Management of early (&lt;30 day) vascular groin infections using vacuum-assisted closure alone without muscle flap coverage in a consecutive patient series

Dosluoglu, Hasan H.; Loghmanee, Cyrus; Lall, Purandath; Cherr, Gregory S.; Harris, Linda M.; Dryjski, Maciej L.

doi:10.1016/j.jvs.2009.11.053

Cited by 89 publications

(85 citation statements)

References 28 publications

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“…Some surgeons have recommended wound coverage with a vacuum-assisted closure device, either alone or as a possible bridge to muscle flap. 65,66,68 The use of a wound vacuum-assisted closure device enhances healing by negative pressure and simplifies wound care by nursing staff but should not be applied if purulence is present in the wound. The use of a vacuum-assisted closure device without subsequent muscle flap should be restricted to selected patients in whom muscle flap may not be an option.…”

Section: Management Of Vgismentioning

confidence: 99%

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

358

307

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The use of synthetic material for reconstructive vascular surgery was first reported during the early 1950s. Infection involving vascular graft prostheses is an infrequent but devastating complication of reconstructive vascular graft surgery and is associated with a high morbidity and, in some situations, mortality. Improvements in surgical techniques and graft design, including the use of native venous or arterial tissue, have reduced the frequency of infection and severity of complications from vascular graft infection (VGI). However, these advances have also led to more frequent vascular graft procedures occurring in a patient population with multiple underlying comorbidities that would have previously disqualified them as candidates for vascular reconstructive surgery. Underlying comorbidities, such as diabetes mellitus or immune compromise, increase the risk of infection and serious infection-related complications. The major complications of VGI include sepsis, amputation, disruption of infected anastomotic suture line with rupture or pseudoaneurysm formation, embolization of infected thrombi, reinfection of reconstructed vascular grafts, enteric fistulae to the small or large bowel, bacteremic spread of infection to other sites, and death. VGIs can be categorized broadly into those that occur in an extracavitary location, primarily in the groin or lower extremities, or in an intracavitary location, primarily within the abdomen or less commonly within the thorax. frequencyThe frequency of VGI depends on the anatomic location of the graft. The infection rate is 1.5% to 2% for most extracavitary grafts and as high as 6% with vascular grafts in the groin. [1][2][3][4][5][6][7][8][9] For intracavitary grafts, the infection rate is ≈1% to 5%. 1-6 Graft infection is most common after emergency procedures and after reoperation. [1][2][3][4]10 Aortic graft erosion or fistulous communication into the duodenum or other areas of the bowel reportedly occurs in 1% to 2% of patients after aortic reconstruction. 11,12 MicrobiologyThe microbiological cause of VGI has evolved over the years. 1 In early published studies, Staphylococcus aureus was the predominant microorganism recovered. 1,13 Improvements in surgical technique, administration of prophylactic antistaphylococcal antimicrobial therapy, and other factors have resulted in a changing microbiological epidemiology. Vascular graft surgery performed on patients with multiple underlying comorbidities and the increased frequency of emergency procedures have contributed to the changing spectrum of infection. Other factors such as changes in hospital flora, surgery in patients with complicated vascular anatomy, and multiple revisions of previous vascular surgery have resulted in a more diverse microbio- clInIcal stateMents anD GuIDelInes logical spectrum of infection, which includes multidrugresistant strains, polymicrobial infection, and Candida species. Gram-positive cocci accounts for at least two thirds of VGIs. 1,13 Infections caused by coagulase-negative staphylococ...

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Section: Management Of Vgismentioning

confidence: 99%

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

358

307

View full text Add to dashboard Cite

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“…Negatif basınçlı yara tedavisi sonucu başarılı sonuçlar bildiren makaleler literatürde çok sayıda bulunmaktadır (12,13). Kas flebi uygulanmadan önce granülasyon dokusunu teşvik etmek içinde kullanılabilmektedir.…”

Section: Discussionunclassified

“…Pinocy ve arkadaşları Szilagyi III enfeksiyonu olan hastalara negatif basınçlı yara tedavisi uygulamışlar ve 12. ayın sonunda tüm hastalarda enfeksiyonun tamamen iyileştiğini bildirmişlerdir (14). Bu uygulamada en çok karşılaşılan komplikasyonlar özellikle kanama ve pseudoanevrizmadır (12)(13)(14). Kliniğimizde PVG enfeksiyonunlarında rutin olarak kültür antibiyograma uygun antibiyotik, debridman ve bir takım yara örtülerini kullanmaktayız.…”

