PMID: 11716277

Issn Print: 0148-7043

Publication Date: 2001/11/01


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Negative Pressure for the Management of an Exposed Vascular Dacron Polyester Patch

Uberto M. Giovannini; Roland G. Demaria; Paul-André Chaptal; Luc Téot

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Excerpt

Infected wounds with exposure of alloplastic materials are a challenge to the surgeon. The treatment of choice is a muscular flap to cover the exposed materials in association with the administration of systemic antibiotics. The poor general status of the patient may not allow such aggressive therapy. Less invasive approaches must then be considered. Thanks to the promising results obtained in different fields of surgery with negative-pressure therapy, this approach is becoming a valid alternative in the management of these wounds. 1–3 We extended the use of this technique to the treatment of a purulent surgical wound in the groin region with an exposed vascular Dacron patch.
A 66-year-old man with stenosis of the right common femoral artery underwent a surgical revascularization procedure under general anesthesia. This procedure consisted of endarterectomy and vascular enlargement with a polyester Dacron polyester patch. He had severe vasculopathy with bilateral carotid stenosis and calcified aortic retraction. He was moderately obese, chronically anemic, on hemodialysis for chronic renal insufficiency, and had midline herniation of a previous laparotomy incision.
Twenty days after surgery he presented with purulent wound dehiscence. The vascular patch was partly exposed. Aggressive surgical debridement and myoplasty was contraindicated because of the poor general condition and anticoagulant therapy. The wound needed to be drained and the vascular patch covered. Negative-pressure therapy was started using hydrocellular foam, a surgical drain, and an occlusive film dressing. Bacteriological cultures of the exudate revealed the presence of coagulase-negative Staphylococcus at 48 hours. Systemic antibiotic therapy was begun according to culture results. The dressing was changed every 2 days. Negative pressure was kept at −150 mmHg.
After 19 days of treatment, the vascular prosthesis was covered with granulation tissue, wound size had decreased substantially, and the patient’s condition was highly improved. The wound was then covered readily with a local fasciocutaneous flap. Nine days after surgery the wound was healed and the patient discharged. At 1 month, cutaneous healing was excellent and Doppler ultrasound showed patency of the reconstructed artery.
Negative pressure is reported to be useful in the treatment of severe wound infections. 4,5 It is possible to extend this technique to vascular surgery-infected wounds. 6 Subatmospheric suction did not impair arterial flow, promoted granulation even over alloplastic material, and amplified the absorption power of the hydrocellular foam. There was no damage to the surrounding skin, and a local rotational flap was performed successfully.
This case demonstrates the efficacy of negative-suction hydrocellular foam in the treatment of severely infected wounds. Even in the presence of synthetic vascular material, negative pressure therapy can greatly simplify challenging wound-healing problems.
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