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Wübbeke LF, Conings JZM, Elshof JW, Scheltinga MR, Daemen JWHC, Jacobs MJ, Mees BM. Outcome of rectus femoris muscle flaps for groin coverage after vascular surgery. J Vasc Surg 2020; 72:1050-1057.e2. [PMID: 32122734 DOI: 10.1016/j.jvs.2019.11.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/04/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this retrospective cohort study was to investigate the outcome of rectus femoris muscle flaps (RFFs) for deep groin wound complications in vascular surgery patients and to compare the outcome with a cohort of sartorius muscle flaps (SMFs) because the RFF is a promising alternative technique for groin coverage. METHODS All RFFs and SMFs performed by vascular surgeons in a regional collaboration in The Southern Netherlands were retrospectively reviewed. Primary outcomes were muscle flap survival, overall and secondary graft salvage, and limb salvage. Secondary outcomes were 30-day groin wound complications and mortality, donor site and vascular complications, 1-year amputation-free survival, overall patient survival, impaired knee extensor function, and length of hospital stay. RESULTS A total of 96 RFFs were performed in 88 patients (mean age, 68 years; 67% male) and compared with a cohort of 30 SMFs in 28 patients (mean age, 64 years; 77% male). At a mean follow-up of 29 months and 23 months, respectively, comparable flap survival (94% vs 90%), secondary graft salvage (80% vs 92%), and limb salvage (89% vs 90%) rates were found. The 30-day mortality rates were 12% and 17%, respectively, and the 1-year amputation-free survival was comparable between treatment groups (71% vs 68%). CONCLUSIONS This study presents a large series of RFFs for deep groin wound complications after vascular surgery. We demonstrate that muscle flap coverage using the rectus femoris muscle by vascular surgeons is an effective way to manage complex groin wound infections in a challenging group of patients, achieving similarly good results as the SMF.
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Affiliation(s)
- Lina F Wübbeke
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jurek Z M Conings
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Marc R Scheltinga
- Department of Surgery, Maxima Medical Center, Veldhoven, The Netherlands
| | - Jan-Willem H C Daemen
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michael J Jacobs
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; European Vascular Center Aachen-Maastricht, Aachen, Germany
| | - Barend M Mees
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; European Vascular Center Aachen-Maastricht, Aachen, Germany.
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Ryu DY, Jung HJ, Ramaiah VG, Rodriguez-Lopez JA, Lee SS. Infected Groin (Graft/Patch): Managed with Sartorious Muscle Flap. Vasc Specialist Int 2016; 32:11-6. [PMID: 27051655 PMCID: PMC4816020 DOI: 10.5758/vsi.2016.32.1.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/07/2015] [Accepted: 12/14/2015] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The purpose of this study was to review the natural history, clinical outcome and safety in patients undergoing sartorius muscle flap (SMF) for groin infection, including lymphocele. MATERIALS AND METHODS We retrospectively reviewed the records of patients who underwent SMF in a single center between 2000 and 2009. RESULTS Thirty patients (17 male, 13 female) underwent SMF for groin infection, which included infections of 22 artificial femoral bypass grafts (including 2 cryoveins) and 5 common femoral patch grafts, and 3 lymphocele infections (2 cardiac catheterizations and 1 penile cancer lymph node dissection). Wound isolates were most commonly Gram-positive organisms (n=22) with Gram-negative isolates and mixed infections accounting for 4 and 3 cases, respectively. In 9 patients there was no growth of organisms. Adjunctive wound vacuum-asssisted wound closure therapy was performed in 18 patients. Follow-up duration ranged from 8 days to 56 months (mean 14.1 months) after SMF. Reoperation was performed in 3 patients due to wound bleeding (n=1) and reinfection (n=1). One patient underwent graft excision with external bypass operation. There was 1 mortality case due to sepsis during the study period. CONCLUSION We found that muscle flap surgery provides successful single-intervention therapy for groin infections including lymphocele. Graft ligation or aggressive excision with bypass surgery should be reserved for patients requiring rapid control of sepsis for lifesaving.
