Wound Complications After Infrainguinal Bypass

Johnson, Joel A.

doi:10.1001/archsurg.1988.01400310073012

Cited by 77 publications

(6 citation statements)

References 21 publications

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“…It has been reported that wound complications of the groin following vascular surgery range from 10-41%. [1][2][3][4][5][6][7] Of these, incisional breakdown is particularly troublesome. The groin is a moist, often contaminated, environment with shearing forces, making incisions difficult to manage and prone to breakdown.…”

Section: Introductionmentioning

confidence: 99%

Prophylactic Muscle Flaps in Primary Vascular Procedures of the Groin

Wallace

Piper

Holland

et al. 2022

Annals of Vascular Surgery

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Background: Complications following vascular procedures involving the groin can lead to significant morbidity. Achieving stable soft tissue coverage over sites of revascularization can help mitigate complications. Prior evidence supports the use of muscle flaps in reoperative groins and in high risk patient populations to reduce postoperative complications. Data regarding the use of prophylactic muscle flap coverage of the groin is lacking. Therefore, the purpose of this study is to evaluate the effect of immediate prophylactic muscle flap coverage of vascular wounds involving the groin. Methods: A retrospective cohort study was performed on all patients undergoing primary open vascular procedures involving the groin for occlusive, aneurysmal, or oncologic disease between 2014 and 2020 at a single institution where plastic surgery was involved in closure. Patient demographics, comorbidities, surgical details, and postoperative complications were compared between patients who had sartorius muscle flap coverage of the vascular repair versus layered closure alone. Results: A total of 133 consecutive groins were included in our analysis. A sartorius flap was used in 115 groins (86.5%) and a layered closure was used in 18 (13.5%). Wound breakdown was similar between groups (25.2% sartorius vs. 38.9% layered closure, P = 0.26). However, the rate of reoperation was significantly higher in the layered closure group (50.0% vs. 12.2%, P < 0.01). Among patients who experienced wound breakdown ( N = 36), a larger proportion of layered closure patients required operative intervention (71.4% vs. 20.7%, P = 0.02). Other rates of complications were not statistically different between groups. Conclusions: In patients undergoing primary open vascular procedures involving the groin, patients who underwent prophylactic sartorius muscle flap closure had lower rates of reoperation. Although incisional breakdown was similar between the groups overall, the presence of a vascularized muscle flap overlying the vascular repair was associated with reduced need for reoperation and allowed more wounds to be managed with local wound care alone. Consideration should be given to this low morbidity local muscle flap in patients undergoing vascular procedures involving the groin.

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Section: Introductionmentioning

confidence: 99%

Prophylactic Muscle Flaps in Primary Vascular Procedures of the Groin

Wallace

Piper

Holland

et al. 2022

Annals of Vascular Surgery

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“…Furthermore, several of these studies examined only subsets of lower extremity bypass patients undergoing specific approaches, and reported 30-day SSI risk factors including critical limb ischemia, prior bypass operation, use of non-autogenous grafts, the in situ autogenous technique and location of distal bypass target (anterior tibial or dorsalis pedis arteries). 3,5,6,11,12 This may reflect a difference due to the inclusion of different technical approaches aside from the in-situ approach in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Evidence-Based Bundled Quality Improvement Intervention for Reducing Surgical Site Infection in Lower Extremity Vascular Bypass Procedures

Hekman

Michel

Blay

et al. 2019

Journal of the American College of Surgeons

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Background: Surgical site infection (SSI) poses a significant burden to patients and healthcare resources. Vascular Quality Initiative (VQI) data identify a higher rate of SSI for lower extremity bypass surgery than other vascular procedures. Bundled interventions have successfully reduced SSI in other surgical procedures. Study Design: We evaluated our institution-specific VQI data for modifiable risk factors associated with index hospitalization SSI from January 2012 through October 2015. We implemented an evidence-based lower extremity bypass surgery SSI reduction bundle (perioperative chlorhexidine showers and transverse groin incisions) and prospectively enrolled all patients who had lower extremity bypass procedures, with a target adherence rate of 50% per bundle component. Bundle adherence and SSI events were measured from March 2016 through August 2017. We carried out a pre-post evaluation of bundle effectiveness in reducing index hospitalization SSI. Results: In the pre-intervention period, 43/234 patients (18%) had SSI events. The only risk factors associated with SSI (female sex, diabetes, overweight body mass index) were not readily modifiable. In an 18-month period after introduction of our intervention, adherence rates to pre-operative chlorhexidine showers, a transverse incision and a post-operative chlorhexidine shower were 71% (52/73), 48% (24/50) and 88% (64/73), respectively. Compliance with all applicable bundle components was 36% (26/73). The SSI rate post-intervention decreased from 18% to 4% (3/73). Intention-to-treat multivariable analysis showed a 97% SSI risk reduction with the bundle (p=0.002). As-treated analysis identified an 85% (p=0.02) and 62% (p=0.047) SSI risk reduction from the pre-operative and post-operative chlorhexidine showers, respectively. Conclusion: In this evaluation study of the effectiveness of a quality improvement intervention, SSIs were markedly decreased after implementation of our evidence-based bundle for lower extremity vascular bypass procedures.

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“…Numerous studies have revealed a poor patency rate with use of synthetic material in reconstructive femorocrural vascular surgery, especially in cases of multiple occlusions of the tibioperoneal vessels [7,12,14,28]. Also, the compatibility of synthetic materials in the composite technique has very often been investigated [8,17,25,27].…”

Section: Discussionmentioning

confidence: 99%