Haga Makoto, Inoue Hidenori, Shindo Shunya
Department of Cardiovascular Surgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.
Ann Med Surg (Lond). 2020 Oct 21;60:68-71. doi: 10.1016/j.amsu.2020.10.037. eCollection 2020 Dec.
Prosthetic graft infection (PGI) is associated with low patient survival rates. The effectiveness of ultrasound debridement in chronic wound healing has been previously reported; however, data on the use of ultrasound technology and its effect on the treatment of PGI are still lacking. We report a case in which PGI in the groin was managed by graft removal using ultrasound debridement.
A 70-year-old man was diagnosed with chronic limb-threatening ischemia and underwent a femoral-femoral bypass with a polytetrafluoroethylene graft. Eight months postoperatively, he developed an infection at the femoral incision site. Graft removal was performed using ultrasound debridement. The estimated blood loss was 10 mL. The wound healed, and the patient has remained in good health for 2 years postoperatively.
When the ultrasonic probe is applied to the wound, ultrasonic energy penetrates into the tissue, and a fibrinolytic action removes necrotic or infected tissue without removing healthy tissue, thereby minimizing bleeding. Using this technique, we were able to perform effective debridement at not only the wound but also the anastomosis.
It is our opinion that this technique can be used to achieve adequate debridement with little bleeding during graft removal and may provide a new option for the treatment of PGI.
人工血管移植物感染(PGI)与患者低生存率相关。超声清创在慢性伤口愈合中的有效性此前已有报道;然而,关于超声技术的应用及其对PGI治疗效果的数据仍然缺乏。我们报告一例腹股沟PGI通过超声清创去除移植物进行治疗的病例。
一名70岁男性被诊断为慢性肢体威胁性缺血,并接受了聚四氟乙烯移植物的股-股旁路手术。术后8个月,他在股部切口部位发生感染。采用超声清创进行移植物切除。估计失血量为10毫升。伤口愈合,患者术后2年一直保持健康。
当超声探头应用于伤口时,超声能量穿透组织,纤维蛋白溶解作用可去除坏死或感染组织,而不损伤健康组织,从而使出血最小化。使用该技术,我们不仅能够对伤口进行有效清创,还能对吻合口进行清创。
我们认为,该技术可用于在移植物切除过程中实现充分清创且出血少,并可能为PGI的治疗提供一种新选择。