Do operative results justify tibial artery reconstruction in the presence of pedal sepsis?
An aggressive surgical approach is warranted in all patients with a salvageable weight-bearing pedal surface. Although patients with pedal sepsis (69 limbs) had a lower 30 day limb salvage rate and higher morbidity and mortality rates than those without sepsis (34 limbs), the long-term salvage rates of both groups by life table analysis were not statistically different and remained at the 70 percent level 3 years postoperatively. Peribypass amputation, debridement of the septic foot, or both should be carried out when deemed necessary to decrease the risk of septic complications after revascularization. Other risk factors such as diabetes or heart disease had no bearing on the short-term results of bypass in either the septic or nonseptic group. Autogenous saphenous vein is preferable to synthetic bypass material, especially in patients with ongoing infection. Lastly, even though the medical climate in 1988 must reflect the stark reality of economic restrictions imposed by third-party payors, optimal patient care remains our primary responsibility. We believe that long-term pedal salvage, as achieved by arterial reconstruction, aggressive wound management, and rehabilitation, attains this goal.
Rubin
J R
JR
Department of Surgery, Veterans Administration Medical Center, Cleveland, Ohio 44106.
Pitluk
H C
HC
Graham
L M
LM
D000671:Amputation, Surgical; D001158:Arteries / Q000601:surgery; D001424:Bacterial Infections / Q000150:complications*; D003646:Debridement; D005528:Foot / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D011379:Prognosis; D012086:Reoperation; D013927:Thrombosis / Q000209:etiology / Q000601:surgery; D013977:Tibia / Q000098:blood supply