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Major leg wound complications after saphenous vein harvest for coronary revascularization
C E Paletta1, D B Huang, A C Fiore
1Division of Plastic and Reconstructive Surgery, Saint Louis University School of Medicine, Missouri 63110-0250, USA. palettac@slu.edu
Insights
Major leg wound complications after coronary artery bypass graft surgery are rare but serious. Female gender, peripheral vascular disease, and intra-aortic balloon pump use increase risk, necessitating careful patient selection and surgical technique.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Wound Healing
Background:
- Major leg wound complications following coronary artery bypass graft (CABG) procedures are uncommon.
- This study details the experience of managing 23 patients with severe leg wound issues post-coronary revascularization.
Purpose of the Study:
- To analyze the incidence and risk factors associated with major leg wound complications after CABG using saphenous vein grafts.
- To identify predictors that may guide preventative strategies.
Main Methods:
- A retrospective review of 3,525 CABG procedures utilizing saphenous vein grafts over a decade.
- Multivariate analysis of ten potential risk factors in patients with major leg wound complications compared to the general CABG cohort.
Main Results:
- Lower extremity wound complications occurred in 4.1% of patients, with 0.65% requiring significant surgical intervention.
- Significant independent predictors for major leg wound complications included female gender, peripheral vascular disease, and postoperative intra-aortic balloon pump use (p < 0.0001).
- Surgical interventions ranged from debridements and skin grafts to amputations and tissue transfers.
Conclusions:
- Major leg wound complications after saphenous vein harvest for CABG are multifactorial.
- Recommendations include pre-harvest vascular assessment, meticulous surgical technique, and judicious harvest site selection to minimize risks.
Background:
Major leg wound complications after coronary artery bypass graft procedures are infrequent and few are reported in the literature. We present our experience in treating 23 patients with major leg wound complications after coronary revascularization procedures.
Methods:
A retrospective review of 3,525 bypass procedures with saphenous vein grafts performed over a 10-year period was conducted. Ten potential risk factors for those who developed major leg wound complications were analyzed and compared with the entire cohort of patients undergoing similar bypass procedures during the same period.
Results:
Lower extremity wound complications occurred in 145 patients (4.1%), 23 of whom (0.65%) required additional surgical interventions (62 total). There were 32 wound debridements, 8 skin grafts, 11 vascular procedures, 5 amputations, 3 fasciotomies, 2 free tissue transfers, and 1 fasciocutaneous flap. Of ten variables evaluated by multivariate analysis, female gender, peripheral vascular disease, and postoperative intraaortic balloon pump use were identified as significant independent predictors of major leg wound complications (p < 0.0001).
Conclusions:
The causes of major leg wound complications after saphenous vein harvest for coronary artery bypass graft procedures are multifactorial. To minimize these complications, we recommend vascular evaluations before saphenous vein harvest, attention to proper surgical technique, and careful harvest site selection.