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[Flap repair for vascular prosthesis exposure after artificial blood vessel bypass surgery for critical limb
1Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China.
Objective:
To investigate the effectiveness of flap repair for vascular prosthesis exposure after the artificial blood vessel bypass surgery for critical limb ischemia.
Methods:
From August 2007 to December 2011, bypass surgery with vascular prosthetic grafts were performed in 192 patients with critical limb ischemia.Five patients among them (2.6%) suffered from vascular prosthesis exposure 6 to 13 days after the previous surgery, including 4 males and 1 female, with a median age of 68 years(arranged from 52 to 81 years). The surgical managements included surgical debridement and local flap or transferred muscle-cutaneous flap repair to preserve the prosthetic vascular grafts. Three patients underwent Z-plasty with local flap repair, while 2 patients underwent transferred rectus abdominis or rectus femoris muscle flap repair of the wounds.
Results:
After the surgery, prosthetic vascular graft was successfully preserved in 4 of the 5 cases with first intention healing. At a median follow-up of 38 months (arranged from 5 to 57 months), all the 4 limbs were salvaged with patent of the prosthetic grafts.One flap failed to heal and the prosthetic graft had to be removed due to infection and hemorrhage. An above-knee-amputation was performed due to severe limb ischemia.
Conclusions:
The vascular prosthesis exposure is often a disaster after artificial blood vessel bypass surgery for critical limb ischemia.Local flap or transferred muscle-cutaneous flap repair is an effective surgical management to salvage the exposed graft and the affected limb.
