Muscle-Flap Coverage for Infected Peripheral Vascular Prostheses

Meland, Nils; Arnold, Phillip G.; Pairolero, Peter C.; Lovich, Stephen F.

doi:10.1097/00006534-199404001-00015

Cited by 48 publications

(42 citation statements)

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“…Although the number of graft infections is generally low (1-6%), they are associated with significant rates of limb loss (30-50%) and mortality (25-75%). 15 Debridement, graft preservation, and muscle flap coverage have been used as an alternative to graft removal and extra-anatomic bypass. Meland and Arnold, in their classic paper, describe the role of muscle flaps in the management of 24 periprosthetic graft infections.…”

Section: Graft Infectionsmentioning

confidence: 99%

“…Meland and Arnold, in their classic paper, describe the role of muscle flaps in the management of 24 periprosthetic graft infections. 15 The infected grafts were treated with extensive debridement followed by muscle flap coverage and postoperative wound irrigation with a povidoneiodine solution delivered through implanted catheters. Systemic intravenous antibiotics were also employed.…”

Section: Graft Infectionsmentioning

confidence: 99%

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Muscle Flaps and their Role in Limb Salvage

Klebuc¹,

Menn

2013

Methodist DeBakey Cardiovascular Journal

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Muscle flaps have proved to be a valuable and versatile tool in the surgical treatment of the severely compromised lower extremity. Utilized as both local pedicle flaps and free tissue transfers, muscles have been successfully employed to cover complex wounds, manage osteomyelitis, salvage infected vascular grafts, treat recalcitrant venous stasis ulcers, preserve amputation levels, and restore motion following compartment syndrome. Free flap pedicles have also been used in a flow-through fashion to create a distal arterial bypass. This article explores the multipurpose role of muscle flaps in limb salvage surgery and their beneficial physiologic characteristics in hostile wound environments.

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Section: Graft Infectionsmentioning

confidence: 99%

Section: Graft Infectionsmentioning

confidence: 99%

Muscle Flaps and their Role in Limb Salvage

Klebuc¹,

Menn

2013

Methodist DeBakey Cardiovascular Journal

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“…26,59,64,65 Muscle flaps obliterate the dead space, promote healing, increase vascular supply and oxygen tension, augment the effects of antimicrobial therapy, protect the wound from contamination with other microorganisms, and protect the graft from desiccation and thrombosis. 26,52,55,56,60,66,67 The choice of a rotational or transpositional muscle flap should be made in consultation with vascular and plastic surgeons. Some surgeons have recommended wound coverage with a vacuum-assisted closure device, either alone or as a possible bridge to muscle flap.…”

mentioning

confidence: 99%

“…Close surveillance of the graft is reasonable during the first 2 years when the risk of recurrence of infection is highest. 1,4,25,26,55,86,88 Patients should have a physical examination, laboratory tests including complete blood count and differential, biomarkers of inflammation such as erythrocyte sedimentation rate and C-reactive protein, and an ultrasound examination every 3 to 6 months for 2 years. For patients with Samson group III, IV, or V VGI, lifelong follow-up with ultrasound every 6 to 12 months is reasonable.…”

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confidence: 99%

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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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Aortofemoral Graft Infection

Gibbons

2006

Vascular Surgery

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Muscle-Flap Coverage for Infected Peripheral Vascular Prostheses

Cited by 48 publications

References 0 publications

Muscle Flaps and their Role in Limb Salvage

Muscle Flaps and their Role in Limb Salvage

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

Aortofemoral Graft Infection

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