004 and P = 0 001, respectively) The cell proliferation assay of

004 and P = 0.001, respectively). The cell proliferation assay of CD4+ and CD8+ lymphocytes performed in stimulated samples did not show a trend from the shortest hyperoxia exposure on,

check details while we observed a decrease in proliferation with hyperoxia exposure longer than 16 h (P = 0.001, 88 h hyperoxia data compared to shorter exposures). Furthermore, we found increasing prevalence of naïve CDR45RA+CD4+ cells with duration of hyperoxia in stimulated samples (P = 0.001). The proportion of regulatory T cells (CD4+Foxp3+) in unstimulated samples did not change systematically after hyperoxia, nor did the other investigated population with regulatory properties – the NK T cells. We did not find any association between hyperoxia exposure and frequencies of CD4+ and CD8+ populations in the culture. The activation molecules (CD25, CD69, HLA-DR) and T helper (Th) 1 and Th2 chemokine receptor expressions (CXCR3, CCR4, respectively) of CD4+ T helper cells were not altered during hyperoxia. We found a decrease in prevalence of CXCR3 expressing CD4+ T (Th1) cells and increased prevalence of CCR4 expressing cells (Th2) at all time points after stimulation compared to resting cultures that was

not influenced by hyperoxia. Along with activation markers, we observed a marked increase in Foxp3 expressing CD4+ cells after stimulation in all cultures but the one with the 88-h hyperoxia exposure. Similar to proliferation assay, the escalating hyperoxia trend analysis did not show any association from the shortest hyperoxia exposure on, but we noted the very low Foxp3 expression after 88-h hyperoxia (P = 0.001, 88-h hyperoxia Protein Tyrosine Kinase inhibitor data compared to shorter exposures). The prevalence of NK cells was similar in all experimental arms. In view of experimental evidence that hyperoxia may suppress autoimmunity [8–10, 13], alloreactivity [2] or modify response to infection [12], we aimed to examine the influence of hyperoxia on prevalence of naturally Inositol monophosphatase 1 occurring Tregs and basic T cell subsets important in adaptive immune response. In unstimulated cells exposed to normobaric hyperoxia of different

duration, we found no change in relative frequency of Tregs and their cellular environment including CD4+, CD8+, the Th1, Th2 populations, naïve/memory T cells or NK T cells. This finding suggests that these cell types are similarly resistant to normobaric hyperoxia while not stimulated. This in vitro finding concerning major CD4+ and CD8+ subtypes is in line with the results of other clinical studies [19, 20] which also confirmed stable numbers of circulating CD3+, CD4+, CD8+, CD25+ and HLA-DR+ expressing lymphocytes in patients undergoing repeated hyperbaric hyperoxia therapy. While some authors reported changes of circulating CD4+/CD8+ lymphocyte absolute counts and ratio [5, 6] after a single hyperbaric hyperoxia challenge, this is likely transient as 24 h after exposure they found a partial reversal to normal values.

Free iron is found at higher levels in patients with type 1 diabe

Free iron is found at higher levels in patients with type 1 diabetes [30] and exogenous apoTf may prevent iron to engage in reactions that lead to production of hydroxyl radicals and consequent oxidative stress, as represented by the AZD9291 in vivo effects of desferrioxamine (DFO) treatment on hypoxia-inducible

factor (HIF)-1α and vascular endothelial growth factor (VEGF) expression in encapsulated human islets [27], oxidative stress in mouse pancreatic beta cells [30] and chronic allograft damage [31]. The reduced production of proinflammatory cytokines may have contributed to the anti-diabetogenic effects of apoTf, but we cannot rule out that this effect ensues from the apoTf-related inhibition check details of other different steps of autoimmune diabetogenesis in vivo that may lead secondarily to the reduced prevalence of these cytokines. The prolonged treatment with apoTf could, primarily, have inhibited other diabetogenic pathways including, but not limited to, leucocyte chemotaxis into pancreatic islets, the generation and maintenance of cytotoxic effectors (macrophages, CD8+ and NK cells) or the induction of tolerogenic cells or cells such as DC1 or M1. It is known that naive B and T cells

express low levels of TfR1 (transferrin receptor 1) that increase after stimulation with the mitogen phytohaemagglutinin (PHA), thus suggesting its role in the modulation of the inflammatory process mediated by the binding

