DISTAL WOUND COMPLICATIONS FOLLOWING PEDAL BYPASS - ANALYSIS OF RISK-FACTORS

Wound complications of the pedal incision continue to compromise succe ssful limb salvage following aggressive revascularization. Significant distal wound disruption occurred in 14 of 142 (9.8%) patients undergo ing pedal bypass with autogenous vein for limb salvage between 1986 an d 1993. One hundred forty-two pedal bypass procedures were performed f or rest pain in 66 patients and tissue necrosis in 76. Among the 86 me n and 56 women, 76% were diabetic and 73% were black. All but eight pa tients had a history of diabetes and/or tobacco use. Eight wounds were successfully managed with maintenance of patent grafts from 5 to 57 m onths. Exposure of a patent graft precipitated amputation in three pat ients, as did graft occlusion in an additional patient. One graft was salvaged by revision to the peroneal artery and one was covered by a l ocal bipedicled flap. Multiple regression analysis identified three fa ctors associated with wound complications at the pedal incision site: diabetes mellitus (p = 0.03), age >70 years (p = 0.03), and rest pain (p = 0.05). Ancillary techniques (''pie-crusting'') to reduce skin ten sion resulted in no distal wound problems among 15 patients considered to be at greatest risk for wound breakdown. Attention to technique of distal graft tunneling, a wound closure that reduces tension, and con trol of swelling by avoiding dependency on and use of gentle elastic c ompression assume crucial importance in minimizing pedal wound complic ations following pedal bypass.