Role of Negative Pressure Wound Therapy in Treating Peripheral Vascular Graft Infections

Abstract

Wound complications involving large subcutaneous vessels can cause significant challenges for surgeons. Negative pressure wound therapy (NPWT) has been increasingly used for treating complex wounds in vascular surgery, including groin infections, either as a bridge to surgical closure or as a primary wound treatment modality. Although a growing body of evidence exists for managing various problematic wounds, such as diabetic foot ulcers and open abdominal wounds, the role of NPWT in wounds involving large blood vessels or wounds complicating infected vascular grafts has not been well defined. A multidisciplinary advisory panel reviewed the literature relevant to wounds related to vascular surgical procedures and complications, focusing on large subcutaneous or infected vascular conduits. The results supported by the literature and the clinical practice of the consensus panel suggested that NPWT can be a useful adjunct to the management of vascular groin infections and dehiscences but must be used with caution.

The anterolateral thigh pedicled perforator flap for closure of a groin defect with lymphorrhea following vascular surgery in a peripheral vascular disease patient—case report

“…Any surgical solution needs to encompass this condition. VAC is being increasingly used and finding places to treat inguinal infections involving alloplastic graft material infections [4,5]. Some authors also propose its use for lymphorrhea [6] control.…”

Vacuum-assisted closure therapy with omental transposition for salvage of infected prosthetic femoral–distal bypass involving the femoral anastomosis

“…[3][4][5][6][7] Reported complications of VAC therapy in the setting of exposed vascular grafts include bleeding and pseudoaneurysm formation. [8][9][10] Recognizing the potential for serious adverse outcomes, a nonadherent dressing should be interposed between the exposed anastomosis and VAC sponge and the patient should be in a critical care unit.…”

Contemporary Evaluation and Management of the Diabetic Foot

“…Surgical correction of biomechanical defects, plastic and soft-tissue reconstruction, and appropriate measures to minimize foot pressure are all essential to enable the patient to walk effectively again. Likewise, the use of negative pressure wound therapy has been a big advance in the care of advanced wounds [80, 81, 103]. Clinical pathways related to diabetic foot ulcers frequently involve persistent sharp debridement, expensive wound care products, long-term IV antibiotics, total contact casting with tendo-Achilles lengthening, use of skin equivalents, electrical stimulation, multiple off-loading orthopedic devices, and even amputation.…”