Matić Predrag, Tanaskovic Slobodan, Živić Rastko, Jocić Dario, Gajin Predrag, Babić Srdjan, Soldatović Ivan, Vučurević Goran, Nenezić Dragoslav, Radak Djordje
Srp Arh Celok Lek. 2016 Nov-Dec;144(11-12):621-5.
Infection of synthetic graft in the groin is a rare but devastating complication. When it occurs, several possibilities of treatment are available. Extra-anatomic reconstruction and in-situ implantation of new, infection resistant grafts are associated with high mortality and morbidity. Therefore, more conservative approach is needed in some cases. Negative-pressure wound therapy is one of the options in treating such patients.
The aim of this study was to assess the outcome for deep groin vascular graft infection treated with negative-pressure wound therapy.
Seventeen patients (19 wounds), treated for Szilagyi grade III groin infections between October 2011 and June 2014, were enrolled into this observational study.
Majority of the wounds (11/19) were healed by secondary intention, and the rest of the wounds (8/19) were healed by primary intention after initial negative-pressure wound therapy and graft substitution with silver-coated prostheses or autologous artery/vein implantation. No early mortality was observed. Minor bleeding was observed in one patient. Reinfection was noted in three wounds. Only one graft occlusion was noted. Late mortality was observed in three patients.
Negative-pressure wound therapy seems to be safe for groin vascular graft infections and comfortable for both patient and surgeon. However, the rate of persistent infection is high. This technique, in our opinion, can be used as a “bridge” from initial wound debridement to definitive wound management, when good local conditions are achieved for graft substitution, either with new synthetic graft with antimicrobial properties or autologous artery/vein. In selected cases of deep groin infections it can be used as the only therapeutic approach in wound treatment.
腹股沟区人工血管感染是一种罕见但严重的并发症。一旦发生，有多种治疗手段可供选择。解剖外重建以及原位植入新型抗感染人工血管与高死亡率和高发病率相关。因此，在某些情况下需要采取更保守的方法。负压伤口治疗是治疗此类患者的选择之一。
本研究旨在评估负压伤口治疗深部腹股沟血管移植感染的效果。
选取2011年10月至2014年6月间接受治疗的17例（19处伤口）Szilagyi III级腹股沟感染患者纳入本观察性研究。
大多数伤口（11/19）通过二期愈合，其余伤口（8/19）在初始负压伤口治疗以及用银涂层假体或自体动静脉替代人工血管后一期愈合。未观察到早期死亡病例。1例患者出现少量出血。3处伤口出现再次感染。仅发现1例人工血管闭塞。3例患者出现晚期死亡。
负压伤口治疗对于腹股沟血管移植感染似乎是安全的，对患者和外科医生来说都较为便利。然而，持续感染率较高。我们认为，当具备良好的局部条件以便用具有抗菌性能的新型人工血管或自体动静脉替代人工血管时，该技术可作为从初始伤口清创到最终伤口处理的“桥梁”。在部分深部腹股沟感染的特定病例中，它可作为伤口治疗的唯一方法。
