Correlation of preoperative ankle-brachial index and pulse volume recording with impaired saphenous vein incisional wound healing post coronary artery bypass surgery

Risk factors for limb surgical site infection following coronary artery bypass graft using open great saphenous vein harvesting: a retrospective cohort study

OBJECTIVES

Our goal was to define risk factors for limb (leg) surgical site infections (SSIs) following coronary artery bypass grafting (CABG) with open saphenous vein grafting and to estimate their consequences for patients.

METHODS

We performed a retrospective cohort study in a primary and tertiary hospital in Israel that included all adult patients undergoing CABG with open saphenous vein harvesting (November 2014-August 2016). Patients were followed perioperatively from admission until 90 days postoperatively, including post-discharge follow-up. Operative data were collected prospectively. We analysed risk factors for leg SSIs using univariate and multivariate methods.

RESULTS

Thirty-six of 351 (10.3%) patients developed leg SSI. Median time to detection was 14 days (interquartile range 11-24) and 25/36 (69.4%) patients were diagnosed after discharge. Independent risk factors for SSI included female sex [odds ratio (OR) 4.08, 95% confidence interval (CI) 1.79-9.28], body mass index >30 (OR 2.12, 95% CI 1.01-4.48), peripheral vascular disease (OR 3.33, 95% CI 1.48-7.49) and use of more than 1 saphenous vein graft (OR 2.08, 95% CI 0.88-4.96). Infected patients had longer hospitalizations after surgery [7 days (5-12) vs 6 days (5-7), P = 0.002], higher antibiotic consumption (P = 0.002) and higher readmission rates of 24/36 (66.7%) vs 59/262 (22.5%) (P < 0.001) than non-infected controls.

CONCLUSIONS

Leg SSIs following coronary artery bypass surgery are common and associated with morbidity. We suggest reconsidering open saphenous vein harvesting in obese female patients with peripheral vascular disease.

Multimodal optical measurement for study of lower limb tissue viability in patients with diabetes mellitus

According to the International Diabetes Federation, the challenge of early stage diagnosis and treatment effectiveness monitoring in diabetes is currently one of the highest priorities in modern healthcare. The potential of combined measurements of skin fluorescence and blood perfusion by the laser Doppler flowmetry method in diagnostics of low limb diabetes complications was evaluated. Using Monte Carlo probabilistic modeling, the diagnostic volume and depth of the diagnosis were evaluated. The experimental study involved 76 patients with type 2 diabetes mellitus. These patients were divided into two groups depending on the degree of complications. The control group consisted of 48 healthy volunteers. The local thermal stimulation was selected as a stimulus on the blood microcirculation system. The experimental studies have shown that diabetic patients have elevated values of normalized fluorescence amplitudes, as well as a lower perfusion response to local heating. In the group of people with diabetes with trophic ulcers, these parameters also significantly differ from the control and diabetes only groups. Thus, the intensity of skin fluorescence and level of tissue blood perfusion can act as markers for various degrees of complications from the beginning of diabetes to the formation of trophic ulcers.

Staples versus sutures for closing leg wounds after vein graft harvesting for coronary artery bypass surgery

BACKGROUND

Surgical site infection (SSI) after saphenous vein graft harvesting is a complication occurring in up to 18% of patients who undergo coronary artery bypass surgery (CABG). It is not known whether the method of skin closure influences the infection rate.

OBJECTIVES

To compare the rates of SSI and wound dehiscence of staples and sutures for skin closure after saphenous vein graft harvesting for CABG.

SEARCH STRATEGY

We searched the following electronic databases: The Cochrane Wounds Group Specialised Register (searched 11/3/10); The Cochrane Central Register of Controlled Trials (CENTRAL) - The Cochrane Library 2010 Issue 1; Ovid MEDLINE - 1950 to March Week 1 2010; Ovid MEDLINE - In-Process & Other Non-Indexed Citations (Searched 11/3/10); Ovid EMBASE - 1980 to 2010 Week 09 and EBSCO CINAHL - 1982 to March 11 2010. No date or language restrictions were applied.

SELECTION CRITERIA

Trials comparing staples and sutures for closing leg wounds after vein graft harvesting in patients undergoing CABG were eligible for inclusion in this review.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the titles and abstracts of references identified by the search strategy against the selection criteria and extracted data from eligible trials. Included trials were assessed for the following risks of bias: generation of random allocation sequence, allocation concealment, blinding, incomplete outcome data, selective reporting and freedom from other biases. For dichotomous variables, we calculated the relative risk with 95% confidence intervals (CI).

MAIN RESULTS

We included three prospective, randomised studies reporting on a total of 148 leg wounds closed with staples and 175 with sutures after vein graft harvesting in patients undergoing CABG. All trials were of sub-optimal methodological quality and all trials were at risk of bias. Leg wound infection rate was 10.8% (16/148) after leg wound closure with staples compared with 8% (14/174) with sutures (relative risk 1.20, 95% CI 0.60 to 2.39). Leg wound dehiscence occurred in 9.3% (10/108) of patients after leg wound closure with staples compared with 8.8% (12/137) with sutures (relative risk 1.05, 95%CI 0.43 to 2.53).

AUTHORS' CONCLUSIONS

These results suggest that there is no evidence of a difference in the risk of SSI and wound dehiscence when staples rather than sutures are used to close leg wounds after vein graft harvesting during CABG, however more research is needed.