Infection in a peripheral vascular prosthesis continues to be a seriou
s complication in arterial reconstructive surgery and threatens the pa
tient with loss of either limb or life. Infection rates at major cente
rs are now low, ranging from 1 to 6 percent; however, limb loss and mo
rtality rates for this complication range from 25 to 75 percent depend
ing on the location of the graft and the extent of the infection. The
use of muscle flaps in the management of acute wounds, infection-prone
wounds, exposed orthopedic hardware, and osteomyelitis is now commonp
lace. Transposed muscle has been shown to be well-vascularized tissue
that improves healing time and decreases local wound bacterial counts.
After considering the preceding facts, we used muscle flaps for cover
age of infected peripheral vascular prostheses in a highly select grou
p of patients. These patients were ''end of the line,'' and last-ditch
efforts were made to salvage life or limb. Twenty-four infected vascu
lar grafts in 20 patients have been analyzed. Ages ranged from 52 to 8
7 years. All patients had grade 3, stage I, II, or III peripheral graf
t infections, as previously defined by Szilagyi and modified by vonDon
gen. Aortofemoral reconstruction was the most common initial bypass pr
ocedure (14), followed by femoral popliteal (6), axillofemoral (2), il
iofemoral (1), and subclavian/subclavian bypass (1). Staphylococcus au
reus was the most common infecting organism. Muscles used for coverage
were the rectus femoris (13), the sartorius (9), the rectus abdominis
(1), and the pectoralis major (1). The graft material was composed of
Dacron in 16 instances and polytetrafluoroethylene in 8. The 24 graft
infections were treated by extensive debridement, muscle-flap transpo
sition, and closed-suction irrigation system with dilute povidone-iodi
ne. Sixteen (66.7 percent) were successful with a mean follow-up of 41
months. There were eight failures, and three patients required amputa
tion. Two patients died of septic and vascular complications secondary
to central aortic graft infection and/or necrotizing fasciitis of the
extremities. This procedure can be successful in patients with well-l
ocalized peripheral graft infections not extending to the aortoiliac s
ystem.