An analysis of limb-threatening lower extremity wound complications after 1090 consecutive coronary artery bypass procedures

The objective of this study was to examine and characterize limb-threatenin g lower extremity wound or soft tissue complications after coronary artery bypass (CABG) and determine risk factors for their cause. While minor wound problems of the leg after CABG are not uncommon, serious limb-threatening complications, though less frequent, do occur and are often de-emphasized i n the surgical literature. A review of 1090 consecutive CABG procedures performed from January 1, 1995 through December 31, 1995 was instituted, which screened for limb-threaten ing lower extremity wound or soft tissue complications defined as wounds th at: required additional surgery for treatment; prolonged the length of stay ; or which required lengthy home health nursing for treatment. Minor lymph leaks, leg swelling, infections or wound problems treated as an outpatient were excluded. Of 1090 patients, 54 (5.0%) experienced a limb-threatening lower extremity complication. Complications were categorized as vein harvest incision non-h ealing (n = 36, 66.7%), decubitus ulceration (n = 11, 20.4%), forefoot isch emia/embolization (n = 10, 18.5%), groin hematoma/abscess (n = 6, 11.1%), s evere cellulitis (n = 3, 5.6%), or a combination (n = 12, 22.2%), Statistic ally significant risk factors by univariate and bivariate analysis for a co mplication included older age (68 years vs 62 years, p = 0.007), female sex (57% vs 28%, p < 0.001), diabetes (57% vs 33%, p = 0.005) and longer pump lime (129 min vs 114 min, p = 0.009), These complications necessitated five major lower extremity amputations and nine revascularization procedures. C hronic lower extremity ischemia from peripheral vascular disease (PVD) was a major contributing factor for the development of wounds in at least 23 (4 2.6%) of these patients, though suspected in only 10 (43.5%) preoperatively . A non-healing vein harvest incision below the knee of a patient retrospec tively found to have inadequate distal circulation for healing occurred in 17 (31.5%) of the total 54 cases. It was concluded that non-healing vein incisions, decubitus ulcers and fore foot ischemic lesions frequently occurring in older diabetic females with u ndetected pre-existing PVD, comprise the majority of limb-threatening leg c omplications after CABG. Nearly one-third of the complications may have bee n avoided had the vein harvest incision not been made at the ankle of a pat ient with unappreciated PVD.