Skin Closure After No-Touch Saphenous Vein Harvest: Strategies to Minimize Wound Complications

Abstract

The no-touch saphenous vein with surrounding pedicle tissue harvesting technique preserved endothelium and vessel wall integrity and demonstrated improved long-term saphenous vein conduit patency that was comparable to internal thoracic artery conduit patency. Despite improved saphenous vein conduit patency rates, there is a possibility that no-touch saphenous vein harvest may increase wound complication rates by increased tissue disruption, including venous and lymphatic channels. Comprehensive strategies to minimize leg wound complications after no-touch saphenous vein harvest are discussed.

Strategies to Minimize Sternal and Leg Wound Complications after Coronary Artery Bypass Grafting Using No-Touch Saphenous Vein Grafts

“… 13 , 14) To minimize the development of wound complications after NT SV harvest, preoperative evaluation of lower limb vascular status, selection of an adequate vein, creation of a precise incision, careful harvest, placement of a drain in the vein harvest site, and meticulous skin wound closure were performed in this study. 16) …”

“…13,14) To minimize the development of wound complications after NT SV harvest, preoperative evaluation of lower limb vascular status, selection of an adequate vein, creation of a precise incision, careful harvest, placement of a drain in the vein harvest site, and meticulous skin wound closure were performed in this study. 16) We believe that prevention of serosanguinous fluid and blood collection and alleviating dead space by using an appropriate drain are mandatory for decreasing the potential risk of wound complications. Another study after endoscopic SV harvesting also showed that the use of a high vacuum leg drain was associated with decreased hematoma formation, higher patient satisfaction, and reduced antibiotic administration.…”

“…An ABI ratio of 0.7 or less in any lower limb suggested moderate-to-severe peripheral arterial disease and harvesting the ipsilateral SV was avoided to prevent skin wound complications. 16) Lower extremity vein CT angiography was performed at the same time as thoracoabdominal CT without additional contrast material for a thorough evaluation of lower extremity veins. After anesthetic induction, Doppler ultrasonography mapping was performed to reassess the course, size, quality, and tributaries of the SV.…”

“…After anesthetic induction, Doppler ultrasonography mapping was performed to reassess the course, size, quality, and tributaries of the SV. 16) …”

“…After anesthetic induction, Doppler ultrasonography mapping was performed to reassess the course, size, quality, and tributaries of the SV. 16) Bone wax was not used for application to the cut edges of the sternum, and topical antibiotics were applied to the cut edges of the sternum on opening and before closing because they have been found to significantly reduce the incidence of sternal wound infections. 3) The unilateral left ITA harvested with a semi-skeletonization technique was used in most of the patients.…”