Vacuum-assisted Closure Therapy Versus Alginate for Surgical Site Infection After Vascular Surgery (Szilagyi Grade III)

Abstract

Introduction: In vascular surgery, surgical site infection is the most common postoperative morbidity, occurring in 5-25% of vascular patients. The optimal management of surgical site infection with involved lower limb vascular grafts remains controversial. The aim of the study was to evaluate the benefit of vacuum-assisted closure (VAC) therapy in the management of deep surgical site infections (Szilagyi grade III). Methods: A retrospective 3-year review of patient with postoperative surgical site infection in lower limb with involved vascular grafts in our department between January 2014 and December 2016. All patients with deep infected wounds (Szilagyi grade III) were surgically revised and left open for secondary healing, antibiotics, then randomized to either VAC or alginate (Aquacel) therapy. Microorganism cultured, duration of VAC use, time to healing, additional interventions, and follow-up data (limb salvage, survival) were analyzed. Results: Thirty-nine patients (39 groins, mean age 66.37 years [range, 45-84 years]) presented with deep groin infections. In all cases early graft infections (< 30 days after implantation) was identified, involving native as well as synthetic graft. Two groups were comparable in patient and wound characteristics. 24 cases involved native grafts (autovein), while 15 cases involved nonnative grafts [12 polytetrafluorethylene (PTFE) grafts and 3 Dacron grafts]. Four treatment failures occurred in two groups (10,3%). One femur amputation was performed in VAC group, and three in alginate group as a consequence of the groin infection, none died in both groups. Patients were randomized to VAC (n=18) or alginate (n=17). In the non-native group, synthetic graft preservation without revision was achieved in 13 of 15 (86.6%) patients. The mean duration of VAC therapy was 15.2±5.7 days, and postoperative mean hospital stay was 23,5±1.1 days in VAC and 25,3±1.3 in alginate groups. In 23 of 35 (65.7%) cases, a secondary closure of the wound was achieved; in the other 10 cases, wound healing was achieved by meshed split-thickness skin grafting. Mean wound healing time for all wounds was 34,11±3,10 days in VAC group and 38,71±2,94 days in alginate group (>0,05). Six months after initiation of therapy, overall, graft salvage was achieved in 35 of 39 (89.7%) cases. Conclusion: VAC achieves faster healing than alginate therapy after wound debridement for deep perivascular wound infections in the groin after vascular surgery. Our long-term experience demonstrates the safety and effectiveness of VAC therapy in the management of deep surgical site infections. Disclosure: Nothing to disclose