Section: Discussionunclassified

Femoral Bolgedeki Prostetik Vaskuler Greft Enfeksiyonlarinin Gracilis Kas Flebleri ile Rekonstruksiyonu

Ovalı

2018

GMJ

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ÖZETAmaç: Femoral bölgedeki prostetik vasküler greft (PVG) enfeksiyonlarında gracilis kas flebi kullanarak tedavi ettiğimiz hastalara ait erken ve orta dönem sonuçlarımızı sunmak. Materyal ve metot: Ocak 2012 ile Ağustos 2016 tarihleri arasında kliniğimizde femoral bölgede PVG enfeksiyonu nedeniyle gracilis kas flebi kullanarak tedavi edilen 8 hasta çalışmaya alındı. PVG enfeksiyonu gelişen hastalarla ilgili bütün dosya içerikleri incelenip kaydedildi. Tüm bu verilerin yanında rutin biyokimyasal tetkikler, doppler ultrasonografi, bilgisayarlı tomografi, anjiografi yara yeri ve kan kültürü sonuçları da ayrıntılı olarak değerlendirildi. Bulgular:Çalışmamızda gracilis kas flebi kullanarak tedavi ettiğimiz 8 hastanın 5' i erkek 3' ü bayan idi. Ortalama yaş 58±8,9 (39-67) yıl idi. Tüm hastalarda cilt atı dokular ile birlikte greft enfekte idi (Szilagyi III). Bunun yanında, prostetik greft 2 hastada Dacron iken 6 hastada ise Polytetrafluoroethylene (PTFE) idi. Enfeksiyon 6 hastada erken dönemde oluşurken 2 hastada ise geç dönemde oluştu. Greft enfeksiyonuna neden olan patojenler; staphylococcus aureus (3 hasta), staphylococcus epidermidis (1 hasta) ve polimikrobiyal (4 hasta) idi. Bir hastada greft oklüzyonu, bir diğer hastada ise cilt kesisinin distal tarafında yaklaşık 2 cm bir açılma oldu. Hiçbir hastada ekstremite kaybı veya mortalite olmadı. En önemlisi, hastaların tamamında tam iyileşme sağlandı. Sonuç: PVG enfeksiyonlarında gracilis kas flebi rekonstriksiyonu, enfeksiyona maruz kalan alanı örtmek ve prostetik greft materyalini kurtarmak için etkili ve uygulanabilir bir alternatiftir. ABSTRACT Aim: To present early and midterm results of our patients treated using gracilis muscle flap for prosthetic vascular graft (PVG) infections located in the femoral region. Materials and Methods: Eight patients admitted to our clinic between January 2012 and August 2016 and treated using gracilis muscle flap owing to PVG infection in the femoral region were included in the present study. The contents of hospital files of the patients with PVG infection were thoroughly evaluated and recorded. Additionally, routine biochemical tests, Doppler ultrasonography, computed tomography; angiography wound site and blood culture results pertaining to the patients were also evaluated in detail.Results: In the present study, we treated 8 patients (5 males and 3 females) using gracilis muscle flap. Their average age was 58 ± 8.9 (39-67) years. All the patients suffered from the graft infections spreading to the subcutaneous tissues (Szilagyi grade III). While the prosthetic grafts used in 6 patients were Polytetrafluoroethylene (PTFE), they were Dacron in 2 patients. Moreover, 6 patients developed infections in the early period while 2 patients showed infections in the late period. The pathogens causing graft infections were identified to be staphylococcus aureus in 3 patients, staphylococcus epidermidis in 1 patient and polymicrobial agents in 4 patients. Furthermore, while graft occlusion was noted in one of the patients, a 2 cm opening ...

