The role of muscle flaps in wound salvage after vascular graft infections: the Emory experience.
BACKGROUND
The incidence of prosthetic graft infection is 1 to 6 percent, and the mortality rate of infected aortoiliac or aortofemoral bypass is 25 to 75 percent. The goal of this study was to report the use of muscle flaps in the management of patients presenting with infected vascular grafts.


METHODS
A total of 22 patients required 26 muscle flaps to cover 24 infected vascular grafts. Muscle flaps were used for local wound control in all patients regardless of the fate of the graft. The vascular surgeons elected for graft salvage in eight of the 24 grafts. All of the muscle flaps survived.


RESULTS
The average time interval between the bypass and infection was 371 days. One-month follow-up revealed an 88 percent salvage rate, but this decreased to 50 percent during the mean follow-up of 23 months. None of the patients originally managed with a salvaged graft lost a limb, and overall, 14 of 22 limbs in this series remained viable (64.0 percent). The mortality rate during the index hospitalization was 9 percent. In this series, suprainguinal grafts had a higher mortality rate. In addition, infection occurring more than 1 month postoperatively, culture-positive Pseudomonas and methicillin-resistant species, and exposure of the arterial-graft anastomosis were poor prognostic indicators of graft preservation.


CONCLUSIONS
Management of infected vascular grafts remains a challenging problem. Muscle flap coverage should have a high priority, as the chance of a good outcome is highly favorable in early infections.
Division of Plastic and Vascular Surgery, Joseph B. Whitehead Department of Surgery, Emory University, Atlanta, GA 30327, USA. hseifymd@gmail.com
Hisham
H
Seify
Hunter R
HR
Moyer
Glyn E
GE
Jones
Antonio
A
Busquets
Katherine
K
Brown
Atef
A
Salam
Albert
A
Losken
John
J
Culbertson
T Roderick
TR
Hester
D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps; D014945:Wound Healing