title: Negative pressure wound therapy on exposed prosthetic vascular grafts in the groin.
abstract: OBJECTIVE
  This study assessed the outcome of vacuum-assisted closure (VAC) as primary therapy for exposed prosthetic vascular grafts in the groin (Szilagyi III).
  
  
  METHODS
  The study included all consecutive patients with Szilagyi III groin infections and exposed prosthetic graft material from 2009 to 2011. After initial wound debridement, VAC was applied using a two-layer combination, consisting of polyvinyl alcohol and polyurethane sponges. Continuous negative pressure was set on a maximum of 50 mm Hg. All patients received complementary antibiotic therapy. The primary end point was defined as complete wound closure. Secondary end points comprised bleeding complications, amputation, and death.
  
  
  RESULTS
  The study evaluated 15 patients with 17 Szilagyi III groin infections. Mean total length of VAC therapy was 43 days (range, 14-76 days). Mean time until complete healing was 51 days (range, 24-82 days). Mean length of VAC therapy in the hospital was 21 days (range, 5-61 days). Eleven patients received continued VAC treatment at home for a mean length of 22 days (range, 5-69 days). Complete healing was achieved in 14 groins (82%). Three failures due to persisting infection, persisting necrosis, and a pseudomonas infection were noted. No bleeding complications, amputations, or late reinfections occurred. Median follow-up was 380 days (range, 56-939 days). Despite therapy failure, all 17 grafts were preserved.
  
  
  CONCLUSIONS
  VAC therapy on an exposed prosthetic vascular graft in the groin is safe and feasible when applying a combination of polyvinyl alcohol and polyurethane foam dressing and 50 mm Hg of continuous negative pressure, resulting in midterm graft preservation.
authors.affiliation: Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. p.berger@umcutrecht.nl
authors.forename: Paul
authors.initials: P
authors.lastname: Berger
authors.forename: Dennis
authors.initials: D
authors.lastname: de Bie
authors.forename: Frans L
authors.initials: FL
authors.lastname: Moll
authors.forename: Gert-Jan
authors.initials: GJ
authors.lastname: de Borst
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D003646:Debridement; D005260:Female; D006119:Groin / Q000098:blood supply*; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000295:instrumentation; D009426:Netherlands; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D012086:Reoperation; D015503:Surgical Sponges; D013530:Surgical Wound Infection / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D000900:Anti-Bacterial Agents