NPWT-induced effective wound healing in the treatment of vascular graft infections

Vascular graft infections (VGI) bring high morbidity and mortality and can be challenging primarily due to life-threatening proffuse bleeding.

For PAD patients who have undergone vascular graft implantation (VGI), the lack of circulation, low nutritional status and in some cases thick adipose tissues can often lead to surgery site infections (SSI). In cases of SSI-based exposed grafts neither wound management is feasible nor primarly wound closure.

Negative pressure wound therapy (NPWT) could be a proper solution to induce effective wound healing by reducing edema surrounding the wound, stimulating circulation, increasing rate of granulation tissue formation, decreasing the size of wound, and keeping the wound closed until secondary wound closure.

Methods

In our clinical practice between May to December in 2018, 8 patients were treated with NPWT due to VGI-related SSI. Graft patency and perigraft infiltration was diagnosed by MINO wireless ultrasound system.

Etiopathology involved postpunction haematoma (1 case), femoral reconstruction with direct suture lines (1 case), femoroprofundal synthetic graft infection (1 case), femoropoliteal synthetic graft infection (2 cases), and femoro-crural GSV reconstruction (3 cases). After initial surgical wound debridement, VAC was applied using a two-layer combination with PVA and polyurethane sponges.

Continuous negative pressure was set on between 80-90 mmHg. All patients recieved systemic antibiotic therapy from 2 to 6 weeks postoperatively. Therapy was continued until the vascular graft was covered with granulation tissue and either wound size had reduced to secondary closure or could be covered by skin grafts.

Results

After NPWT removal in 5 cases, secondary wound closure became possible, in 2 cases open wound management was continued to 4 weeks and 1 patient required transpositional sking graft.All wounds healed. Application of NPWT was 9±6 days on average. During the initial observation period (3-6 months), no SSI or VGI reinfection occured.

Conclusion

As long as prosthetic grafts are used to treat PAD patients, and biological grafts are not the one and only solution for treatment, higher morbidity of VGI has to be expected, although NPWT-induced effective wound healing can be a strong weapon to avoid higher risk of adverse outcome.

Melinda Gadacsi
Theta Center, Pecs, Hungary, University of Pecs, Department of Vascular Surgery, Pecs, Hungary

Istvan Rozsos
Theta Center, Pecs, Hungary

Gergely Vadasz
Theta Center, Pecs, Hungary, University of Pecs, Department of Vascular Surgery, Pecs, Hungary