[Groin abscesses and vascular catastrophes in intravenous drug users--strategy and results].
BACKGROUND
Drug addiction is a global medical and public health-care problem. Infections of the groin and fossa cubitalis are a common clinical problem in these patients. Severe vascular complications are rare but if they occur, therapy is difficult and requires emergency management and surgery because of bleeding problems.


METHODS
In a retrospective case series, we report on patients treated within an emergency setting in our hospital because of groin abscesses with vascular involvement between 2003 and 2006. The therapeutic concepts and results are reported and discussed in the context of a review of the international literature.


RESULTS
We report on 4 patients with a long-standing history of i. v. drug abuse (average age 33, range 29-36 years). All were hepatitis C Ag positive and HIV negative. The general health and nutritional status were not compromised, all patients had one or more DVT in their medical history. In two cases, emergency surgery with revascularisation was necessary (after 2 days in one case and 4 weeks in the other) because of septic bleeding subsequent to abscess incision. Two patients underwent primary revascularisation because of pseudoaneurysms. The grafts were a saphenous vein patch and a superficial femoral artery patch in one and deep vein segments in two cases. In two cases, a sartorius muscle flap and VAC therapy were used to cover the defect. All patients survived, minor amputation became necessary in one case.


CONCLUSIONS
Abscess excision and debridement have to be as complete as possible and primary revascularisation is the procedure of choice in cases of severe groin infection. In the case of large vessel involvement, abscess incision alone without revision of the vascular structures is dangerous because of subsequent complications like secondary ruptures. For this reason, these patients require intensive care and close monitoring. Successful treatment exclusively based on ligation is described in literature with regard to isolated lesions of the superficial or deep femoral artery. Because of the very common involvement of the femoral bifurcation, revascularisation is, however, necessary in most cases and should be performed with autologous grafts if possible. If complete covering of the defect is not possible, a sartorius muscle flap is a good choice. Primary wound closure can be problematic because of recurrences, therefore vacuum-assisted wound closure is a valuable addition to the overall therapeutic approach in these cases.
Scheuerlein
H
H
Klinik für Allgemein-, Viszeral- und Gefäbchirurgie, Universitätsklinikum Jena. hubert.scheuerlein@med.uni-jena.de
Ruff
S
S
Haage
P
P
Zirngibl
H
H
Fraunhofer
S
S
Settmacher
U
U
D000038:Abscess / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D000328:Adult; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019917:Blood Vessel Prosthesis Implantation; D003131:Combined Modality Therapy; D003646:Debridement; D004636:Emergency Service, Hospital; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006119:Groin / Q000601:surgery; D006470:Hemorrhage / Q000209:etiology / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D018810:Magnetic Resonance Angiography; D008297:Male; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D015819:Substance Abuse, Intravenous / Q000150:complications*; D018616:Ultrasonography, Doppler, Duplex; D014680:Veins / Q000637:transplantation; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery
D000900:Anti-Bacterial Agents