Comparison of Muscle Flaps and Delayed Secondary Intention Wound Healing for Infected Lower Extremity Arterial Grafts

Keith D. Calligaro, Frank J. Veith, Clifford Sales, Matthew J. Dougherty, Ronald P. Savarese, D. A. DeLaurentis

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Selective preservation of infected arterial grafts is an alternative to graft excision. The purpose of this study was to compare the outcome and cost of treating infected lower extremity arterial grafts with either muscle flaps (MFs) or delayed secondary intention (DSI) wound healing. Between 1985 and 1991 we treated 28 graft infections by graft preservation. All grafts (19 polytetrafluoroethylene, 8 autologous vein, and 1 Dacron) were patent with intact anastomoses and showed no signs of sepsis. Wounds in 18 patients were treated by repeated, aggressive operative debridement and allowed to heal by DSI. Wounds in 10 patients were treated with MFs (4 sartorius, 3 gracilis, 1 rectus abdominis, 1 semimembranous, and 1 gastrocnemius). Costs included anesthesiologists' and surgeons' fees, operating room charges, and daily semiprivate and ICU bed charges. Four (14%) patients died from cardiac complications (1 DSI and 1 MF), sepsis (1 MF), and anastomotic hemorrhage (1 DSI). Of the 24 survivors, 4 patients treated by DSI requited graft excision for nonhealing wounds (2), graft thrombosis (1), and recurrent infection (1). However, 3 of these 4 patients were not candidates for MFs because the wounds were not considered acceptable for a flap. Twenty (83%) grafts in survivors were successfully preserved after long-term follow-up (mean 26 mo). No survivors required an amputation. Twenty patients who did not require graft removal were compared for treatment by MF (n = 8) or DSI (n = 12). Two MFs (both sartorius) in survivors necrosed and a new flap was required to successfully preserve the graft. Average hospital and intensive care stay as well as hospital costs were not significantly different for the two groups. The majority of infected, patent lower extremity grafts with intact anastomoses can be successfully preserved with either MFs or DSI wound healing. We found no significant difference in outcome or cost for the two methods of treatment.

Original languageEnglish (US)
Pages (from-to)31-37
Number of pages7
JournalAnnals of Vascular Surgery
Volume8
Issue number1
DOIs
StatePublished - Jan 1 1994
Externally publishedYes

Fingerprint

Wound Healing
Lower Extremity
Transplants
Muscles
Survivors
Wounds and Injuries
Costs and Cost Analysis
Sepsis
Rectus Abdominis
Polyethylene Terephthalates
Fees and Charges
Hospital Costs
Polytetrafluoroethylene
Debridement
Operating Rooms
Critical Care
Infection
Amputation
Veins
Thrombosis

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Calligaro, Keith D. ; Veith, Frank J. ; Sales, Clifford ; Dougherty, Matthew J. ; Savarese, Ronald P. ; DeLaurentis, D. A. / Comparison of Muscle Flaps and Delayed Secondary Intention Wound Healing for Infected Lower Extremity Arterial Grafts. In: Annals of Vascular Surgery. 1994 ; Vol. 8, No. 1. pp. 31-37.
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abstract = "Selective preservation of infected arterial grafts is an alternative to graft excision. The purpose of this study was to compare the outcome and cost of treating infected lower extremity arterial grafts with either muscle flaps (MFs) or delayed secondary intention (DSI) wound healing. Between 1985 and 1991 we treated 28 graft infections by graft preservation. All grafts (19 polytetrafluoroethylene, 8 autologous vein, and 1 Dacron) were patent with intact anastomoses and showed no signs of sepsis. Wounds in 18 patients were treated by repeated, aggressive operative debridement and allowed to heal by DSI. Wounds in 10 patients were treated with MFs (4 sartorius, 3 gracilis, 1 rectus abdominis, 1 semimembranous, and 1 gastrocnemius). Costs included anesthesiologists' and surgeons' fees, operating room charges, and daily semiprivate and ICU bed charges. Four (14{\%}) patients died from cardiac complications (1 DSI and 1 MF), sepsis (1 MF), and anastomotic hemorrhage (1 DSI). Of the 24 survivors, 4 patients treated by DSI requited graft excision for nonhealing wounds (2), graft thrombosis (1), and recurrent infection (1). However, 3 of these 4 patients were not candidates for MFs because the wounds were not considered acceptable for a flap. Twenty (83{\%}) grafts in survivors were successfully preserved after long-term follow-up (mean 26 mo). No survivors required an amputation. Twenty patients who did not require graft removal were compared for treatment by MF (n = 8) or DSI (n = 12). Two MFs (both sartorius) in survivors necrosed and a new flap was required to successfully preserve the graft. Average hospital and intensive care stay as well as hospital costs were not significantly different for the two groups. The majority of infected, patent lower extremity grafts with intact anastomoses can be successfully preserved with either MFs or DSI wound healing. We found no significant difference in outcome or cost for the two methods of treatment.",
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Comparison of Muscle Flaps and Delayed Secondary Intention Wound Healing for Infected Lower Extremity Arterial Grafts. / Calligaro, Keith D.; Veith, Frank J.; Sales, Clifford; Dougherty, Matthew J.; Savarese, Ronald P.; DeLaurentis, D. A.

In: Annals of Vascular Surgery, Vol. 8, No. 1, 01.01.1994, p. 31-37.

Research output: Contribution to journalArticle

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