In bone and soft tissue infections, blood flow is poor in the affected bones and soft tissues, creating an environment in which it is difficult for intravenously administered antibiotics to migrate. Implants placed by surgery and bones and soft tissues with poor blood flow are prone to biofilm formation, and once biofilms have formed, a higher concentration of antibacterial drugs is required to control bone and soft tissue infections. 

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It is impossible to achieve local concentrations sufficient to destroy biofilms when antibiotics are administered intravenously, and side effects associated with systemic administration of antibiotics are also a concern.

 

Therefore, by continuously administering (infusion) the necessary concentration of antibacterial drugs to the local area and using negative pressure to guide the antibacterial drugs to the target area by drainage (drainage). In this way, the antibacterial drugs are locally perfused (= 'perfusion') by constructing a route.

 

The concept of this Continuous Local Antibiotics Perfusion (CLAP)is defined as a novel drug delivery system. This makes it possible to induce the required concentration of the antibacterial drug to the desired area. Antibiotics are infused to the serum to a small amount for locally, but blood translocation can be minimized by appropriate local negative pressure.  More over, antimicrobial drug concentrations in blood and effluent fluid should be monitored. By monitoring local and systemic concentration, treatment was continued for required period while confirming its safety and efficacy.

 

 Historically, there is a suction-irrigation system as a method of locally circulating antibacterial drugs. The purpose of this system is aggressive curettage and wash out the curettage dead space = 'irrigation'. On the other hand, CLAP, which avoids aggressive curettage and preserves the tissue and distribute antibiotics = 'perfusion', is considered to be a new antibiotic drug delivery system.

​　As a concrete way to achieve CLAP system, iMAP is constructed for bone and iSAP is constructed for soft tissue ,which is described after.

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