Successful Management of Prosthetic Graft Infection With Continuous Povidone-Iodine Irrigation

Kwaan, Jack H. M.

doi:10.1001/archsurg.1981.01380170188033

Cited by 89 publications

(17 citation statements)

References 4 publications

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“…In these series [25,26], the treatment consisted of sur gical dÃ©bridement and drainage followed by antibiotic or povidoneâ€"iodine irrigation and muscle flap coveragewith appropriate IV an tibiotic therapy. This approach has also been used to treat patients with extensive aortic graft infection with satisfactory results [1,26,27].…”

Section: Discussionmentioning

confidence: 99%

Aortic graft infection: the value of percutaneous drainage.

Bélair¹,

Soulez²,

Oliva³

et al. 1998

American Journal of Roentgenology

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treated by primary percutaneous drainage with patients who initially underwent surgery. MATERIALS AND METHODS. A retrospective reviewof 23 consecutive patientstreated for aortic graft infection was performed. Eleven patients were initially treated with per cutaneous drainage and 12 were treated with surgery. The morbidity, mortality, and postproce dural reintervention rates and clinical outcome were analyzed for each group.RESULTS.Theseptic process resolved in nine(82%)of 11patients treated withpercutane ous drainage. Of these nine patients, four were treated with percutaneous drainage alone. Drainage was followed by removal of the infected prosthetic graft in the remaining five pa tients. In the surgical group, sepsis resolved in only four patients (33%) (p = .036). No penpro cedural deaths occurred in the percutaneous drainage group, whereas six patients in the surgical group died in the penoperative period (p = .014). The purpose of our study was to compare the efficiencyof primary percutaneous drain age with classic surgical treatment of patients with aortic graft infections. CONCLUSION. Percutaneous drainage canbeusedasaninitialformof treatment in the Materials and MethodsOur study group included 23 consecutive pa tients (three women and 20 men) treated for in fected aortic grafts between January 1985 and January 1997 in our institution. To be included in thestudy, patients hadto fulfilltwospecific crite na: presence of a fluid collection surrounding the graft above the inguinal ligament shown on cross sectional imaging or during surgery and clinical evidence of a septic state (fever, WBC > 10,000/ mm3 [10 x l0@Ill,or discharge of pus at the in guinal incision). Patients presenting with local groin infection without evidence of a retroperito neal fluidcollection were excluded from the study.Patients were distributed in two groups on the basis of the initial treatment technique. The treat ment method was decided on a case-by-case basis by the referring physician without randomization and included a group composed of 11 patients mi tially treated with percutaneous drainage (age.65.9 Â± 9.32 years; I I men) and a second group of I2 patients initially treated with surgical interven tion (age, 68.75 Â± 9.68 years; 9 men; 3 women).In the percutaneous drainagegroup,nineof 11 patients received a multitherapeuticantibiotic regi men and two had a single drug prescribed.The dis tribution and types of antibiotics prescribed to patientsin the percutaneousdrainagegroup were as follows:ampicillin(n = I), cefazolin(n = I), cefo taxime (n = I), cefoxitine (n = I), cefuroxime (n = I), ciprofloxacin(n = 3), clindamycin(n = 2), cloxacil lin sodium (n = 2), ceftazidime (n = I), gentamicin (n = I), imipenem (n = 2), metronidazole (n = 5), netilmicin sulfate (n = 3), penicillin (n = I), piper

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Section: Discussionmentioning

confidence: 99%

Aortic graft infection: the value of percutaneous drainage.

Bélair¹,

Soulez²,

Oliva³

et al. 1998

American Journal of Roentgenology

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Section: Management Of Vgismentioning

confidence: 99%

“…Meticulous, often multiple débridements are necessary. 25,26,[57][58][59] Many authorities suggest adjunctive wound irrigation therapy with povidone iodine solution, which may also contain antibiotic drugs.25,26 Suction-irrigation catheters to bathe the exposed prosthetic material with antibiotic-containing solutions have been used in patients with large abscesses or gross purulence next to the graft or in patients with infections caused by a multidrug-resistant microorganism. Zetrenne et al 25,26 suggested serial quantitative bacterial cultures should be performed and that graft preservation should not be attempted until the colony count of the causative microorganism was <10 5 colony-forming units per gram of tissue.…”

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confidence: 99%

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Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

