Management of Draining Wounds in Vascular Surgery

Abstract

Drainage from a wound overlying a prosthetic vascular graft is a source of major concern in vascular surgery, often heralding serious complications including hemorrhage, thrombosis or infection. Despite improvement in graft design and surgical technique, healing problems are reported to occur in about 2 % of cases. 1 Perigraft fluid collections may be secondary to infection, accumulation of lymph or serum, to failure of the graft material or to allergy to graft material or some foreign substance adherent to its surface. 1-6The management of draining wounds remains controversial. Early experience with infected grafts treated locally was uniformly unsuccessful, and resulted in significant morbidity and mortality. 1 This led to the classic teaching that grafts underlying infected wounds must be removed and replaced through extra anatomic pathways. Recently local treatment has received renewed interest in an attempt to salvage an otherwise functioning graft. 2,3 We have utilized an early aggressive local approach to draining wounds with salvage of grafts that would otherwise have been removed and a considerable decrease in morbidity. Materials and MethodsThe records of all patients undergoing arterial bypass procedures with prosthetic grafts in the past five years were reviewed. Seven patients with eight wound healing problems were encountered for an incidence of 2.3%. The patients were all male ranging from forty-four to eighty-three years of age. The indication for surgery was threatened limb loss in all cases. There were four axillo-femoral grafts, all of which were knitted double velour, and three aortofemoral grafts, two of which were knitted Dacron and one woven. Two patients