Rotational muscle flaps to treat localized prosthetic graft infection: Long-term follow-up

Bruce Alan Perler, Craig Vander Kolk, Paul Manson, G. Melville Williams

Research output: Contribution to journalArticle

Abstract

Purpose: The conventional management of prosthetic graft infection (PGI), including graft excision and extraanatomic revascularization, continues to be associated with substantial morbidity. Rotational muscle flap (RMF) closure of the infected wound, with preservation of the graft, is an alternative, albeit controversial, approach. Methods: Over the last 7 years, 22 RMF procedures have been performed to close 19 wounds in 18 patients, ranging in age from 39 to 79 (mean 63.7) years, with PGI. Twenty-one grafts constructed of Dacron (13) or polytetrafluoroethylene (8) were covered in the groin (16), neck (2), or chest (1). The clinical presentations included abscess or purulent drainage in 14 grafts, hemorrhage in three, and infected false aneurysm in two wounds; positive bacterial culture results were obtained in each case. Results: There was one (5.6%) operative death. Healing was achieved in the 18 wounds of the 17 operative survivors. No patients have been lost to follow-up. Three (17.6%) of these 17 patients had recurrent infection, including one patient who underwent a secondary RMF procedure with graft salvage, one who underwent excision of an occluded graft, and one who underwent excision and extraanatomic bypass and died. Four other patients died 1 to 6 (mean 3) months after RMF closure with healed wounds. Eleven (92%) of the 12 survivors have healed wounds and intact grafts with follow-up ranging from 8 to 83 (mean 39) months. For the entire series 15 (88%) of these 17 patients had healed wounds and intact grafts, with a mean follow-up of 30 months. Conclusions: These results suggest that RMF procedures are well tolerated and can achieve acceptable long-term graft salvage in selected patients with PGI.

Original languageEnglish (US)
Pages (from-to)358-365
Number of pages8
JournalJournal of Vascular Surgery
Volume18
Issue number3
DOIs
StatePublished - 1993

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Transplants
Muscles
Infection
Wounds and Injuries
Survivors
Infected Aneurysm
Polyethylene Terephthalates
Groin
Lost to Follow-Up
False Aneurysm
Polytetrafluoroethylene
Abscess
Drainage
Neck
Thorax
Hemorrhage
Morbidity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Rotational muscle flaps to treat localized prosthetic graft infection : Long-term follow-up. / Perler, Bruce Alan; Vander Kolk, Craig; Manson, Paul; Williams, G. Melville.

In: Journal of Vascular Surgery, Vol. 18, No. 3, 1993, p. 358-365.

Research output: Contribution to journalArticle

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abstract = "Purpose: The conventional management of prosthetic graft infection (PGI), including graft excision and extraanatomic revascularization, continues to be associated with substantial morbidity. Rotational muscle flap (RMF) closure of the infected wound, with preservation of the graft, is an alternative, albeit controversial, approach. Methods: Over the last 7 years, 22 RMF procedures have been performed to close 19 wounds in 18 patients, ranging in age from 39 to 79 (mean 63.7) years, with PGI. Twenty-one grafts constructed of Dacron (13) or polytetrafluoroethylene (8) were covered in the groin (16), neck (2), or chest (1). The clinical presentations included abscess or purulent drainage in 14 grafts, hemorrhage in three, and infected false aneurysm in two wounds; positive bacterial culture results were obtained in each case. Results: There was one (5.6{\%}) operative death. Healing was achieved in the 18 wounds of the 17 operative survivors. No patients have been lost to follow-up. Three (17.6{\%}) of these 17 patients had recurrent infection, including one patient who underwent a secondary RMF procedure with graft salvage, one who underwent excision of an occluded graft, and one who underwent excision and extraanatomic bypass and died. Four other patients died 1 to 6 (mean 3) months after RMF closure with healed wounds. Eleven (92{\%}) of the 12 survivors have healed wounds and intact grafts with follow-up ranging from 8 to 83 (mean 39) months. For the entire series 15 (88{\%}) of these 17 patients had healed wounds and intact grafts, with a mean follow-up of 30 months. Conclusions: These results suggest that RMF procedures are well tolerated and can achieve acceptable long-term graft salvage in selected patients with PGI.",
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