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Affiliation(s)
- Dong Yeon Ryu
- Division of Vascular and Endovascular, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyuk Jae Jung
- Division of Vascular and Endovascular, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | | | | | - Sang Su Lee
- Division of Vascular and Endovascular, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
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Vascular complications and special problems in vascular trauma. Eur J Trauma Emerg Surg 2013; 39:569-89. [DOI: 10.1007/s00068-013-0336-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 09/30/2013] [Indexed: 12/17/2022]
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Hisata Y, Hashizume K, Tanigawa K, Miura T, Odate T, Tasaki Y, Eishi K. Vacuum-assisted closure therapy for salvaging a methicillin-resistant Staphylococcus aureus-infected prosthetic graft. Asian J Surg 2013; 37:46-8. [PMID: 23978424 DOI: 10.1016/j.asjsur.2013.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 10/18/2012] [Accepted: 07/09/2013] [Indexed: 10/26/2022] Open
Abstract
Infection of a vascular prosthesis after a bypass surgery is relatively rare. However, once developed, serious complications can occur, such as bleeding, sepsis, and organ ischemia, occasionally resulting in leg amputation or even death in some cases. The treatment of a vascular prosthesis infection involves the necessary removal of the infected graft; subsequently, an extra-anatomical bypass surgery is often considered. We herein report a case in which postoperative methicillin-resistant Staphylococcus aureus infection caused dehiscence of the femoral vessels and exposure of the graft vessel and anastomosed area. The infected tissue was surgically removed (debridement), and the patient's condition was successfully treated by the application of a nonadherent dressing and vacuum-assisted closure therapy combined with the bridging technique.
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Affiliation(s)
- Yoichi Hisata
- Division of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8108, Japan.
| | - Koji Hashizume
- Division of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8108, Japan
| | - Kazuyoshi Tanigawa
- Division of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8108, Japan
| | - Takashi Miura
- Division of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8108, Japan
| | - Tomohiro Odate
- Division of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8108, Japan
| | - Yuichi Tasaki
- Division of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8108, Japan
| | - Kiyoyuki Eishi
- Division of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8108, Japan
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Verma H, Ktenidis K, George RK, Tripathi R. Vacuum-assisted closure therapy for vascular graft infection (Szilagyi grade III) in the groin-a 10-year multi-center experience. Int Wound J 2013; 12:317-21. [PMID: 23796163 DOI: 10.1111/iwj.12110] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 05/06/2013] [Indexed: 11/30/2022] Open
Abstract
The aim of the study was to evaluate the benefit of vacuum-assisted closure (VAC) therapy in the management of deep, alloplastic graft infections (Szilagyi grade III) in the groin. From 2000 to 2009, we identified and included in our study 72 deep inguinal infections in 68 patients, involving native as well as synthetic graft or patch material. There were 29 early graft infections (<30 days after implantation) and 43 late infections (≥30 days after implantation). Among these, 17 cases involved native grafts/patches (12 grafts and 5 patches), while 55 cases involved non-native grafts/patches [26 polytetrafluorethylene (PTFE) grafts and 24 Dacron grafts (Haemashield, Meadox Medical, Boston Scientific Corporation, Natick, NY; Gelsoft graft, Vascutek, Inchinnan, Renfrewshire, Scotland, UK; Intervascular, Mahwah, NJ); INVISTA, and 5 Vascu-Guard(™) bovine pericardial patches; Synovis Surgical Innovation]. All patients were treated with multiple wound debridements, graft salvage, sartorius myoplasty, intravenous antibiotics and VAC therapy until thorough surface healing was achieved. Exclusion criteria were an alloplastic graft infection with proximal expansion above the inguinal ligament, blood culture positive for septicaemia or septic anastomotic herald or overt bleeding. Nine months after initiation of therapy, overall, graft/patch salvage was achieved in 61 of 72 (84·7%) cases. Of the native graft/patch group, infected graft material was replaced with an autogenous great saphenous vein graft or patch in four patients (23·5%). In the non-native group, vein or synthetic graft preservation without revision was achieved in 48 of 55 (87·3%) patients. The mean duration of VAC therapy was 16 ± 7·7 days, and postoperative mean hospital stay was 25·3 ± 8·5 days. In 23 of 72 (31·9%) cases, a secondary closure of the wound was achieved; in the other 49 cases, wound healing was achieved by meshed split-thickness skin grafting. Mean wound healing time for all wounds was 24·3 ± 12·5 days. Specific complications during VAC therapy were wound fluid retention in 2 cases and an increased need for analgesics in 12 cases (16·66%). Negative pressure wound therapy (NPWT) has been reported to be useful in the treatment of severe wound infections. Even in the presence of synthetic vascular graft material, NPWT can greatly simplify challenging wound-healing problems leading to wound dehiscence and its sequelae. Our long-term experience demonstrates the safety and effectiveness of VAC therapy in the management of deep graft infections.
