1):47-52
Original Article
Percutaneous re-circulating isolated limb perfusion of gentamicin in a
large animal model: targeted delivery of gentamicin to limb
Melissa J Byrne, Rejhan Idrizi, John M Power, David M Kaye
Heart Failure Research Group, BakerIDI Heart & Diabetes Institute, Melbourne, Victoria, Australia
Received September 18, 2012; Accepted November 27, 2012; Epub January 21, 2013; Published January 30,
2013
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 ad-ministration (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.
(AJTR1209005).
Keywords: Wound infection, percutaneous delivery, gentamicin, limb
Address correspondence to: Melissa J Byrne, Heart Failure Research Group, BakerIDI Heart & Diabetes
Institute, P.O. Box 6492, St Kilda Road Central, Melbourne, Victoria, 8008, Australia. Phone: +61 3 8532 1263; Fax:
+61 3 8532 1100; E-mail: melissa.byrne@bakeridi.edu.au
Original Article
Percutaneous re-circulating isolated limb perfusion of gentamicin in a
large animal model: targeted delivery of gentamicin to limb
Melissa J Byrne, Rejhan Idrizi, John M Power, David M Kaye
Heart Failure Research Group, BakerIDI Heart & Diabetes Institute, Melbourne, Victoria, Australia
Received September 18, 2012; Accepted November 27, 2012; Epub January 21, 2013; Published January 30,
2013
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 ad-ministration (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.
(AJTR1209005).
Keywords: Wound infection, percutaneous delivery, gentamicin, limb
Address correspondence to: Melissa J Byrne, Heart Failure Research Group, BakerIDI Heart & Diabetes
Institute, P.O. Box 6492, St Kilda Road Central, Melbourne, Victoria, 8008, Australia. Phone: +61 3 8532 1263; Fax:
+61 3 8532 1100; E-mail: melissa.byrne@bakeridi.edu.au
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