[Flap repair for vascular prosthesis exposure after artificial blood vessel bypass surgery for critical limb ischemia.]

Zhonghua wai ke za zhi [Chinese journal of surgery]

PubMedID: 24252678

Wu WW, Wu H, Zeng A, Bai M, Zeng R, Chen Y, Liu CW. [Flap repair for vascular prosthesis exposure after artificial blood vessel bypass surgery for critical limb ischemia.]. Zhonghua Wai Ke Za Zhi. 2013;51(8):715-718.
OBJECTIVE
To investigate the effectiveness of flap repair for vascular prosthesis exposure after the artificial blood vessel bypass surgery for critical limb ischemia.

METHODS
From August 2007 to December 2011, bypass surgery with vascular prosthetic grafts were performed in 192 patients with critical limb ischemia.Five patients among them (2.6%) suffered from vascular prosthesis exposure 6 to 13 days after the previous surgery, including 4 males and 1 female, with a median age of 68 years(arranged from 52 to 81 years). The surgical managements included surgical debridement and local flap or transferred muscle-cutaneous flap repair to preserve the prosthetic vascular grafts. Three patients underwent Z-plasty with local flap repair, while 2 patients underwent transferred rectus abdominis or rectus femoris muscle flap repair of the wounds.

RESULTS
After the surgery, prosthetic vascular graft was successfully preserved in 4 of the 5 cases with first intention healing. At a median follow-up of 38 months (arranged from 5 to 57 months), all the 4 limbs were salvaged with patent of the prosthetic grafts.One flap failed to heal and the prosthetic graft had to be removed due to infection and hemorrhage. An above-knee-amputation was performed due to severe limb ischemia.

CONCLUSIONS
The vascular prosthesis exposure is often a disaster after artificial blood vessel bypass surgery for critical limb ischemia.Local flap or transferred muscle-cutaneous flap repair is an effective surgical management to salvage the exposed graft and the affected limb.