Outcomes in the management of vascular prosthetic graft infections confined to the groin: a reappraisal.
نویسندگان
چکیده
The management of vascular prosthetic graft infections confined to the groin continues to be controversial. To critically evaluate this problem, we reviewed the records of our vascular registry from December 1992 through February 1995 and found 17 incidences of groin sepsis involving a vascular prosthesis in 10 patients. These included a proximal prosthetic femoropopliteal bypass (n = 6), an aortobifemoral graft limb (n = 5), an ileofemoral bypass (n = 3), a prosthetic femoral patch (n = 2), and an aortofemoral/femorofemoral bypass (n = 1). The mean age of these patients was 65 years. Six patients were diabetic, four were on systemic steroids, and two were diabetic and on steroids. All infections were Szilagyi grade III including three in which the patients presented with local hemorrhage. Treatment consisted of irrigation, radical debridement with or without in situ graft replacement, and local rotational muscle flap coverage in nine cases, graft excision with extra-anatomic (obturator ileofemoral bypass) graft replacement in six cases, and excision alone in two cases. Of the 17 infections treated operatively and followed from 1 week to 18 months (median 5 months), eight (47%) showed no evidence of recurrence, six (35%) recurred, two (12%) caused early death, and one resulted in a thrombosed graft requiring extra-anatomic reconstruction. Of the nine infected grafted treated locally with muscle flaps, six showed recurrent infection from 3 weeks to 15 months and one thrombosed for a total local treatment failure rate of 78%. Only two grafts are free of infection at 4 and 5 months, respectively. Of the six incidences of infection treated with obturator bypass, four (66%) are free of infection and two resulted in patient death; both infections treated with excision alone were eradicated but resulted in a major lower extremity amputation. These data question the growing acceptance of debridement and local muscle flap coverage for the treatment of all prosthetic vascular graft infections confined to the groin, especially in patients who are diabetic or on systemic steroids.
منابع مشابه
Rectus Femoris and Sartorius Muscle Flap for Graft Infection in the Groin
Infections of vascular prosthesis are severe adverse events following vascular reconstruction. The incidence varying between 1 and 6 per cent, depending on the anatomical site, with the highest rate occurring in vascular access grafts placed in inguinal and lower extremity incisions in patients undergoing bypass procedures [1,2]. The management of infected prosthetic vascular grafts continues t...
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BACKGROUND Vascular prosthetic graft infection in the groin is associated with high morbidity and mortality. This article presents a case series on the use of 2 flaps in the treatment of this condition. METHODS Five patients, mean age 65 years (range, 49-74 years), with significant comorbidity were treated for an exposed and infected vascular prosthetic graft in the groin with a combination o...
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متن کاملDoes Orientation of Full-Thickness Groin Grafts Affect Hyperpigmentation in Burn Contracture and Syndactyly Hands?
BACKGROUND Some grafts harvested from the groin area do not become hyperpigmented and in an individual with multiple pieces of grafts, the hyperpigmentation of the pieces may vary. This study evaluates the orientation of the inset of groin grafts according to their donor sites (superior-inferior) and its role in graft hyperpigmentation. METHODS Patients with hand burn contracture or syndacty...
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عنوان ژورنال:
- Annals of vascular surgery
دوره 10 2 شماره
صفحات -
تاریخ انتشار 1996