PMC4298813_01
Gout affecting the joints of the left hand.
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F1
Joints affected by the gout included the knees, elbows, ankles and small joints of the hands (see Figs. 1, 2).
Joints of the patient's feet demonstrate gouty tophi.
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F2
Joints affected by the gout included the knees, elbows, ankles and small joints of the hands (see Figs. 1, 2).
Exudate expressed from left knee at initial arthroscopic
washout.
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F3
The chalky, gritty accumulations of monosodium urate crystals were expressed followed by a thorough washout (see Figs. 3, 4).
Debridement and washout of the left knee.
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F4
The chalky, gritty accumulations of monosodium urate crystals were expressed followed by a thorough washout (see Figs. 3, 4).
Intra-articular portals to enable access to the joint space.
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F5
On day 26 of admission, a further joint debridement and washout was undertaken and three intra-articular portals were established based on previous incisions (see Fig. 5).
V.A.C. VeraFlo  negative pressure equipment.
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F6
C-reactive protein (CRP) trend with surgical intervention.
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G1
By day 53 of admission, four weeks after attachment of topical negative pressure device, the extent of healing of the three incisions meant that the instillations were no longer penetrating to the joint space (see Fig. 7).
Left knee after V.A.C. VeraFlo  therapy.
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F7
Able to mobilise independently18 months post discharge.
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F8