of transferrin molecules. Moreover, earlier evidence demonstrated that iron-saturated transferrin may decrease the production of granulocyte–macrophage colony-stimulating factors (GM-CSF) by human T lymphocytes that had been stimulated by either PHA or ConA, while no inhibitory effect was observed upon treatment with a monoclonal antibody against transferrin receptors [32]. Based on these observations, we speculate that the effects of exogenous ApoTf Avelestat (AZD9668) may be due partially to its chelation of iron and the subsequent binding to TfR1. Additional immunopharmacological in-vitro and ex-vivo studies are awaited to clarify this point. In conclusion, the translational findings gathered from our study suggest that apoTf manifests powerful anti-diabetogenic effects in established models of type 1 diabetes and that the blood levels of this protein are reduced significantly in a substantial proportion of newly diagnosed type 1 diabetes with elevated HbA1C. These data warrant further studies on the role of endogenous and exogenous apoTf in autoimmune diabetogenesis and its possible use for the prevention and early treatment of human disease. The authors received a grant support for research from a MIUR (Ministry of Education, University, Research) project (Decree no. 795 of 21 June 2004). The authors have no financial conflict of interest.

(reviewed in ref 35) It is therefore possible that IL-10, produc

(reviewed in ref. 35) It is therefore possible that IL-10, produced by a small number of skin-resident Treg cells, mediates potent anti-inflammatory effects by serving to limit the amplification of inflammatory networks. With this in mind it is

therefore tempting to speculate that in our model, IL-10 produced by skin-resident Treg cells, acts to suppress the accumulation and survival of neutrophils at the site of antigenic challenge thereby reducing the overall immunogenicity of the antigen. These findings have implications for vaccine efficacy because they indicate that even partial removal of Treg cells will alter vaccine immunogenicity through limiting the influence of the cells on both innate and adaptive immune responses. This work was supported by an MRC non-clinical

find more senior fellowship (G117/488), an MRC collaboration grant (G0500617) and project grants from the AICR (05-028) and the Wellcome Trust (067046). The authors declare that there are no conflicts of interest. “
“Membrane microdomains play an important role in the regulation of natural killer (NK) cell activities. These cholesterol-rich membrane domains are enriched at the activating immunological synapse and several activating NK-cell receptors are known to localize to membrane microdomains upon Hydroxychloroquine receptor engagement. In contrast, inhibitory receptors do not localize in these specialized membrane domains. In addition, the functional competence of educated NK cells correlates with a confinement of activating receptors in membrane microdomains. However, the molecular basis for this confinement is unknown. Here we investigate the structural requirements for the recruitment of the human activating NK-cell receptors NKG2D and 2B4 to detergent-resistant membrane fractions in the murine BA/F3 cell line an in the human NK-cell line NKL. This stimulation-dependent recruitment occurred

independently of the intracellular domains of the receptors. However, either interfering with the association between NKG2D and DAP10, or mutating the transmembrane region of 2B4 impacted the recruitment of the receptors to detergent-resistant Histamine H2 receptor membrane fractions and modulated the function of 2B4 in NK cells. Our data suggest a potential interaction between the transmembrane region of NK-cell receptors and membrane lipids as a molecular mechanism involved in determining the membrane confinement of activating NK-cell receptors. This article is protected by copyright. All rights reserved “
“Immunoinflammatory-mediated demyelination, the main pathological feature of multiple sclerosis (MS), is regularly accompanied by neurodegenerative processes, mostly in the form of axonal degeneration, which could be initiated by glutamate excitotoxicity. In the current study, the relationship between Th17-mediated inflammatory and excitotoxic events was investigated during an active phase of MS.

[125] Sonographic needle

puncture and drainage may also b

[125] Sonographic needle

puncture and drainage may also be an option in rare cases of primary hepatic aspergillosis.[126] The main intention for surgical intervention in IA is to obtain material for diagnosis and antifungal susceptibility testing. There are, however, also therapeutic implications for surgical interventions in rare manifestation of IA such as endocarditis or mycotic aneurysm. Despite the fact that early initiation of systemic STA-9090 mw anti-mould therapy remains the most important measure to reduce mortality, surgical debridement remains an important adjunctive therapeutic option in many cases of primary, localised extrapulmonary IA. M. Hoenigl received research grant from Merck and Pfizer; served on the speakers’ bureau of Pfizer, Gilead, this website Astellas and Merck and received travel grants

