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The Role of Muscle Flaps in Wound Salvage after Vascular Graft Infections: The Emory Experience

Seify, Hisham M.D.; Moyer, Hunter R. M.D.; Jones, Glyn E. M.D.; Busquets, Antonio M.D.; Brown, Katherine M.D.; Salam, Atef M.D.; Losken, Albert M.D.; Culbertson, John M.D.; Hester, T Roderick M.D.

Plastic and Reconstructive Surgery: April 1st, 2006 - Volume 117 - Issue 4 - p 1325-1333
doi: 10.1097/01.prs.0000204961.32022.ab
Reconstructive: Lower Extremity: Original Articles

Background: The incidence of prosthetic graft infection is 1 to 6 percent, and the mortality rate of infected aortoiliac or aortofemoral bypass is 25 to 75 percent. The goal of this study was to report the use of muscle flaps in the management of patients presenting with infected vascular grafts.

Methods: A total of 22 patients required 26 muscle flaps to cover 24 infected vascular grafts. Muscle flaps were used for local wound control in all patients regardless of the fate of the graft. The vascular surgeons elected for graft salvage in eight of the 24 grafts. All of the muscle flaps survived.

Results: The average time interval between the bypass and infection was 371 days. One-month follow-up revealed an 88 percent salvage rate, but this decreased to 50 percent during the mean follow-up of 23 months. None of the patients originally managed with a salvaged graft lost a limb, and overall, 14 of 22 limbs in this series remained viable (64.0 percent). The mortality rate during the index hospitalization was 9 percent. In this series, suprainguinal grafts had a higher mortality rate. In addition, infection occurring more than 1 month postoperatively, culture-positive Pseudomonas and methicillin-resistant species, and exposure of the arterial-graft anastomosis were poor prognostic indicators of graft preservation.

Conclusions: Management of infected vascular grafts remains a challenging problem. Muscle flap coverage should have a high priority, as the chance of a good outcome is highly favorable in early infections.

Atlanta, Ga.

From the Joseph B. Whitehead Department of Surgery, Division of Plastic and Vascular Surgery, Emory University.

Received for publication September 5, 2004; revised January 4, 2006.

Hisham Seify, M.D., Division of Plastic Surgery, Emory University, 3200 Downwood Circle, Atlanta, Ga. 30327, hseifymd@gmail.com

©2006American Society of Plastic Surgeons