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Wound complications of the in situ saphenous vein bypass technique
T Reifsnyder1, D Bandyk, G Seabrook
1Department of Vascular Surgery, Medical College of Wisconsin, Milwaukee.
Insights
Wound complications are common after in situ saphenous vein bypass surgery, but aggressive treatment ensures all grafts are salvaged. Early detection and intervention are key to successful outcomes in these vascular procedures.
Area of Science:
- Vascular Surgery
- Surgical Complications
- Graft Patency
Background:
- Wound complications frequently occur after in situ saphenous vein bypass.
- These complications can prolong hospitalization and compromise graft viability.
Purpose of the Study:
- To analyze the incidence and risk factors of wound complications following in situ saphenous vein bypass.
- To evaluate the effectiveness of an aggressive treatment strategy for managing these complications and ensuring graft salvage.
Main Methods:
- A retrospective review of 126 in situ saphenous vein bypass operations performed on 117 male patients between May 1981 and March 1991.
- Analysis of wound complication types, incidence, risk factors, and treatment outcomes, including graft salvage rates.
Main Results:
- 44% of grafts experienced wound complications, with invasive infections threatening the graft occurring in 13 cases.
- Risk factors for infection included lymph leaks and early graft revisions.
- Aggressive management, including debridement and reconstructive surgery, led to universal graft salvage without mortality.
Conclusions:
- Despite a high incidence of wound complications, in situ saphenous vein bypass can achieve universal graft salvage with prompt and aggressive therapeutic interventions.
- Identifying and managing risk factors like lymph leaks and early graft revisions is crucial for preventing severe complications.
Abstract:
Wound complications after in situ saphenous vein bypass occur frequently, lengthen hospitalization, and threaten graft viability. From May 1981 to March 1991, 117 consecutive male patients underwent 126 in situ operations: 45 (36%) femoropopliteal, 75 (59%) femorotibial, and 6 (5%) grafts to the dorsal pedal artery for gangrene or ulcer (n = 69), rest pain (n = 54), or claudication (n = 3). Wound complications developed in 55 grafts (44%): erythema developed in 11, but they healed primarily, 19 had skin edge necrosis or localized lymph leaks, 12 had necrosis or infection into the subcutaneous tissue without danger to the graft, and invasive infections that threatened the graft developed in 13. Risk factors for a subsequent wound infection included the development of a lymph leak (p less than or equal to 0.05) and early postoperative graft revision for thrombosis, wound hematoma, retained valve or arteriovenous fistula (p less than or equal to 0.05). The mean time to appearance of a graft-threatening wound infection was 31 days, and 10 of 13 were located in the distal limb. Twelve of the 13 deep infections required operative debridement, and seven required a flap or split thickness skin graft for coverage. Gram-negative as well as gram-positive infections responded equally well. No grafts were lost, and no deaths occurred. Despite the high incidence of wound complications, an aggressive therapy regimen permitted universal graft salvage.