title: Management of early (<30 day) vascular groin infections using vacuum-assisted closure alone without muscle flap coverage in a consecutive patient series.
abstract: OBJECTIVE
  Vacuum-assisted closure (VAC) therapy without muscle flap coverage is our primary approach for graft preservation in early, deep groin infections with and without exposed grafts; however, concerns exist regarding its safety. We report our experience in a consecutive series of patients with early groin infections managed without muscle flap closure.
  
  
  METHODS
  All patients with early (<30 day), deep vascular groin infections without (Szilagyi II) or with (Szilagyi III) exposed vascular graft or suture line between January 2004 and December 2008 were reviewed. Graft preservation followed by local wound care with VAC was attempted in all with intact anastomoses, patent grafts, and absence of systemic sepsis. Szilagyi classification, microorganism cultured, duration of VAC use, time to healing, additional interventions, and follow-up data (limb salvage, survival) were analyzed.
  
  
  RESULTS
  Twenty-two patients (26 groins, mean age 69.1 +/- 9.5 years [range, 44-86 years]) presented with deep groin infections 16 +/- 5 days (range, 7-28 days) after the index procedure (bypass-polytetrafluoroethylene [n = 11], autologous vein [n = 3], endarterectomy/patch [n = 6], extra-anatomic bypass [n = 5], percutaneous closure device [n = 1]). Grafts were exposed in 12 groins (Szilagyi III, nine with suture lines). VAC was started one to six days (median, three) after operative debridement. All had positive wound cultures and received culture-directed antibiotic therapy for 47 +/- 45 days (range, 14-180 days). Length of stay was significantly more in Szilagyi III, whereas mean VAC use and time-to-healing were similar. Mean follow-up was 33.4 +/- 19.5 months (range, 2-72 months). All wounds healed (mean, 49 +/- 21 days). Two treatment failures occurred in the Szilagyi III group (17%). One patient had bleeding from the anastomotic heel eight days after debridement, had graft removal/in situ replacement and one presented with reinfection on day 117 and had partial graft removal/extra-anatomic bypass. There was no perioperative mortality or limb loss, but six late unrelated mortalities and one amputation at 46 months unrelated to the groin infection.
  
  
  CONCLUSIONS
  Management of early, deep groin wound infections with debridement, antibiotics, and VAC treatment is safe and enables graft preservation in the majority of patients with minimal morbidity, no perioperative limb loss, or mortality.
authors.affiliation: Division of Vascular Surgery, Veteran Affairs Medical Center, Buffalo, NY, USA. dosluoglu@yahoo.com
authors.forename: Hasan H
authors.initials: HH
authors.lastname: Dosluoglu
authors.forename: Cyrus
authors.initials: C
authors.lastname: Loghmanee
authors.forename: Purandath
authors.initials: P
authors.lastname: Lall
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Cherr
authors.forename: Linda M
authors.initials: LM
authors.lastname: Harris
authors.forename: Maciej L
authors.initials: ML
authors.lastname: Dryjski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects* / Q000379:methods; D003646:Debridement; D005260:Female; D005263:Femoral Artery / Q000473:pathology / Q000601:surgery; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006119:Groin; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D011150:Popliteal Artery / Q000473:pathology / Q000601:surgery; D011859:Radiography; D018570:Risk Assessment; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods; D014945:Wound Healing / Q000502:physiology