from Astellas, Merck, Gilead and Pfizer. F. Reischies: no conflicts to declare. “
“A variety of fungal pulmonary infections can produce radiologic findings that mimic lung cancers. Distinguishing these infectious lesions from lung cancer remains challenging for radiologists and clinicians. In such cases, radiographic findings and clinical manifestations can be highly suggestive of lung cancer, and misdiagnosis can significantly delay the initiation of appropriate treatment. Likewise, the findings of imaging studies cannot replace the detection of a species as the aetiological agent. A biopsy is usually required to diagnose the infectious nature of the lesions. In this article, we review the clinical, histologic and radiologic features of the most common fungal infections that can mimic primary lung cancers, including paracoccidioidomycosis, histoplasmosis, cryptococcosis, coccidioidomycosis, aspergillosis, mucormycosis and blastomycosis. “
“The purpose of the study was to establish the prevalence of new Candida glabrata complex species: Candida nivariensis and Candida bracarensis isolated from clinical material, evaluate their phenotypes and the prevalence of gene Terminal deoxynucleotidyl transferase family encoding extracellular glycosylphosphatidylinositol-linked

aspartyl proteases, crucial for C. glabrata virulence. Study material included 224 C. glabrata clinical strains. Candida glabrata phenotypes were identified using CHROMagar Candida medium. Strains were analysed by using C. glabrata-specific PCR for the internal transcribed spacer region to confirmed the identification. To identify C. nivariensis and C. bracarensis strains, the D1/D2 region of 26S rRNA was sequenced. The prevalence of YPS-family proteases genes was detected using standard PCR method. Candida nivariensis amounted about 6% among the total number of C. glabrata strains. Candida nivariensis strains had a white phenotype on chromogenic agar media and assimilated two sugars – trehalose and glucose. Among the 13 C. nivariensis strains, 10 did not present any YPS-family protease genes. Coexistence of all detected YPS-family protease genes was specific for C. glabrata species. This study identified C.

We compared gene expression profiles to the c2_all collection of

We compared gene expression profiles to the c2_all collection of curated gene-sets from the molecular signatures database (version 2·5) [35]. This collection contains gene-sets that are experimentally derived, as well as from expert curated pathway databases. A preranked file was created, containing the average difference between AA and SS for each probeset, sorted from most up-regulated in SS GS-1101 in vivo to most down-regulated. We used the na28 annotation csv file from http://www.affymetrix.com to determine the gene symbol for each probeset and collapsed probesets to unique genes using the default, max_probe option, resulting in 18 600 unique genes. GSEA (version 2·0) [35] was run in preranked mode, using default

parameters (gene-set sizes between 15 and 500 leaving 1387 gene-sets, 1000 permutations, images on the top 50 gene-sets). We used mRNA extracted from distal colons obtained from four

SS and four AA mice for RT–PCR confirmation of our gene expression study. Reverse transcription to produce cDNA was performed using RT2 First Strand Kits (SA Biosciences, Frederick, MD, USA), according to the manufacturer’s instructions. RT–PCR was performed utilizing the LightCycler 480 real-time PCR system (Roche Applied Science, Mannheim, Germany) with RT2 SYBR green PCR master mix according, to the manufacture’s protocol (SA Biosciences). Predesigned primers for genes of interest (slpi, s100A8, lbp, CD68, IL18R1, IL33, ccl8, cxcl10, ccl12, GSK 3 inhibitor pf4, ccl5, ccl7, fpr1 and ccr5) were obtained from SA Biosciences. For reference genes we evaluated three candidates, β-actin, β-glucuronidase and 18S rRNA. Beta-glucuronidase was selected based on similar expression patterns to most of our genes of interest and also because it was expressed invariantly between the groups. Hence, each

sample was normalized on the until basis of its β-glucuronidase content. Thermal cycling was performed as follows: initial denaturation at 95°C for 10 min, followed by 40 cycles of 95°C for 15 s and 60°C for 1 min. Each assay was performed in duplicate. The quantification points generated from quantitative RT–PCR (qRT–PCR) were normalized against a reference gene using this formula: normalized value of gene of interest with β-glucuronidase = 2–(QPGOI–QPRG), where QP = quantitative point, GOI = gene of interest and RG = reference gene (i.e. β-glucuronidase). We used the same 14 genes that we used for RT–PCR confirmation of our microarray study. We collected distal colonic samples from 3 days, 14 days and 28 days after the last (second) surgery. For each of the time-points we used four SS and four AA mice. The colons were collected, stored and processed for RT–PCR as described earlier. Group comparisons were analysed using the Mann–Whitney U-test with GraphPad Prism (Graphpad Software, San Diego, CA, USA). The differences were considered to be significant if P < 0·05.

