Skip to main content

Advertisement

Log in

Continuous Irrigation as a Therapeutic Option for Graft Infections of the Groin

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Wound infections following vascular procedures occur in 1–7 % of patients and can lead to severe problems including amputation and death. There are no established treatment options for this complication. The aim of our study was to introduce continuous irrigation as a new treatment technique.

Methods

We retrospectively evaluated patients who had undergone bypass surgery involving the groin and had been treated with continuous irrigation because of deep wound infections. The irrigation solution was saline in all cases. The patients were additionally treated with antibiotics. The end point of the study was either complete wound healing or complications such as recurrent infection, amputation, or death.

Results

Wound complications occurred in 65 (15.3 %) of 424 operations. Overall, 20 patients (4.7 %) developed a deep wound infection involving prosthetic graft material. They were treated with continuous irrigation. Complete wound healing was achieved in 13 cases (65.0 %). One patient died. No amputations were necessary.

Conclusions

Based on our results, constant irrigation may be a therapeutic option in patients with deep wound infections. The main advantages of continuous irrigation over other treatments are ongoing bacterial reduction despite primary wound closure and the ability to measure the remaining colonization by microbiologic examination of the irrigation fluid.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Darouiche R (2004) Treatment of infections associated with surgical implants. N Engl J Med 350:1422–1429

    Article  PubMed  CAS  Google Scholar 

  2. Herrera F, Kohanzadeh S, Nasseri Y et al (2009) Management of vascular graft infections with soft tissue flap coverage: improving limb salvage rates—a Veterans Affairs experience. Am Surg 75:877–881

    PubMed  Google Scholar 

  3. Hasse B, Husmann L, Zinkernagel A et al (2013) Vascular graft infections: review article. Swiss Med Wkly 143:w13754

    PubMed  Google Scholar 

  4. Williams I, Milling M, Shandall A (2003) Vascularised muscular flaps and arterial graft infection in the groin. Eur J Vasc Endovasc Surg 25:390–395

    Article  PubMed  CAS  Google Scholar 

  5. Bandyk D (2008) Vascular surgical site infection: risk factors and preventive measures. Semin Vasc Surg 21:119–123

    Article  PubMed  Google Scholar 

  6. Antonios V, Noel A, Steckelberg J et al (2006) Prosthetic vascular graft infection: a risk factor analysis using a case–control study. J Infect 53:49–55

    Article  PubMed  Google Scholar 

  7. Debus E (2012) Infektionen in der Gefäßchirurgie. Gefäßchirurgie 17:6–7

    Article  Google Scholar 

  8. Cherry K, Roland C, Pairolero P et al (1992) Infected femorodistal bypass: is graft removal mandatory? J Vasc Surg 5:295–303

    Article  Google Scholar 

  9. Szylagyi E, Smith R, Elliott J et al (1972) Infection in arterial reconstruction with synthetic grafts. Ann Surg 176:321–333

    Article  Google Scholar 

  10. Samson R, Veith F, Janko G (1988) A modified classification and approach to the management of infections involving peripheral arterial prosthetic grafts. J Vasc Surg 8:147–153

    Article  PubMed  CAS  Google Scholar 

  11. Rieger H, Schoop W (2004) Allgemeine Maßnahmen bei Eingriffen am Gefäßsystem. In: Heberer, van Dongen (eds) Gefäßchirurgie. Springer, New York

    Google Scholar 

  12. Kogel H (2001) Möglichkeiten des Gefässersatzes und Einsatz von Nahtmaterialien. In: Hepp H, Kogel H (eds) Gefäßchirurgie. Urban und Schwarzenberg, Jena

    Google Scholar 

  13. Kellersmann R, Assadian O, Zegelman M (2012) Infections of vascular prostheses: options for prophylaxis. Gefässchirurgie 17:12–22

    Article  Google Scholar 

  14. Mangram A, Horan T, Pearson M et al (1999) Guideline for prevention of surgical site infection. Infect Control Hosp Epidemiol 20:247–280

    Article  Google Scholar 

  15. Calligaro K, Veith F, Yuan J et al (2003) Intra-abdominal aortic graft infection: complete or partial graft preservation in patients at very high risk. J Vasc Surg 38:1199–1205

    Article  PubMed  Google Scholar 

  16. Swain T, Calligar K, Dougherty M (2004) Management of infected aortic prosthetic grafts. Vasc Endovasc Surg 38:75–82

    Article  Google Scholar 

  17. Saleem B, Meerwaldt R, Tielliu I et al (2010) Conservative treatment of vascular prosthetic graft infection is associated with high mortality. Am J Surg 200:47–52

    Article  PubMed  Google Scholar 

  18. Dosluoglu H, Loghmanee C, Lall P et al (2010) Management of early (<30 days) vascular groin infections using vacuum-assisted closure alone without muscle flap coverage in a consecutive patient series. J Vasc Surg 51:1160–1166

    Article  PubMed  Google Scholar 

  19. Mayer D, Hasse B, Koelliker J et al (2011) Long-term results of vascular graft and artery preserving treatment with negative pressure wound therapy in Szylagyi grade III infections justify a paradigm shift. Ann Surg 254:754–759

    Article  PubMed  Google Scholar 

  20. Svensson S, Monsen C, Kölbel T et al (2008) Predictors for outcome after vacuum assisted closure therapy of perivascular surgical site infections in the groin. Eur J Vasc Endovasc Surg 36:84–89

    Article  PubMed  CAS  Google Scholar 

  21. Taylor S, Weatherford D, Langan E et al (1996) Outcomes in the management of vascular prosthetic graft infections confined to the groin: a reappraisal. Ann Vasc Surg 10:117–122

    Article  PubMed  CAS  Google Scholar 

  22. Töpel I, Steinbauer M (2012) Biologische Sicherungsoperationen bei infektiösen Komplikationen in der Leiste. Gefässchirurgie 17:63–73

    Article  Google Scholar 

  23. Kotsis T, Lioupis C (2007) Use of vacuum assisted closure in vascular graft infection confined to the groin. Acta Chir Belg 107:37–44

    PubMed  CAS  Google Scholar 

  24. Karl T, Storck M (2012) Negative pressure wound therapy (NPWT). Gefässchirurgie 17:37–45

    Article  Google Scholar 

  25. Colwell A, Donaldson M, Belkin M et al (2004) Management of early groin vascular bypass graft infections with sartorius and rectus femoris flaps. Ann Plast Surg 52:49–53

    Article  PubMed  Google Scholar 

  26. Dosluoglu H, Schimpf D, Schultz R et al (2005) Preservation of infected and exposed vascular grafts using vacuum assisted closure without muscle flap coverage. J Vasc Surg 42:989–992

    Article  PubMed  Google Scholar 

  27. Domingos C, Schulte S, Horsch S (2007) Vacuum assisted wound closure in postoperative periprosthetic groin infections: a new gold standard? J Cardiovasc Surg (Torino) 48:477–483

    Google Scholar 

  28. Berger P, de Bie D, Moll F et al (2012) Negative wound therapy on exposed prosthetic vascular grafts in the groin. J Vasc Surg 56:714–720

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Florian Thermann.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Thermann, F., Wollert, U. Continuous Irrigation as a Therapeutic Option for Graft Infections of the Groin. World J Surg 38, 2589–2596 (2014). https://doi.org/10.1007/s00268-014-2650-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-014-2650-8

Keywords

Navigation