Vascular prosthetic complications: success of salvage with muscle-flap reconstruction.
Prosthetic vascular complications such as exposure and infection represent one of the most challenging and devastating complications in surgery. Nineteen patients underwent a retrospective review of the efficacy of soft-tissue flap coverage in the management of vascular prostheses complications. These patients were divided into three groups. Group 1 included 14 patients with documented culture-positive infection. Group 2 comprised 4 patients with culture-negative exposed grafts. Group 3 included 1 patient with autogenous vein and documented culture-positive infection. The most common vascular procedure requiring flap reconstruction was aortobifemoral in groups 1 and 2. One femoral-distal reconstruction was performed in group 3. Graft complications occurred at an average of 4.8 months after vascular reconstruction in group 1, 11 months in group 2, and 1 month in group 3. Follow-up was obtained on all patients. Initial flap reconstruction was successful in 43 percent of group 1, 100 percent of group 2, and 100 percent of group 3. Reoperative therapy for flap coverage in group 1 was successful in 62.5 percent. Overall, 79 percent of patients obtained a closed wound after reconstructive attempts in group 1. Recurrence appeared to be independent of graft material, microbiology, or graft location. Debridement and muscle coverage of exposed or infected vascular grafts has produced clinical salvage.
Division of Plastic and Reconstructive Surgery, Johns Hopkins Medical Institutions, Baltimore, Md.
G R
GR
Evans
T J
TJ
Francel
P N
PN
Manson
D000368:Aged; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000601:surgery*; D013524:Surgical Flaps; D017211:Treatment Failure