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Anus, Any Site, Bones and Joints, Breast, Brain and Nervous System, Other Hematopoietic, Other Female Genital, Other Endocrine System, Other Digestive Organ, Non-Hodgkin's Lymphoma, Myeloid and Monocytic Leukemia, Mycosis Fungoides, Multiple Myeloma, Melanoma, skin, Lymphoid Leukemia, Lung, Liver, Lip, Oral Cavity and Pharynx, Leukemia, other, Leukemia, Not Otherwise Specified, Larynx, Kidney, Kaposi's sarcoma, Ill-Defined Sites, Hodgkin's Lymphoma, Eye and Orbit, Esophagus, Corpus Uteri, Colon, Cervix, Other Male Genital, Other Respiratory and Intrathoracic Organs, Other Urinary, Urinary Bladder, Thyroid, Stomach, Soft Tissue, Small Intestine, Rectum, Prostate, Pancreas, Ovary, Other Skin
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Virginia Commonwealth University Richmond, Virginia
• Injury meeting at least one of the following criteria:
* Gustilo type III tibia (OTA 41 plateau, OTA 42 shaft and OTA 43 pilon) requiring a second procedure for final debridement and definitive coverage / closure following the index stabilization
* Gustilo type IIIB ankle fractures (OTA 44)
* Gustilo type IIIB calcaneus fractures (OTA 82)
* Gustilo type IIIB talus fractures (OTA 81)
* Traumatic "zone-of-injury" trans-tibial amputations requiring DPC, and/or flap coverage
• Ages 18 - 64 years inclusive
• Patients may have risk factors for infection including diabetes, immunosuppression from steroids or other medications, HIV, or other infections.
• Patients may have a traumatic brain injury.
• Patients may have other fractures including spine, upper extremity fractures, contralateral lower extremity injuries, ipsilateral pelvis, hip, femur or foot injuries.
• Patients may be treated initially at an outside institution prior to transfer to the study institution, as long as the definitive wound closure or coverage was not performed prior to entrance into the study.
• Patients with bilateral injuries that meet inclusion criteria may be included, but only the limb rated as "more severe" by the treating surgeon will be enrolled in the study.
• Patients may have co-existing non-tibial or hindfoot infection, with or without antibiotic treatment.
• Patients may be definitively stabilized using any method (nail, plate, ex fix or cast).
• Patients may have a fasciotomy.
Exclusion Criteria:
• Patient in current therapy for a wound, implant or fracture site infection related to the study site.
• Patient likely to have difficulty maintaining follow-up, including:
* Diagnosis of a severe psychiatric condition
* Intellectually challenged without adequate family support
* Resides outside of the hospital's catchment area
* Planning to follow-up at another medical center
* Being a prisoner
* Not having a means of contact (address, cell phone, home phone, e-mail)
DRUG: Standard of care, DRUG: Vancomycin and Tobramycin
Post Operative Surgical Site Infection
Surgical site infection risk prevention, Bacterial species type and antibacterial sensitivities
Melanoma, skin, Other Urinary, Urinary Bladder, Thyroid, Stomach, Soft Tissue, Small Intestine, Rectum, Prostate, Pancreas, Ovary, Other Respiratory and Intrathoracic Organs, Other Male Genital, Other Female Genital, Other Endocrine System, Other Digestive Organ, Lung, Liver, Lip, Oral Cavity and Pharynx, Larynx, Kidney, Eye and Orbit, Ill-Defined Sites, Esophagus, Corpus Uteri, Colon, Cervix, Breast, Brain and Nervous System, Bones and Joints
* Adults ≥18 years
* At least one episode of diverticulitis confirmed by CT scan and a colonoscopy (completed or scheduled) to rule out or screen for other colon pathology in accordance with colorectal cancer screening guidelines
* Persistent signs, symptoms, or concerns related to diverticulitis after recovery from an episode of left-sided diverticulitis
* Self-reported QoL limitation (assessed with 12 questions modified from the Diverticulitis Quality of Life \[DV-QOL\] instrument).
Exclusion Criteria:
* Unable to consent in English or Spanish
* Current diagnosis or previous endoscopic or surgical interventions for fistula, or stricture or current significant bleeding, related to diverticulitis
* Last episode of acute diverticulitis currently unresolved (i.e., on antibiotics for diverticulitis; drain in place)
* Previous operation for diverticulitis
* Right-sided diverticulitis
* Immunodeficiency (e.g., absolute neutrophil count \<500/mm3, chronic immunosuppressive drugs like oral corticosteroids, anti-TNF agents, or known AIDS \[i.e., recent CD4 count \<200\] assessed by patient history)
* Actively undergoing chemotherapy or radiation for malignancy
* Expectant or concurrent hemodialysis, peritoneal dialysis, treatments using indwelling venous catheters, or conditions putting patient at risk for bacterial seeding
* Diagnosis of inflammatory bowel disease (i.e., Crohn's, ulcerative colitis)
* Taking prescription medication for irritable bowel syndrome
* Intolerance or allergy to all medications in the medical management arm
* Surgeon is unwilling to offer surgery due to comorbid or prior surgical conditions that contraindicate elective surgery (e.g., liver failure, renal failure, malignancy, "frozen abdomen")
* Abdominal/pelvic surgery within the past month
* Pregnant or expecting to become pregnant in the 30 days following baseline/screening
* Unable to consent to research or self-respond to follow-up surveys (e.g., altered mental status)
* Currently incarcerated in a detention facility or in police custody at baseline/screening (patients wearing a monitoring device can be enrolled)
* Prior enrollment in the COSMID study or planning on enrollment in another investigational drug or vaccine while on study treatment
* Unable or unwilling to return, be contacted for, or complete research surveys.
PROCEDURE: Partial Colectomy, OTHER: Medical Management