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An infected vascular prosthesis is a risk to life and limb, with many of the infections insidious in nature. A retrospective analysis with a minimum 49-month follow-up identified 18 patients (mean age, 61.3 years) with culture-positive infections and exposed prosthetic grafts in the infrainguinal region. All patients were managed with muscle flaps. Mean follow-up was 59 months, with a long-term salvage of infected prosthetic grafts in 16 of 18 patients; there was no loss of life or limb. Early, aggressive reconstruction of infected prosthetic grafts using a muscle flap technique saves graft, leg, and patient.
THE CONCEPT OF salvaging an infected prosthetic vascular graft instead of always removing it may be controversial. Both retention and extirpation therapies have been advocated for this devastating complication.1-5 Most commonly occurring in groin wounds,6 7 these infectious complications tend to be insidious and often are not identified until years after the initial vascular procedure. Although improved results with graft retention and local muscle flap coverage have been reported,8-11 few long-term outcome studies of this new technique are currently in progress. Considering the latent nature of these infectious complications, long-term outcome is essential for appropriate analysis of the efficacy of this approach. Although arterial graft infection may be latent, the consequences of its treatment are usually determined within 1 to 6 months (i.e., the wound heals, a pseudoaneurysm forms, amputation is required). An analysis of our experience to evaluate the long-term outcome of graft salvage with muscle flaps is reported.
Methods
A retrospective analysis of all patients with extensive vascular prosthetic infections from 1983 through 1996 was performed. Inclusion criteria required patients with documented culture-positive groin infections and infection surrounding or in contact with, or both, the graft following reconstructive vascular procedures with synthetic graft exposure. All patients had a purulent drainage from the involved groin. Eighteen consecutive patients were treated with culture-specific systemic antibiotic therapy, radical surgical debridement, and coverage of the exposed vascular prosthesis with local muscle flaps (gracilis, sartorius, or both). Therapy began as soon as the diagnosis of infection was made. No other surgical treatment was used in management of these patients. No conservative wound-care program was instituted for management of these advanced infections. During this period, 1741 vascular procedures were done, with a wound...