Sartorius Myoplasty for Infected Vascular Grafts in the Groin

Maser, Benjamin; Vedder, Nicholas B.; Rodriguez, Dirk I.; Johansen, Kaj

doi:10.1001/archsurg.1997.01430290068013

Cited by 37 publications

(26 citation statements)

References 11 publications

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“…Of these, the SMF has been most fre- quently utilized, as it has been proven to be efficacious in the compromised groin wound. [19][20][21][22] The SMF has been established as an effective muscle flap to improve groin wound healing, reduce hospital stay, and prevent reinfection in the complicated groin wound. 23 Although the SMF is the initial flap of choice, in wounds with a significant volume of dead space following a vascular intervention, we utilize the RF due to its greater size (Fig 1).…”

Section: Discussionmentioning

confidence: 99%

Prophylactic muscle flaps in vascular surgery

Fischer

Nelson

Mirzabeigi

et al. 2012

Journal of Vascular Surgery

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Complications following open groin surgery are common, lead to significant morbidity, and are very costly. Performing prophylactic muscle flaps at the initial surgery to cover the femoral vessels and reduce dead space can significantly reduce complications in select high-risk patients. Prophylactic flaps are safe, effective, and should be considered in patients with multiple comorbidities undergoing high-risk groin surgery, such as reoperative prosthetic bypass surgery.

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Section: Discussionmentioning

confidence: 99%

Prophylactic muscle flaps in vascular surgery

Fischer

Nelson

Mirzabeigi

et al. 2012

Journal of Vascular Surgery

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“…25,26,55,56,[60][61][62][63] Meticulous débridement and antimicrobial therapy are vital to the success of muscle flap coverage. 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.…”

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

360

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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“…Indeed, the use of a local muscle flap in conjunction with thorough wound debridement aiming to "sterilize" the infectious foci, has been successfully applied for the management of localized prosthetic vascular graft infections especially in the groin. 27 The muscle flap seems to act by increasing local tissue oxygenation and phagocytic activity, decreasing wound bacterial counts, augmenting the delivery of antibiotics to the site, and eliminating dead space. [27][28][29][30][31] The timing of surgical debridement also merits consideration.…”

Section: Discussionmentioning

confidence: 99%

“…27 The muscle flap seems to act by increasing local tissue oxygenation and phagocytic activity, decreasing wound bacterial counts, augmenting the delivery of antibiotics to the site, and eliminating dead space. [27][28][29][30][31] The timing of surgical debridement also merits consideration. As already noticed, radical surgical debridement was performed at a second stage, 1-3 days following stentgraft placement.…”

Section: Discussionmentioning

confidence: 99%