MANAGEMENT OF GROIN ABSCESS AND ITS COMPL ICATIONS IN INTRAVENOUS DRUG-ABUSERS

From 1994 to March 1997, 12 patients with 15 drug-related abscesses of the groin were treated at the Surgical Department of Lubeck Medical U niversity. Besides laboratory, serological and microbiological examina tions, the standard diagnostic investigation consisted of sonography o r duplex sonography. If indicated, the diagnosis was extended to inclu de, for example, clarification of the retroperitoneum by CT. The most common accompanying disease was deep femoral vein thrombosis. Substitu tion was planned individually. After surgical debridement and perioper ative administration of a beta-lactam-protected acylaminopenicillin, o pen wound treatment was successfully carried out in 13 cases; secondar y closure was performed four times in cases of good compliance. One ab scess led to necrotising of the femoral artery; saphenous vein was int erposed because of erosion bleeding and formation of aneurysm. In a se cond case, the bifurcation was reconstructed with saphenous vein after external resection of an infected false aneurysm and early occlusion. Both defects were covered by rotation of sartorius muscle and mesh gr aft. On the basis of the treatment concept, a rapid and successful int ervention was possible; complications such as sepsis, amputation or wi thdrawal delirium did not occur. Resistance against the antibiotic was not observed. In the case of infected aneurysm, we prefer the autogen ous saphenous vein graft followed by rotation of sartorius muscle and mesh graft. Ligation or excision leads to high rates of claudication o r amputation; extended reconstructions are threatened by insufficient compliance of the patients; the use of synthetic grafts is endangered by further bacteraemia or infections.