Hippokratia 1998, 2(3):99-109

Th. Gerasimides

Abstract
Infection of the incision and graft after vascular surgery for the restoration of the blood supply to the legs is a very serious local complication that may endanger the leg or even patient's life if it reaches the anastomoses. The infection is usually introduced into the body during the operation; most often occurs in the groin and involves inflammation of the lymph nodes and vessels. The incidence of deep infection of the incision varies between 0,6 and 2.0% of vascular surgery cases. This can be reduced below 1.0% with a preventive antibiotic regimen, but above all by strict adherence to the principles of asepsis and antisepsis in the operating theatre. When the suppuration involves the lower limbs (groin, thigh, lower leg), the clinical picture presents the classic signs of inflammation. Total mortality is 10-30%, rising to 70% when the posterior peritoneal cavity is infected. The infection can be treated by opening up the incision, surgically cleaning it, locally applying antiseptics and administering antibiotics. Under certain conditions the graft can be retained in up to 60% of superficial infections, especially when it is autologous. Heterologous grafts (Dacron, PTFE) must be removed in 40-50% of cases due to serious bleeding or thrombosis of the graft. One possibility is the Zuhlke method of replacing the graft and covering it with a flap of muscle. The Erhrenfeld method involves replacement in the same position, using previously blocked arterial sections after retrograde endarterectomy, and is successful in 87% of an admittedly small number of cases. The preferred method in the case of graft infection is removal of the septic graft followed by an aseptic bypass using extra -anatomical grafts (axillo - femoral, sub -diaphragmal ascending aortic - femoral, femoral - femoral, obturator bypass, external knee bypass).In conclusion, it seems that infections of the incision and graft continue to occur, and that the small drop in the incidence of amputation and mortality in recent years can be further improved by a strict adherence to the principles of asepsis and antisepsis in the operating theatre, and with appropriate preventive chemotherapy.

Read PDF