Lower extremity vascular prosthesis infection-successful salvage with local muscular flap reconstruction

ABSTRACT

The development of prosthetic arterial substitute has revolutionized the management of patients with aneurysmal and occlusive disease. Despite the prolonged graft usage and numerous refinements in fabrication, infection remains a disastrous problem. Infected or exposed vascular prosthesis is more encountered in lower extremity bypass operations. Multiple surgical approaches approved its efficacy for treatment of such complication among which is the usage of local muscle flap. To study the effect of local muscle flap [Sartorius] reconstruction for salvaging an infected or exposed vascular prosthesis in the lower extremity. Seventeen patients with infected or exposed vascular prosthesis in the lower extremity were studied during the period 2002-2007. They included 14 patients at the groin incision and three at the supragenicular incision. Their medical records were reviewed. Sartorius myoplasty was performed to all cases. The study was extended to include 17 patients, mean age 55.3 years. There were 12 males and 5 females. The initial operations were recorded. Twelve patients presented by chronic discharging sinus, while exposed grafts were the presentation in 5 patients. Sartorius myoplasty was done for 14 infected prostheses at the groin and for three at supragenicular incision. Follow up to all cases was done with a mean interval time, 16 months, with complete wound healing except in one case. Muscle flap coverage of infected wounds following vascular procedures has been helpful not only for filling large tissue defects but also to assist resolution of limited graft infection. It was performed by Wagensteen in 1940, Numerous advantages attend the use of sartorius muscle flap coverage for vascular graft preservation, Multiple researches were done all over the world and were supporting for its usage. In our study, we reported complete wound healing with graft preservation except in one case. Sartorius myoplasty is a simple effective and durable local reconstructive procedure, for treating infected or exposed graft at the groin or supragenicular incision