Sandmann W, Gisbertz K H, Kovacicek S
Chirurg. 1976 Mar;47(3):130-9.
In a series of 581 reconstructions of the aorta to the leg arteries, 28 cases (4.8%) developed wound infection with positive microbiological identification. There were 24 monoinfections with significant prevalence of Staphylococcus aureus and S. epidermis. Thirteen patients with prosthetic implants and one patient with autologous saphenous vein bypass showed graft infection, which occurred in 13 patients as a complication of reoperation for bleeding or graft occlusion in the early postoperative period. The incidence of vascular infection in patients without reoperation was 0.4%. The risk of wound infection could not be lowered by the use of prophylactic broad spectrum antibiotics. Five (33%) patients with graft infection died because of sepsis and/or rupture of anastomosis. In the group of 9 survivors there were 3 patients with excision of the graft and limb preservation without reconstruction, and 3 patients with partial or total excision of the graft and successful simultaneous axillofemoral or obturator bypass. From this study it is assumed that improvement of indication and operative technique in reconstructive procedures is more promising in preventing wound infection than the extended administration of prophylactic antibiotic drugs. In case of vascular infection the excision of the graft is very urgent and consequent "extraanatomic" reconstruction can prevent loss of limb and life.
在对581例从主动脉到腿部动脉的重建手术中，28例（4.8%）发生了伤口感染且微生物鉴定呈阳性。有24例单一感染，其中金黄色葡萄球菌和表皮葡萄球菌感染率较高。13例使用人工血管植入物的患者和1例使用自体大隐静脉旁路移植的患者出现了移植物感染，其中13例是术后早期因出血或移植物闭塞再次手术的并发症。未进行再次手术的患者血管感染发生率为0.4%。使用预防性广谱抗生素并不能降低伤口感染的风险。5例（33%）移植物感染患者因败血症和/或吻合口破裂死亡。在9名幸存者中，有3例患者切除了移植物并保留肢体未进行重建，还有3例患者部分或全部切除了移植物并成功同时进行了腋股或闭孔旁路移植。从这项研究可以推断，在预防伤口感染方面，改善重建手术的适应证和手术技术比扩大预防性抗生素药物的使用更有前景。一旦发生血管感染，切除移植物非常紧急，随后进行“解剖外”重建可以防止肢体和生命丧失。
