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Between 1975 and 1991, we treated 16 patientswith infected lower extremity autologous
vein grafts performed for limb salvage by complete graft preservation. Traditional
treatment of these infections includes immediate graft excision and complex revascularization
procedures to prevent limb loss. The infection involved an intact anastomosis in 12
patients or the body of a patent graft in 4 patients. None of the patients was systemically
septic. All patients were treated with appropriate intravenous antibioties. Six patients
were treated by placement of autologous tissue on the exposed graft (4 rotational
muscle flaps, 2 skin grafts), and 10 were treated with antibiotic-soaked dressing
changes and repeated operative débridements to achieve delayed secondary wound healing.
This treatment resulted in a 19% (3 of 16) mortality rate and an 8% (1 of 13) amputation
rate in survivors. Of the six patients managed by autologous tissue placement onto
the infected graft, five patients had wounds that healed without complications, and
one died of a myocardial infarction. Of the 10 patients treated by delayed secondary
wound healing, 2 developed anastomotic hemorhage, which resulted in death in 1 patient
and above-knee amputation in the other, 1 died of a myocardial infarction, 1 developed
graft thrombosis, and 6 had wounds that healed. Placement of autologous tissue to
cover an exposed, infected patent vein graft with intact anastomoses may prevent graft
dessication, disruption, and thrombosis, which renders graft preservation an easier,
safer method of treatment compared with routine graft excision.
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Article info
Footnotes
*This work was supported by the John F. Connelly Foundation, theJames Hilton Manning and Emma Austin Manning Foundation, the Anna S. Brown Trust, and New York Institute for Vascular Studies.
‡Presented at the 20th Annual Meeting of the Society for Clinical Vascular Surgery, Orlando, Florida, March 25–29, 1992.
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Copyright
© 1992 Reed Publishing USA. Published by Elsevier Inc.
