Inferior pedicle rectus abdominis muscle flap for a contaminated prosthetic aortobifemoral bypass graft

Abstract

Infection of a prosthetic aortic graft carries devastating consequences, which typically requires aggressive surgical intervention in order to reduce mortality. The gold standard surgical technique for the treatment of abdominal aortic graft infections usually results in the excision of the infected graft and secondary revascularization, commonly with an axillary-bifemoral bypass. However following infection, surgeons’ may try to salvage a contaminated/infected graft with a pedicled muscle flap. This technique makes use of a muscle's mass for coverage of the infected graft and the vasculature to potentially increase delivery of antibiotics to the infection site. To our knowledge, there is only one case report describing the use of a rectus abdominis muscle flap, which was superiorly pedicled, for abdominal aortic graft coverage. Herein, we present a case of a successful inferiorly pedicled rectus abdominis muscle flap for the salvage of a contaminated aortobifemoral bypass graft in the setting of gross feculent contamination.