Expanded microporous polytetrafluoroethylene (PTFE) grafts in contaminated wounds: experimental and clinical study

Autogenous vein graft is regarded as an ideal arterial substitute for its long-term patency and relative resistance to infection. A clinical instance of life-threatening hemorrhage from an infected disrupted vein graft stimulated a study in dogs, comparing vein and PTFE graft performance in wounds contaminated with S. aureus and E. coli cultured from the patient's wound. Infective disruption of vein wall occurred in three of ten animals resulting in exsanguination and death. Host artery disruption at PTFE suture line occurred in one of ten animals. Thrombosis of graft and host artery in this animal precluded hemorrhage and death. This led to favorable clinical experiences with PTFE grafts in contaminated wounds of 22 trauma patients. It is concluded that PTFE is better assurance against disruption and hemorrhage than vein graft in contaminated, potentially infected sites. PTFE may be used preferentially as a vascular substitute in trauma patients provided that all traditional surgical safeguards and principles are followed.