Muscle flaps in the management of prosthetic graft infections

It has been estimated that as many as 10,000 patients each year present with vascular graft infection in the United States. Although prosthetic graft infection remains a demanding challenge for the surgeon and a potentially devastating complication for the patient, in recent years management options have increased, and the surgical outcome has improved. Although septic involvement of the main body of an aortoiliac/femoral, or the entire extent of an infrainguinal, bypass continues to require complete graft excision in most cases, among patients with more localized infection there is growing evidence that aggressive local wound care may allow salvage of all or most of the origi nal conduit. Graft coverage with well-vascularized skeletal muscle represents an innovative refinement of the local management of prosthetic graft infection, which may not only increase the likelihood of successful graft salvage but also allow this local management strategy to be extended to cases that formerly would have required graft removal. Because most graft infections present in the groin, local transfer of the sartorius muscle has been most frequently per formed. However, a number of basic laboratory studies and a growing body of nonvascular as well as vascular surgical experience suggest that performance of a formal rotational muscle flap procedure may be the optimal strategy.