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“…Антими-кробные протезы несколько снижают реинфекции [35]. Комплексное лечение с использованием от-рицательного давления в ране улучшает результа-ты при ПИ [12,[36][37][38][39]. Сочетание эндоваскуляр-ных процедур с хирургическим вмешательством позволяет уменьшить частоту летальных исходов при аррозивных кровотечениях [40].…”

Section: хирургическое лечениеunclassified

“…По данным M. Szczot et al (2011), комбини-рованная АБТ в сочетании с аминогликозидами у 37 пациентов резко снижает 30-дневную леталь-ность [43]. Для пероральной АБТ рекомендуют-ся хинолоны, триметоприм-сульфаметоксазол, тетрациклины, рифампицин из-за их высокой биодоступности [5,37,[44][45][46][47]. После удаления некротических, инфицированных тканей, транс-плантата внутривенная АБТ в течение 4-6 недель является оправданной.…”

Section: антибактериальная терапия (абт)unclassified

Infection of vascular grafts

Абдулгасанов¹

2016

Kompleks. probl. serdečno-sosud. zabol.

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Федеральное государственное бюджетное учреждение «Научный центр сердечно-сосудистой хирургии им. А. Н. Бакулева» Российской академии наук, Москва, РоссияОписаны различные варианты хирургической тактики при протезной инфекции (ПИ) сосудов. Приведены основные виды хирургической тактики, такие как: экстраанатомическое шунтирование, использование искусственных протезов, применение ал-лографтов и бедренной вены. Указаны достоинства и недостатки каждого метода. Проведен сравнительный анализ используемых методик. Определены показания и противопоказания для каждого способа. Описаны ситуации, в которых возможно предпринять попытку консервативного ведения ПИ, а также применения искусственных протезов для репротезирования. Подробно изложены возможные пути предотвращения ПИ. Описаны различные подходы к антибиотикопрофилактике нагноений сосудистых протезов. Приведено поэтапное развитие методов профилактики инфекционных осложнений со стороны искусственного протеза.Ключевые слова: искусственный протез, инфекция протеза, экстраанатомическое шунтирование, аллографт. INFECTION OF VASCULAR GRAFTS R. A. ABDULGASANOV Federal State Budgetary Institution Bakoulev Scientific Centre for Cardiovascular SurgeryRussian Academy of Sciences, Moscow, Russia different variants of surgical tactics at suppuration of the vascular prosthesis are described in the review. Basic variants of surgical tactics such as extraanatomic bypass, vascular prosthesis regrafting, appliance of allograft and femoral vein are proposed. Pros and cons of each method are shown. Comparative analysis of the performed techniques was performed. Indications and contraindications for each method are determined. Situations suitable for attempt of conservative treatment of infected prosthesis and regrafting by vascular prosthesis are described. Possible ways of prevention of the vascular prosthesis contamination are described in details. different approaches to the antibiotics prevention of the infectious complications are listed.Step-by-step development of the prevention methods of the infectious complications is carried out.Key words: artificial prosthesis, prosthesis infection, extraanatomic bypass, allograft.Введение Инфекция сосудистого протеза -одно из самых грозных осложнений в сосудистой хирургии. По-сле реконструкции аорты, артерий у 1-6 % боль-ных наблюдается протезная инфекция (ПИ) [1][2]. ПИ артериальных протезов встречается у 4 % боль-ных, аорты 1-3 %, сопровождается потерей конеч-ностей и высокой летальностью (более 20 %) [3][4][5][6]. Актуальность проблемы подтверждает тот факт, что, например, в Швейцарии на лечение одного па-циента с ПИ тратится 72 350 франков [1]. Этиология, факторы риска и патогенезОсновными факторами риска развития ПИ яв-ляются пожилой возраст, ожирение, сердечная, почечная недостаточности, снижение иммуните-та, сахарный диабет, хроническая обструктивная болезнь легких, трофические язвы конечностей, длительное предоперационное пребывание в ста-ционаре, прием кортикостероидов, химиотерапия и др. [7][8][9]. Хирургические факторы риска включа-...

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Management of early (<30 day) vascular groin infections using vacuum-assisted closure alone without muscle flap coverage in a consecutive patient series

Abstract: 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.

Cited by 89 publications

References 28 publications

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Femoral Bolgedeki Prostetik Vaskuler Greft Enfeksiyonlarinin Gracilis Kas Flebleri ile Rekonstruksiyonu

Infection of vascular grafts

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