Replacement of Infected Aortic Prosthetic Grafts with Vascularized Musculofascial Flaps

Abstract

Infected aortic prosthetic grafts are associated with a high rate of morbidity and mortality. In order to examine an alternative to extraanatomic bypass, a canine model of infected aortic Dacron grafts was used to evaluate a vascularized musculofascial pedicle flap fashioned into a cylinder for aortic reconstruction. The flap consists of rectus muscle, posterior rectus fascia and underlying peritoneum, based on the inferior epigastric artery. Infection was established by direct inoculation of the Dacron grafts after insertion, with 1 × 10⁸ CFU of Staphylococcus aureus. All dogs had swab, culture, and histologic proof of infection of the prosthetic Dacron grafts within 72 hours prior to construction of the flap. Three of the four dogs ecovered after flap insertion with normal activity and normal neurovascular status. Aortogram demonstrated patency of the flap with excellent arterial runoff in all dogs 24 days after construction. None of the flaps showed evidence of infection. One animal is now seven months after flap construction with no difficulties and is being maintained long-term for histological evaluation of the flap. A vascularized musculofascial pedicle flap can be successfully used for replacement of infected aortic tube grafts without the need for extraanatomic bypass.