Wound complications of autogenous subcutaneous infrainguinal arterial bypass surgery: Predisposing factors and management

Mark Wengrovitz, Robert Atnip, Robert R.M. Gifford, Marsha M. Neumyer, Daniel F. Heitjan, Brian L. Thiele

Research output: Contribution to journalArticle

109 Citations (Scopus)

Abstract

To identify factors predisposing to wound infection and necrosis complicating in situ or other subcutaneous autogenous lower extremity vein bypass procedures, we retrospectively analyzed all such cases performed in our hospital between July 1983 and July 1988. Among 163 subcutaneous autogenous bypass grafts, wound complications developed in 28 (17%). According to progressive depth of involvement as defined in the text, 10 patients had grade I complications, six had grade II, and 12 had grade III complications with threatened or actual graft exposure. Factors significantly associated with wound morbidity were female gender, chronic steroid therapy, in situ bypass grafting, use of continuous incision (all p ≤ 0.05, chi square); diabetes mellitus, ipsilateral limb ulcer, limb salvage indication (all p < 0.01); and bypass grafting to the dorsalis pedis artery (p < 0.02). A logistic regression analysis identified four factors (in situ bypass grafting, steroid therapy, ipsilateral ulcer, and dorsalis pedis bypass grafting) that predicted a cumulatively increasing risk of wound complications, and in whose absence wound complications were rare. Grade I and II complications responded to standard regimens of wound care and intravenous antibiotics without loss of any graft or limb. In spite of aggressive efforts to provide secondary soft tissue coverage, grade III complications led directly to four major amputations and one death. Measures to prevent these morbid sequelae must include preoperative control of infection in the ischemic foot and meticulous attention to operative technique.

Original languageEnglish (US)
Pages (from-to)156-163
Number of pages8
JournalJournal of Vascular Surgery
Volume11
Issue number1
DOIs
StatePublished - Jan 1 1990

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Causality
Wounds and Injuries
Transplants
Ulcer
Extremities
Steroids
Limb Salvage
Wound Infection
Infection Control
Amputation
Foot
Lower Extremity
Veins
Diabetes Mellitus
Necrosis
Arteries
Logistic Models
Regression Analysis
Anti-Bacterial Agents
Morbidity

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Wengrovitz, Mark ; Atnip, Robert ; Gifford, Robert R.M. ; Neumyer, Marsha M. ; Heitjan, Daniel F. ; Thiele, Brian L. / Wound complications of autogenous subcutaneous infrainguinal arterial bypass surgery : Predisposing factors and management. In: Journal of Vascular Surgery. 1990 ; Vol. 11, No. 1. pp. 156-163.
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abstract = "To identify factors predisposing to wound infection and necrosis complicating in situ or other subcutaneous autogenous lower extremity vein bypass procedures, we retrospectively analyzed all such cases performed in our hospital between July 1983 and July 1988. Among 163 subcutaneous autogenous bypass grafts, wound complications developed in 28 (17{\%}). According to progressive depth of involvement as defined in the text, 10 patients had grade I complications, six had grade II, and 12 had grade III complications with threatened or actual graft exposure. Factors significantly associated with wound morbidity were female gender, chronic steroid therapy, in situ bypass grafting, use of continuous incision (all p ≤ 0.05, chi square); diabetes mellitus, ipsilateral limb ulcer, limb salvage indication (all p < 0.01); and bypass grafting to the dorsalis pedis artery (p < 0.02). A logistic regression analysis identified four factors (in situ bypass grafting, steroid therapy, ipsilateral ulcer, and dorsalis pedis bypass grafting) that predicted a cumulatively increasing risk of wound complications, and in whose absence wound complications were rare. Grade I and II complications responded to standard regimens of wound care and intravenous antibiotics without loss of any graft or limb. In spite of aggressive efforts to provide secondary soft tissue coverage, grade III complications led directly to four major amputations and one death. Measures to prevent these morbid sequelae must include preoperative control of infection in the ischemic foot and meticulous attention to operative technique.",
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Wound complications of autogenous subcutaneous infrainguinal arterial bypass surgery : Predisposing factors and management. / Wengrovitz, Mark; Atnip, Robert; Gifford, Robert R.M.; Neumyer, Marsha M.; Heitjan, Daniel F.; Thiele, Brian L.

In: Journal of Vascular Surgery, Vol. 11, No. 1, 01.01.1990, p. 156-163.

Research output: Contribution to journalArticle

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AU - Atnip, Robert

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