73 m2 Clinical Practice Guidelines and Clinical Practice Recomme

73 m2. Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease,

AJKD, Suppl 2. 49(2):S46, February 2007. (Note covers both type 1 and type 2 diabetes) Patients with diabetes should be screened annually for Selleck MK-8669 CKD. The development of CKD can be attributable to diabetes (diabetic kidney disease, or DKD) or other causes. UK Renal Association: No recommendation. Canadian Society of Nephrology: No recommendation. European Best Practice Guidelines: No recommendation. Ask all people with or without detected nephropathy to bring in a first-pass morning urine specimen once a year. In the absence of proteinuria/urinary tract infection (UTI), send this for laboratory estimation of ACR. Request a specimen on a subsequent visit if UTI prevents analysis. Standards of Medical Care in Diabetes – 2008. Diabetes Care: 31, S1 January 2008. (Note covers both type 1 and type 2 diabetes) Perform an annual test to assess urine albumin excretion in type 1 diabetic patients with diabetes SB203580 in vivo duration of 5 years and in all type 2 diabetic patients, starting at diagnosis. No recommendation. No recommendation. None identified. The Type2 Diabetes

Guidelines project was funded by the Department of Health and Ageing under a contract with Diabetes Australia. The development of the ‘National Evidence Based Guidelines for Diagnosis, Prevention and Management of Chronic Kidney Diease in Type 2 Diabetes’ was undertaken by CARI in collaboration

with The Diabetes Unit, Menzies Centre for Health Policy at the University of Sydney. “
“Aim:  Despite significant advances in medical management and therapeutics, acute kidney injury (AKI) is still a common and serious complication with high morbidity and mortality in hospitalized patients, especially in patients admitted to the intensive care unit (ICU). The primary purpose of this study is to apply the definition proposed by the Acute Kidney Injury Network (AKIN) to investigate the incidence, 28-day mortality and risk factors for the prognosis of AKI in ICU. Methods:  In this retrospective study, data from a cohort of 4642 patients admitted to five ICUs were analyzed. Univariate and multivariate analyses Clomifene were performed to investigate the risk factors for prognosis of AKI. Results:  A total of 1036 patients were enrolled. AKI occurred in 353 of them (34.1%) under the AKIN criteria and the mortality was 54.4%. Multivariable analysis showed that variables related to the prognosis of AKI were: four or more (≥4) organ failed systems (odds ratio (OR) = 25.612), AKI III (OR = 14.441), AKI II (OR = 4.491), mechanical ventilation (OR = 7.201), sepsis (OR = 4.552), severe acute pancreatitis (OR = 3.299), base serum creatinine (OR = 1.004) and the length of stay in ICU (OR = 1.050).

Among the secondary reconstruction patients, 20 patients underwen

Among the secondary reconstruction patients, 20 patients underwent selleckchem reconstruction to improve their function and/or appearance. The goal of reconstruction

for the patients was functional improvement in eight cases, appearance improvement in ten cases, and both function and appearance in two cases. Chi-square analyses were performed between the secondary and primary reconstructive groups with regard to the incidence of postoperative complications. All transferred flaps survived completely. We performed a small postoperative modification procedure in four cases. Minor complications not requiring surgical correction occurred in 2 of 20 patients. Additional operations were required Belinostat concentration owing to major postoperative complications in 2 of 20 patients. No significant associations were identified between the secondary and primary reconstructive groups with regard to postoperative complications. The outcomes of the present report suggest that secondary reconstructive surgery is a relatively safe procedure. The decision to perform adaptation operations depends on various factors after sufficient discussion

with patients. © 2013 Wiley Periodicals, Inc. Microsurgery 34:122–128, 2014. “
“Between 1999 and 2005, seven patients had resection of tumors around the knee joint that involved half of the articular surface of the femoral or tibial side. Average age of the patients was 28 years (range, 14–40). Tumor pathology was giant cell Morin Hydrate tumor in four patients, osteoblastoma in two, and benign fibrous histocytoma in one patient. Two patients had recurrent tumors. The tumor was located in the distal femur in five patients and in the proximal tibia in the remaining two. The ipsilateral patella pedicled on the infrapatellar fat pad was used to substitute the resected articular surface and a vascularized fibula osteoseptocutaneous flap was used to reconstruct the metaphyseal defect. Average follow-up period was 6.5 years (range, 3.5–10

