ROTATIONAL MUSCLE FLAPS TO TREAT LOCALIZED PROSTHETIC GRAFT INFECTION- LONG-TERM FOLLOW-UP

Purpose: The conventional management of prosthetic graft infection (PG I), including graft excision and extraanatomic revascularization, cont inues to be associated with substantial morbidity. Rotational muscle f lap (RMF) closure of the infected wound, with preservation of the graf t, is an alternative, albeit controversial, approach. Methods: Over th e last 7 years, 22 RMF procedures have been performed to close 19 woun ds in 18 patients, ranging in age from 39 to 79 (mean 63.7) years, wit h PGI. Twenty-one grafts constructed of Dacron (13) or polytetrafluoro ethylene (8) were covered in the groin (16), neck (2), or chest (1). T he clinical presentations included abscess or purulent drainage in 14 grafts, hemorrhage in three, and infected false aneurysm in two wounds ; positive bacterial culture results were obtained in each case. Resul ts: There was one (5.6%) operative death. Healing was achieved in the 18 wounds of the 17 operative survivors. No patients have been lost to follow-up. Three (17.6%) of these 17 patients had recurrent infection , including one patient who underwent a secondary RMF procedure with g raft salvage, one who underwent excision of an occluded graft, and one who underwent excision and extraanatomic bypass and died. Four other patients died 1 to 6 (mean 3) months after RMF closure with healed wou nds. Eleven (92%) of the 12 survivors have healed wounds and intact gr afts with follow-up ranging from 8 to 83 (mean 39) months. For the ent ire series 15 (88%) of these 17 patients had healed wounds and intact grafts, with a mean follow-up of 30 months. Conclusions: These results suggest that RMF procedures are well tolerated and can achieve accept able long-term graft salvage in selected patients with PGI.