Limb salvage for an aorto-bifemoral vascular graft infection using multilayer negative pressure wound therapy: a case...

Exposure and infection of aorto-bifemoral grafts are severe complications associated with a high risk of catastrophic hemorrhage and limb loss.

A 71-year-old man presented with rupture of a femoral anastomotic pseudoaneurysm after previous aorto-bifemoral bypass. Following emergency vascular reconstruction, extensive debridement resulted in a large groin defect with exposure of the vascular graft and distal anastomotic sites, complicated by infection and multi-organ failure. In the absence of viable reconstructive options, low-pressure negative-pressure wound therapy (NPWT) was initiated using a customized three-layer protective interface incorporating a silver-impregnated non-adherent dressing placed directly over the graft. Progressive granulation tissue formation allowed staged wound closure and complete healing without flap reconstruction. At follow-up, no clinical evidence of recurrent infection was observed.

NPWT over exposed vascular grafts remains controversial because of the risk of catastrophic hemorrhage. In this patient, extensive soft-tissue destruction and unfavorable vascular anatomy created a true "no-option" reconstructive scenario, making low-pressure NPWT followed by staged wound closure the only feasible limb- and graft-preserving strategy. The customized three-layer protective interface was designed to combine local antimicrobial activity with mechanical protection of the exposed graft.

This case suggests that a tailored three-layer NPWT protective interface incorporating a silver-impregnated dressing may represent a useful adjunct to optimize local infection control in exposed vascular grafts. In carefully selected patients without reconstructive options, low-pressure NPWT followed by staged wound closure may represent a valuable limb- and graft-preserving strategy.