years). All flaps survived. Average time to bone union was 3.5 months (range, 3–4 months), and average time to full weight-bearing was 5 months (range, 4–6 months). No radiological signs of avascular necrosis of the patella were observed in any patient. Two patients required secondary procedures for correction of instability. One patient had local recurrence. At final follow-up, the median range of knee motion was from 10° to 100°. The average Knee Society Score (KSS) was 76 points (range; 50–85 points), and the average KSS functional score was 76.6 points (range, 70–90 points). In conclusion, the procedure is a reliable option for after resection of tumors that involve half the articular surface of the femur or the tibia. © 2010 Wiley-Liss, Inc. Microsurgery 30:603–607, 2010.

Therefore, we carried out supernatant transfer experiments under

Therefore, we carried out supernatant transfer experiments under conditions in which the synthetic TLR-2 agonist was washed from cells prior to supernatant conditioning. Supernatants conditioned for 6 h were sufficient to induce CD1a expression on fresh monocytes (Fig. 3C), although the percentage of cells expressing CD1 was lower than the percentage of CD1-positive cells treated directly with the TLR agonists. This decrement is expected because buy OTX015 factors may be consumed during conditioning and were diluted during transfer. Thus, TLR-2 agonists work

via mechanism that requires only minutes of TLR stimulation but plays out over 3 days in a process that involves cell to cell transfer of

host factors. To identify the host factors, we first screened conditioned supernatants using a multiplex bead-based cytokine array. Consistent with known patterns of TLR-2 dependent cytokine secretion 26, 41, we detected increased levels of IL-1β, IL-6, IL-8 and TNF-α, High Content Screening and we also found GM-CSF in monocyte supernatants. Using recombinant cytokines, we found that GM-CSF or IL-1β were sufficient to induce CD1a, CD1b and CD1c expression (Fig. 4A,C and data not shown). Quantitative ELISA detection showed that both GM-CSF and IL-1β were detected in conditioned supernatants within the dose range at which recombinant cytokines activate CD1a expression (∼100–500 pg/mL), consistent with the conclusion that both contribute to CD1 induction (Fig. 4A–C, Supporting Information Fig. S1 and data not shown). The role of GM-CSF in CD1 induction has been previously observed with recombinant cytokines 12 or mycobacterial infection 17, so we considered this a confirmatory result, while extending the range of pathogens that work via this mechanism. We undertook more detailed studies of IL-1β because it is

a key mediator of innate immunity that occurs downstream of TLRs, potentially providing insight in the pathways that connect TLR ligation to CD1 induction. Also, the potential role of IL-1β in CD1 gene regulation was not previously known and therefore represented a new adjuvant for activating the CD1 system. In our study, the CD1a induction was seen in response to two preparations of recombinant mature IL-1β (17Kd) that were free of detectable Obeticholic Acid order lipopolysaccharide (data not shown). Also, anti-IL-1β blocked CD1a induction, demonstrating that IL-1β was the only active component in the recombinant cytokine preparation (Supporting Information Fig. S1). Measurement of surface expression of all three group 1 was upregulated from trace to high levels in a dose-dependent fashion by IL-1β (Fig. 4C), whereas the group 2 CD1 protein (CD1d) was unaffected (Fig. 4C). Further, IL-1β induction of group 1 proteins increased activation of CD1a autoreactive T cells (Supporting Information Fig. S2).

[57, 71] According to Korting et al [72], the presence of SAP1–S

[57, 71] According to Korting et al. [72], the presence of SAP1–SAP3 transcripts correlates with the appearance of epithelial lesions. Lermann and Morschauser [73] suggested that Sap1–Sap6 were not required for invasion of RHE by C. albicans. Their study reported that mutants lacking SAP1–SAP3 or SAP4–SAP6 genes had the same ability to invade and promote damage to oral and vaginal RHE as the wild-type parental strain. Several studies point to differential expression and specific roles of the SAP genes during colonization

