Related Experiment Videos
Comparison of muscle flaps and delayed secondary intention wound healing for infected lower extremity arterial grafts
K D Calligaro1, F J Veith, C M Sales
1Division of Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, N.Y.
Abstract:
Selective preservation of infected arterial grafts is an alternative to graft excision. The purpose of this study was to compare the outcome and cost of treating infected lower extremity arterial grafts with either muscle flaps (MFs) or delayed secondary intention (DSI) wound healing. Between 1985 and 1991 we treated 28 graft infections by graft preservation. All grafts (19 polytetrafluoroethylene, 8 autologous vein, and 1 Dacron) were patent with intact anastomoses and showed no signs of sepsis. Wounds in 18 patients were treated by repeated, aggressive operative debridement and allowed to heal by DSI. Wounds in 10 patients were treated with MFs (4 sartorius, 3 gracilis, 1 rectus abdominis, 1 semimembranous, and 1 gastrocnemius). Costs included anesthesiologists' and surgeons' fees, operating room charges, and daily semiprivate and ICU bed charges. Four (14%) patients died from cardiac complications (1 DSI and 1 MF), sepsis (1 MF), and anastomotic hemorrhage (1 DSI). Of the 24 survivors, 4 patients treated by DSI required graft excision for nonhealing wounds (2), graft thrombosis (1), and recurrent infection (1). However, 3 of these 4 patients were not candidates for MFs because the wounds were not considered acceptable for a flap. Twenty (83%) grafts in survivors were successfully preserved after long-term follow-up (mean 26 mo). No survivors required an amputation. Twenty patients who did not require graft removal were compared for treatment by MF (n = 8) or DSI (n = 12). Two MFs (both sartorius) in survivors necrosed and a new flap was required to successfully preserve the graft.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Selective arterial graft preservation is effective. Muscle flaps (MFs) and delayed secondary intention (DSI) showed similar graft survival rates, but MFs had higher complication rates. Both methods avoided amputation in infected lower extremity arterial grafts.
Area of Science:
- Vascular Surgery
- Infectious Disease Management
- Wound Healing
Background:
- Infected arterial grafts pose a significant challenge in vascular surgery.
- Graft excision is a traditional approach, but selective preservation offers an alternative.
- Comparing muscle flaps (MFs) and delayed secondary intention (DSI) for graft preservation is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare the outcomes and costs of treating infected lower extremity arterial grafts using muscle flaps (MFs) versus delayed secondary intention (DSI) wound healing.
- To evaluate the effectiveness of graft preservation techniques in preventing graft loss and amputation.
Main Methods:
- A retrospective study of 28 patients with infected arterial grafts treated between 1985 and 1991.
- Grafts were preserved; wounds were managed with either muscle flaps (n=10) or delayed secondary intention (n=18).
- Costs included surgical fees, operating room charges, and bed charges; outcomes assessed graft patency, complications, and need for re-operation.
Main Results:
- Overall graft preservation success was 83% (20/24 survivors) with a mean follow-up of 26 months; no survivors required amputation.
- Four patients (14%) died due to cardiac complications, sepsis, or hemorrhage.
- In survivors, 4 DSI patients required graft excision for non-healing wounds, thrombosis, or re-infection; 2 of these were not flap candidates.
- Two muscle flaps (sartorius) necrosed, necessitating re-operation.
Conclusions:
- Selective arterial graft preservation is a viable strategy for infected lower extremity grafts, successfully avoiding amputation.
- Muscle flaps and delayed secondary intention demonstrate comparable long-term graft survival rates.
- Muscle flaps are associated with a higher rate of initial complications requiring further intervention.