Taylor S M, Weatherford D A, Langan E M, Lokey J S
Department of Surgical Education, Greenville Hospital System, SC 29605, USA.
Ann Vasc Surg. 1996 Mar;10(2):117-22. doi: 10.1007/BF02000754.
The management of vascular prosthetic graft infections confined to the groin continues to be controversial. To critically evaluate this problem, we reviewed the records of our vascular registry from December 1992 through February 1995 and found 17 incidences of groin sepsis involving a vascular prosthesis in 10 patients. These included a proximal prosthetic femoropopliteal bypass (n = 6), an aortobifemoral graft limb (n = 5), an ileofemoral bypass (n = 3), a prosthetic femoral patch (n = 2), and an aortofemoral/femorofemoral bypass (n = 1). The mean age of these patients was 65 years. Six patients were diabetic, four were on systemic steroids, and two were diabetic and on steroids. All infections were Szilagyi grade III including three in which the patients presented with local hemorrhage. Treatment consisted of irrigation, radical debridement with or without in situ graft replacement, and local rotational muscle flap coverage in nine cases, graft excision with extra-anatomic (obturator ileofemoral bypass) graft replacement in six cases, and excision alone in two cases. Of the 17 infections treated operatively and followed from 1 week to 18 months (median 5 months), eight (47%) showed no evidence of recurrence, six (35%) recurred, two (12%) caused early death, and one resulted in a thrombosed graft requiring extra-anatomic reconstruction. Of the nine infected grafted treated locally with muscle flaps, six showed recurrent infection from 3 weeks to 15 months and one thrombosed for a total local treatment failure rate of 78%. Only two grafts are free of infection at 4 and 5 months, respectively. Of the six incidences of infection treated with obturator bypass, four (66%) are free of infection and two resulted in patient death; both infections treated with excision alone were eradicated but resulted in a major lower extremity amputation. These data question the growing acceptance of debridement and local muscle flap coverage for the treatment of all prosthetic vascular graft infections confined to the groin, especially in patients who are diabetic or on systemic steroids.
局限于腹股沟的血管人工血管移植物感染的处理仍然存在争议。为了严格评估这个问题，我们回顾了1992年12月至1995年2月我们血管登记处的记录，发现10例患者中有17例发生了涉及血管假体的腹股沟脓毒症。其中包括近端人工股腘动脉旁路移植术（n = 6）、主动脉双股动脉移植肢体（n = 5）、髂股动脉旁路移植术（n = 3）、人工股动脉补片（n = 2）以及主动脉股动脉/股股动脉旁路移植术（n = 1）。这些患者的平均年龄为65岁。6例患者患有糖尿病，4例使用全身类固醇，2例既患有糖尿病又使用类固醇。所有感染均为西拉吉III级，其中3例患者出现局部出血。治疗包括冲洗、有或无原位移植物置换的根治性清创，9例采用局部旋转肌瓣覆盖，6例采用人工血管切除并进行解剖外（闭孔髂股动脉旁路）移植物置换，2例仅行切除。在接受手术治疗并随访1周至18个月（中位时间5个月）的17例感染中，8例（47%）无复发迹象，6例（35%）复发，2例（12%）导致早期死亡，1例导致移植物血栓形成，需要进行解剖外重建。在9例接受局部肌瓣治疗的感染移植物中，6例在3周内至15个月出现复发性感染，1例血栓形成，局部治疗总失败率为78%。分别只有2例移植物在4个月和5个月时未发生感染。在6例采用闭孔旁路治疗的感染病例中，4例（66%）未发生感染，2例导致患者死亡；仅行切除治疗的2例感染均得到根除，但导致了下肢大截肢。这些数据对越来越多地接受清创和局部肌瓣覆盖治疗所有局限于腹股沟的人工血管移植物感染提出了质疑，尤其是在糖尿病患者或使用全身类固醇的患者中。
