Deep infection of infrapopliteal autogenous vein grafts--immediate use of muscle flaps in leg salvage.
OBJECTIVE
The purpose of this study was to determine the efficacy of an aggressive management of infrapopliteal autogenous vein graft infection.


METHODS
Among 341 consecutive infrapopliteal autogenous vein bypass grafts performed at the Helsinki University Central Hospital, 14 patients (4%) had infragenicular wound infection that involved the vein graft. Six of these patients had graft rupture and bleeding. An extensive debridement was performed in all patients. Seven of the grafts had to be partially removed and replaced. The wound and the graft immediately were covered with local muscle flaps in 4 patients and with free muscle flaps in 10 patients.


RESULTS
One patient died, and another patient underwent above-knee amputation as a result of a persistent infection and necrosis of the local muscle flap during the 30-day postoperative period. No graft rupture occurred after the treatment of the infected conduit. Graft occlusion occurred in 4 patients who underwent regrafting because of graft rupture and in 1 patient with an infected intact conduit. One patient underwent amputation 15 months later because of an uncontrollable infection despite a patent graft and a functioning flap. At the 1-month, 6-month, 1-year, and 2-year follow-up periods, the leg salvage rates were 92%, 75%, 55%, and 44%, respectively. At the same intervals, 92%, 92%, 70%, and 70% of the patients survived and 85%, 68%, 34%, and 34% of the patients were alive without the loss of their legs.


CONCLUSIONS
Radical surgical debridement and immediate muscle flap coverage seem to offer an effective alternative method to preserve an infected infrapopliteal autogenous vein graft and to achieve leg salvage. Poor results are expected when a regrafting procedure is necessary for the rupture of an infected vein graft.
Tukiainen
E
E
Department of Plastic Surgery, Helsinki University Central Hospital, Finland.
Biancari
F
F
Lepäntalo
M
M
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D003646:Debridement; D005260:Female; D006085:Graft Survival; D006801:Humans; D007866:Leg / Q000098:blood supply / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013524:Surgical Flaps; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods; D014680:Veins / Q000637:transplantation*; D014946:Wound Infection / Q000382:microbiology / Q000601:surgery*