and infection of host tissues.[67-69, 71, 72] However, there are discrepancies in the results, which may be related to differences in the sensitivity of the methods used in various laboratories, intrinsic differences even in apparently similar infection models and variability among different Candida spp. strains. The emergence of these organisms as significant pathogens has GPCR Compound Library important implications for diagnosis and management, not only because of their increased incidence but also because many of these organisms are resistant to antifungal therapy. Becker et al. [75] suggested that there is a relationship between resistance to antifungal drugs and pathogenicity of Candida spp. Fungal virulence factors like Sap Ulixertinib ic50 isoenzymes may be potential targets for drug development. The treatment of yeast infections with antifungals aims to reduce the intensity of pathogenic

virulence to eliminate the infection.[76, 77] After 10 years of absence (1990–1999), new antifungal agents

were patented. Voriconazole (2000), posaconazole (2005) and ravuconazole 2-hydroxyphytanoyl-CoA lyase (2007) belong to the azole group, and caspofungin (2002), anidulafungin (2004) and micafungin (2006) belong to the echinocandins.[78] Each antifungal agent has a different mechanism to kill or inhibit the growth of fungal pathogens. The polyenes were the first group of antifungal agents available for the systemic treatment of yeast and mould infections. They promote formation of pores in the fungal membrane that lead to transmembrane potential loss and affect fungal cell viability. Among the polyenic antifungals, amphotericin B formulations (conventional, liposomal and lipid complex) are most commonly used.[79] The azoles act by blocking the pathway of ergosterol biosynthesis, specifically the enzymes 14-alpha-lanosterol demethylase in yeast or 14-alpha-sterol demethylase in moulds. These cytochrome enzymes are encoded by the ERG11 and CYP51 genes, respectively, in yeast and moulds.[80] The echinocandins represent a unique class of antifungal agents that act by blocking the activity of 1,3-β-d-glucan synthase, an important enzyme for the formation of the cell wall component 1,3-β-d-glucan. Caspofungin was the first agent to be cleared for treatment of candidemia in neutropenic and non-neutropenic patients.[81, 82] Flucytosine is a base pyrimidine analog that acts by inhibiting the synthesis of DNA and RNA.[83] It is rarely used for the systemic treatment of fungal infections.

In comparative physiological evaluations, patients lose up to 40%

In comparative physiological evaluations, patients lose up to 40% of trunk flexion strength and 9% of trunk extension strength with loss of both rectus muscles. Subjectively, patients following a bilateral harvest of the rectus muscles, also note a significant decline in functional capacity performing their preoperative activities of daily living. Similarly, numerous breast reconstruction series have reported abdominal bulge

rates of up to 48 percent after pedicled TRAM flap reconstruction.,8–10 Other series have demonstrated that single rectus muscle harvest is well-tolerated with no significant change in post operative functional capacity.[11] Several factors including the patient’s age, concurrent injuries, and post operative functional needs were carefully considered before Selleckchem BGB324 approaching this reconstruction. The extent of lower extremity injury essentially guaranteed some long-term PD0325901 functional limitation that would necessitate upper core strength for ambulation. Severe left shoulder and humeral fracture obviated harvest of the left latissimus dorsi muscle both for concerns of destabilizing the humerus and shoulder, and technical inability to appropriately position the upper extremity intraoperatively. Consideration was given to right latissimus dorsi harvest,

but concern for prolonged necessity for crutch-assisted ambulation given bilateral lower extremity trauma lowered our enthusiasm for this muscle. Radial forearm and anterior lateral thigh flaps were possibilities but suboptimal given size of the defects, and, in the case of the radial forearm flap, additional upper extremity morbidity. RVX-208 The rectus abdominis muscles were appropriately sized and outside any zone of injury. Once again, concerns for sacrifice of core body musculature were considered. Preoperative planning

for this case included a unilateral rectus muscle and unilateral anterior lateral thigh or radial forearm free flaps. Intraoperative examination of the unilateral rectus muscle demonstrated technical ability to perform a split rectus operation yielding two free flaps, one based on the superior system and one on the inferior epigastric system. It has been shown that fasciocutaneous flaps can suppress infection equally well as muscle flaps,[12] and the use of two anterolateral thigh flaps to obviate functional deficits in a young male would have also served as a good option in this case. However, this method would have required harvest of two flaps rather than one, and via this technique we sought to minimize morbidity, although the effectiveness of fascial versus muscle flaps we believe to be equivalent. The rectus abdominis flap first described by Pennington has gained popularity as an excellent choice for lower extremity reconstruction.