Groin wound infection after arterial surgery

Abstract

Fifty-six patients, 30 with superficial and 19 with deep groin wound infections, and seven with lymph fistulae with positive cultures within 30 days of arterial surgery, were identified after 661 operations (873 groins at risk) between September 1984 and August 1988. The commonest infecting organisms were Staphylococcus aureus, Pseudomonas aeruginosa and Proteus spp. In 33 patients the infection settled completely after treatment with culture specific antibiotics. These were given intravenously then orally for up to 6 weeks. Sixteen patients required debridement and excision of necrotic wound edges, including one who had an antibiotic infusion into the wound. Graft excision was performed in seven patients of whom five received an extra anatomic bypass. The need for graft excision was much greater (six versus one) for Dacron and/or polytetrafluoroethylene than for vein. In two lymph fistulae sartorius transposition and wound resuture were used. All groins healed, though three extremities were ischaemic following occlusion of the bypass. There were two deaths, one from myocardial infarction and one from pulmonary embolism and no major amputations. These results suggest that most infective groin problems may be successfully managed conservatively and that radical graft excision is only necessary for a few intractable cases.

Closed‐incision negative pressure therapy to reduce groin wound infections in vascular surgery: a randomised controlled trial

“…Surgical site infections (SSI) in the groin pose a major problem in vascular surgery with an incidence after vascular procedures of 6–30% . Superficial infections limited to the skin and subcutis can usually be treated by debridement with or without open negative pressure wound therapy (NPWT).…”

An Anatomical Study of the Gracilis Muscle and Its Application in Groin Wounds

“…1 With vascular surgery the incidence of prosthetic graft exposure ranges from 0.7% to 7% after bypass procedures. 2,3 The possibility of graft infection with potential loss of limb or life heightens appreciation of this complication.…”

Groin wound infection after vascular exposure (GIVE) multicentre cohort study

“…Furthermore, patients frequently suffer comorbidities such as diabetes mellitus, renal impairment, and malnutrition, which are independent risk factors for SSI development. [6][7][8] Published groin SSI rates varies considerably, ranging from 6.4% to 38.5% [9][10][11][12] ; however, these studies are generally small, retrospective, or use heterogeneous definitions of SSI. 7,11 The National Institute for Health and Care Excellence (NICE) guidelines regarding the prevention and treatment of SSI recommend preoperative, intraoperative, and postoperative strategies.…”

“…Furthermore, patients frequently suffer comorbidities such as diabetes mellitus, renal impairment, and malnutrition, which are independent risk factors for SSI development 6‐8 . Published groin SSI rates varies considerably, ranging from 6.4% to 38.5% 9‐12 ; however, these studies are generally small, retrospective, or use heterogeneous definitions of SSI 7,11 …”