Combined vascular reconstruction and adjunctive tissue transfer in the treatment of infected arterial prostheses and tissue defects.
One of the most serious complications in vascular surgery is infection of the vascular arterial prosthesis (VAP) which might lead to loss of limb or even death. Very often infected prostheses are combined with infectious infiltration of the adjacent tissues or even necrosis and their loss. This paper deals with the experience in the management of 5 patients suffering from infection of vascular arterial prostheses in various locations, for by-passing abdominal aorta and distal arteries with loss or necrosis of the skin and tissues adjacent to the graft. Removal of the infected graft was performed in all of the cases, together with wide debridement of the infested area and placement of a new graft, coursing far from the infected area for revascularization of the affected limb. The cleaned infected area was covered at a first or second stage by applying plastic procedures utilizing musculocutaneous tissue transfer. The results were quite satisfactory. We conclude that the management of infected vascular arterial prostheses, when these are combined with loss of adjacent tissues, is a challenge for the Vascular Surgeon. Their removal, extended cleaning and covering of the area by means of plastic procedures with tissue transfer, proved to be effective in the management of this problem.