Selective application of sartorius muscle flaps and aggressive staged surgical debridement can influence long-term outcomes of complex prosthetic graft infections

摘要: Background The complexity of variables associated with vascular surgical site infections (VSSI) often contribute adversely to reinfection, limb salvage, and mortality rates. This report details our experience the selective use a sartorius muscle flaps (SMF) as part an overall treatment strategy focused on staged debridement (SSD) control prosthetic graft bed infection prior preservation or revision plan. Methods From registry, we identified 422 VSSI which 89 (21%) had SMF for 24 aorto-bifemoral (ABF), 19 extra-anatomic bypasses (EAB), 34 infrainguinal bypasses, 12 combined inflow/outflow reconstructions. All 86 patients Szilagyi grade III (Dacron-36, polytetrafluoroethylene [PTFE]-50) infections. algorithm included: SSD, culture-directed parenteral antibiotics, (n = 3), reconstruction (graft excision/EAB, n 4; rifampin-bonded PTFE, 22; autologous conduit, 57) based microbiology consideration extensive soft tissue defects 43) nonsterilized beds 40). Analysis microbiology, recurrent infection, reconstruction, was completed over mean follow-up 52 months (range: 132 months). Results Thirty-day 2% two aortic dying from sepsis. Survival by life table analysis at 1, 3, 5 years 94%, 92%, 90%, respectively. Wound isolates were most commonly gram positive organisms 58, 65%), negative mixed accounting 19% 10%, A single groin documented 30 days. Freedom 6) 1 98% 92% tables. Methicillen-resistant Staphylococcus aureus (MRSA) involved 50% reinfections. No amputations attributable uncontrolled patency 100% in surveillance monitored patients. Conclusion These results suggest that utilization SSD plan attempt achieve sterilization can effectively complex infectious process allowing potentially improved outcomes situ salvage techniques. Lifelong is recommended.