Pedicled muscle flaps in the management of infected aortofemoral grafts. 1994

M N Gomes, and S L Spear
Department of Surgery, Georgetown University Medical Center, Washington, DC 20007.

Graft infection, although uncommon, is a serious complication of reconstructive vascular surgery, associated with a high mortality and limb loss in a large percentage of the survivors. Although débridement and drainage, specific systemic antibiotics, removal of the entire infected graft and revascularization by extra-anatomic bypass are the general principles of management, this technique has its limitations and in certain circumstances is not feasible. The use of well-vascularized autogenous tissue as coverage of infected grafts has been successful in the lower extremities, with graft and limb salvage, but not when the infection extends above the inguinal ligament. Instances where the infection at the inguinal area extends retrograde along the limb of the aortofemoral graft represent a greater therapeutic challenge. In two instances, a dual muscle flap was used successfully to cover the exposed prosthesis after complete débridement of the perigraft granulation tissue. Sartorius and rectus femoris muscles, with their blood supply, were mobilized and rotated to cover the distal anastomosis and the retroperitoneally exposed graft respectively, with primary wound closure. All flaps survived and the patent grafts were salvaged. There was no long-term functional deficit from the transposition of these muscles. Pedicled muscle flaps appear to be a well-tolerated method of achieving autogenous tissue coverage of an infected graft in the groin, and retroperitoneal portions and should be considered a satisfactory alternative when the traditional methods of management cannot be applied.

UI MeSH Term Description Entries
D007239 Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Infection,Infection and Infestation,Infections and Infestations,Infestation and Infection,Infestations and Infections
D008722 Methods A series of steps taken in order to conduct research. Techniques,Methodological Studies,Methodological Study,Procedures,Studies, Methodological,Study, Methodological,Method,Procedure,Technique
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D001807 Blood Vessel Prosthesis Device constructed of either synthetic or biological material that is used for the repair of injured or diseased blood vessels. Vascular Prosthesis,Blood Vessel Prostheses,Tissue-Engineered Vascular Graft,Graft, Tissue-Engineered Vascular,Grafts, Tissue-Engineered Vascular,Prostheses, Blood Vessel,Prostheses, Vascular,Prosthesis, Blood Vessel,Prosthesis, Vascular,Tissue Engineered Vascular Graft,Tissue-Engineered Vascular Grafts,Vascular Graft, Tissue-Engineered,Vascular Grafts, Tissue-Engineered,Vascular Prostheses,Vessel Prostheses, Blood,Vessel Prosthesis, Blood
D003646 Debridement The removal of foreign material and devitalized or contaminated tissue from or adjacent to a traumatic or infected lesion until surrounding healthy tissue is exposed. (Dorland, 27th ed) Debridements
D005263 Femoral Artery The main artery of the thigh, a continuation of the external iliac artery. Common Femoral Artery,Arteries, Common Femoral,Arteries, Femoral,Artery, Common Femoral,Artery, Femoral,Common Femoral Arteries,Femoral Arteries,Femoral Arteries, Common,Femoral Artery, Common
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001012 Aorta, Abdominal The aorta from the DIAPHRAGM to the bifurcation into the right and left common iliac arteries. Abdominal Aorta,Abdominal Aortas,Aortas, Abdominal
D013524 Surgical Flaps Tongues of skin and subcutaneous tissue, sometimes including muscle, cut away from the underlying parts but often still attached at one end. They retain their own microvasculature which is also transferred to the new site. They are often used in plastic surgery for filling a defect in a neighboring region. Island Flap,Island Flaps,Flap, Surgical,Flaps, Surgical,Pedicled Flap,Surgical Flap,Flap, Island,Flap, Pedicled,Flaps, Island,Flaps, Pedicled,Pedicled Flaps

Related Publications

M N Gomes, and S L Spear
January 2015, Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery,
M N Gomes, and S L Spear
March 1992, Journal of vascular surgery,
M N Gomes, and S L Spear
January 2003, Scandinavian journal of plastic and reconstructive surgery and hand surgery,
M N Gomes, and S L Spear
May 1994, The Annals of thoracic surgery,
M N Gomes, and S L Spear
October 1998, Wiener klinische Wochenschrift,
M N Gomes, and S L Spear
October 1972, Otolaryngologic clinics of North America,
M N Gomes, and S L Spear
January 1987, Revue de chirurgie orthopedique et reparatrice de l'appareil moteur,
M N Gomes, and S L Spear
March 1989, Journal of vascular surgery,
Copied contents to your clipboard!