373

307

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The use of synthetic material for reconstructive vascular surgery was first reported during the early 1950s. Infection involving vascular graft prostheses is an infrequent but devastating complication of reconstructive vascular graft surgery and is associated with a high morbidity and, in some situations, mortality. Improvements in surgical techniques and graft design, including the use of native venous or arterial tissue, have reduced the frequency of infection and severity of complications from vascular graft infection (VGI). However, these advances have also led to more frequent vascular graft procedures occurring in a patient population with multiple underlying comorbidities that would have previously disqualified them as candidates for vascular reconstructive surgery. Underlying comorbidities, such as diabetes mellitus or immune compromise, increase the risk of infection and serious infection-related complications. The major complications of VGI include sepsis, amputation, disruption of infected anastomotic suture line with rupture or pseudoaneurysm formation, embolization of infected thrombi, reinfection of reconstructed vascular grafts, enteric fistulae to the small or large bowel, bacteremic spread of infection to other sites, and death. VGIs can be categorized broadly into those that occur in an extracavitary location, primarily in the groin or lower extremities, or in an intracavitary location, primarily within the abdomen or less commonly within the thorax. frequencyThe frequency of VGI depends on the anatomic location of the graft. The infection rate is 1.5% to 2% for most extracavitary grafts and as high as 6% with vascular grafts in the groin. [1][2][3][4][5][6][7][8][9] For intracavitary grafts, the infection rate is ≈1% to 5%. 1-6 Graft infection is most common after emergency procedures and after reoperation. [1][2][3][4]10 Aortic graft erosion or fistulous communication into the duodenum or other areas of the bowel reportedly occurs in 1% to 2% of patients after aortic reconstruction. 11,12 MicrobiologyThe microbiological cause of VGI has evolved over the years. 1 In early published studies, Staphylococcus aureus was the predominant microorganism recovered. 1,13 Improvements in surgical technique, administration of prophylactic antistaphylococcal antimicrobial therapy, and other factors have resulted in a changing microbiological epidemiology. Vascular graft surgery performed on patients with multiple underlying comorbidities and the increased frequency of emergency procedures have contributed to the changing spectrum of infection. Other factors such as changes in hospital flora, surgery in patients with complicated vascular anatomy, and multiple revisions of previous vascular surgery have resulted in a more diverse microbio- clInIcal stateMents anD GuIDelInes logical spectrum of infection, which includes multidrugresistant strains, polymicrobial infection, and Candida species. Gram-positive cocci accounts for at least two thirds of VGIs. 1,13 Infections caused by coagulase-negative staphylococ...

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“…Finally, contamination of miniature mammary implants with S epidermidis caused capsular contracture in experimental animals (10). Reduction of contracture was observed using intraoperative irrigation with 5% povidineiodine solution (16). Multiple publications (1,17) have recommended intravenous intraoperative antibiotics and pocket irrigation with Bacitracin, Betadine or both.…”

Section: Discussionmentioning

confidence: 99%

Absence of capsular contracture in 319 consecutive augmentation mammaplasties: Dependent drains as a possible factor

Fanous¹

2004

J Plast Surg

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N Fanous, I Salem, C Tawilé, AE Bassas. Absence of capsular contracture in 319 consecutive augmentation mammaplasties: Dependent drains as a possible factor. Can J Plast Surg 2004;12(4):193-197. Capsular contracture is one of the major complications of augmentation mammaplasty. A review of 638 augmented breasts in 319 consecutive patients who underwent primary augmentation, with an average follow-up of 17.2 months and without a single case of capsular contracture of any degree to date, is presented, along with a discussion of the surgical technique and complications, and an analysis of measures used to prevent capsular contraction. Each patient received a pair of smooth saline-filled implants (Mentor, USA) placed in the submuscular space through an inframammary incision. In all operated breasts, many of the known measures commonly used for capsular contracture prevention were implemented. As well, a dependent drain was used as the final hemostatic step to prevent blood accumulation in the pocket. Leaving a dependent drain in the dissected pocket overnight, as one of the sequence of measures aimed at eliminating blood accumulation, is believed to be a contributing factor in capsular contracture prevention.Key Words: Augmentation mammaplasty; Drains; Prevention of capsular contractionAbsence de contracture capsulaire dans 319 augmentations mammaires consécutives : Rôle possible des drains chirurgicaux La contracture capsulaire est l'une des importantes complications de l'augmentation mammaire. On présente ici une revue de 638 augmentations mammaires chez 319 patientes consécutives ayant subi une première augmentation, avec suivi moyen de 17,2 mois, sans un seul cas de contracture capsulaire quel qu'il soit à ce jour; la présentation s'accompagne d'une description de la technique chirurgicale, de ses complications et d'une analyse des mesures utilisées pour prévenir la contracture capsulaire. Chaque patiente a reçu une paire d'implants lisses de sérum physiologique (Mentor, U.S.A.), placés dans l'espace sous-musculaire au moyen d'une incision inframammaire. Dans tous les seins opérés, les mesures connues et couramment utilisées pour prévenir la contracture capsulaire ont été appliquées. De même, un drain chirurgical a été installé comme étape hémostatique finale pour prévenir l'accumulation de sang dans la poche. Parmi les mesures visant à éliminer l'accumulation de sang dans la poche disséquée, l'installation d'un drain chirurgical jusqu'au lendemain serait un facteur propice à la prévention de la contracture capsulaire. C apsular contracture is a particularly frustrating problem for everyone concerned with breast augmentation: the surgeon, the patient and the manufacturer. It is virtually the single major complication of prosthetic use, yet has stubbornly resisted solutions despite more than 25 years of persistent clinical and laboratory investigation (1,2).Because sound etiological evidence has been lacking, many different theories have been advanced to explain capsular contracture: blood accumulation in the...

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Successful Management of Prosthetic Graft Infection With Continuous Povidone-Iodine Irrigation

Cited by 89 publications

References 4 publications

Aortic graft infection: the value of percutaneous drainage.

Aortic graft infection: the value of percutaneous drainage.

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Absence of capsular contracture in 319 consecutive augmentation mammaplasties: Dependent drains as a possible factor

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