Methods
We reviewed the case of a young adult male admitted to our department with an expanding right groin hematoma, emergent vascular reconstruction, and SSI and sepsis.
Results
The patient was admitted for a large hematoma of the right medial thigh with localized pain. Twelve hours after admission the patient became hypotensive, tachycardic and a vascular fistula developed over the area of the hematoma. Immediate surgery was performed and found a ruptured superficial femoral artery aneurism for which hemostasis and a proximal femoropopliteal bypass with a no. 8 PTFE were performed.
On postoperative day 9 the patient developed sepsis from an SSI. Source control was achieved with large skin and muscle debridement followed by covering the vascular prosthesis and the operative site with an omental pedicle obtained by laparotomy. NPWT was initiated over the omentum and the septic phenomena resolved in 48 hours. Granulation tissue started to develop over muscle tissue but was slow to form over the omental pedicle. Multiple skin grafts were necessary. Three years into follow-up the patient exhibits normal function of the right lower limb with slight edema.
Conclusion
The management of infected vascular prostheses remains challengeing. Management often leads to excision of the grafts and limb loss. The use of an omental pedicle combined with exudate management with NPWT led to excellent source control and to a resolution of sepsis.
Clinical relevance
The combined use of omental pedicles and NPWT can lead to salvage of infected synthetic prostheses after SSI of bypass graft procedures.
References
Acosta S, Björck M, Wanhainen A. Negative-pressure wound therapy for prevention and treatment of surgical-site infections after vascular surgery. Br J Surg. 2017 Jan;104(2):e75-e84.
