Heroic procedures in vascular injury management: the role of extra-anatomic bypasses

The insertion of an extra-anatomic bypass graft is an accepted operative technique in highly selected patients with atherosclerotic occlusive disease and contraindications to in situ grafting. In similar fashion, the technique should be considered in injured or septic patients with large soft tissue defects or wound infections overlying arterial repairs or involving native arteries. The combination of vigorous débridement of injured or infected soft tissue and insertion of an extra-anatomic bypass graft allows for appropriate care of the wound without concern for further injury to the now-displaced arterial repair.