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Affiliation(s)
- Himanshu Verma
- Narayana Institute of Vascular Sciences, Narayana Hrudayalaya, Bangalore, India
| | - Kiriakos Ktenidis
- Ist Surgical University Clinic, Department of Vascular Surgery, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Robbie K George
- Narayana Institute of Vascular Sciences, Narayana Hrudayalaya, Bangalore, India
| | - Ramesh Tripathi
- Narayana Institute of Vascular Sciences, Narayana Hrudayalaya, Bangalore, India
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Sumpio BE. Contemporary evaluation and management of the diabetic foot. SCIENTIFICA 2012; 2012:435487. [PMID: 24278695 PMCID: PMC3820495 DOI: 10.6064/2012/435487] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 09/30/2012] [Indexed: 06/02/2023]
Abstract
Foot problems in patients with diabetes remain a major public health issue and are the commonest reason for hospitalization of patients with diabetes with prevalence as high as 25%. Ulcers are breaks in the dermal barrier with subsequent erosion of underlying subcutaneous tissue that may extend to muscle and bone, and superimposed infection is a frequent and costly complication. The pathophysiology of diabetic foot disease is multifactorial and includes neuropathy, infection, ischemia, and abnormal foot structure and biomechanics. Early recognition of the etiology of these foot lesions is essential for good functional outcome. Managing the diabetic foot is a complex clinical problem requiring a multidisciplinary collaboration of health care workers to achieve limb salvage. Adequate off-loading, frequent debridement, moist wound care, treatment of infection, and revascularization of ischemic limbs are the mainstays of therapy. Even when properly managed, some of the foot ulcers do not heal and are arrested in a state of chronic inflammation. These wounds can frequently benefit from various adjuvants, such as aggressive debridement, growth factors, bioactive skin equivalents, and negative pressure wound therapy. While these, increasingly expensive, therapies have shown promising results in clinical trials, the results have yet to be translated into widespread clinical practice leaving a huge scope for further research in this field.
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Affiliation(s)
- Bauer E. Sumpio
- Department of Vascular Surgery, Yale University School of Medicine, New Haven, CT 06510, USA
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Bastos R, Noronha C, Andrade M, Fraga ZB. The anterolateral thigh pedicled perforator flap for closure of a groin defect with lymphorrhea following vascular surgery in a peripheral vascular disease patient—case report. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-011-0596-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Impellizzeri P, Dardik H, Shah HJ, Brotman-O'Neil A, Ibrahim IM. Vacuum-assisted closure therapy with omental transposition for salvage of infected prosthetic femoral–distal bypass involving the femoral anastomosis. J Vasc Surg 2011; 54:1154-6. [DOI: 10.1016/j.jvs.2011.03.300] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 01/24/2011] [Accepted: 03/01/2011] [Indexed: 11/25/2022]
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Gabriel A, Shores J, Bernstein B, de Leon J, Kamepalli R, Wolvos T, Baharestani MM, Gupta S. A clinical review of infected wound treatment with Vacuum Assisted Closure (V.A.C.) therapy: experience and case series. Int Wound J 2011; 6 Suppl 2:1-25. [PMID: 19811550 DOI: 10.1111/j.1742-481x.2009.00628.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Over the last decade Vacuum Assisted Closure((R)) (KCI Licensing, Inc., San Antonio, TX) has been established as an effective wound care modality for managing complex acute and chronic wounds. The therapy has been widely adopted by many institutions to treat a variety of wound types. Increasingly, the therapy is being used to manage infected and critically colonized, difficult-to-treat wounds. This growing interest coupled with practitioner uncertainty in using the therapy in the presence of infection prompted the convening of an interprofessional expert advisory panel to determine appropriate use of the different modalities of negative pressure wound therapy (NPWT) as delivered by V.A.C.((R)) Therapy and V.A.C. Instill((R)) with either GranuFoam() or GranuFoam Silver() Dressings. The panel reviewed infected wound treatment methods within the context of evidence-based medicine coupled with experiential insight using V.A.C.((R)) Therapy Systems to manage a variety of infected wounds. The primary objectives of the panel were 1) to exchange state-of-practice evidence, 2) to review and evaluate the strength of existing data, and 3) to develop practice recommendations based on published evidence and clinical experience regarding use of the V.A.C.((R)) Therapy Systems in infected wounds. These recommendations are meant to identify which infected wounds will benefit from the most appropriate V.A.C.((R)) Therapy System modality and provide an infected wound treatment algorithm that may lead to a better understanding of optimal treatment strategies.
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Affiliation(s)
- Allen Gabriel
- The Department of Plastic Surgery, Loma Linda University School of Medicine, Loma Linda, CA
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Current World Literature. Curr Opin Support Palliat Care 2009; 3:305-12. [DOI: 10.1097/spc.0b013e3283339c93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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