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Classification, Predisposing Factors, and Management

Joel A. Johnson, MD; Thomas H. Cogbill, MD; Pamela J. Strutt, RN; Adolf L. Gundersen, MD

Arch Surg. 1988;123(7):859-862.

Abstract
• We studied 135 patients during a three-year period to determine the incidence and treatment of wound complications after infrainguinal bypass. The site of distal anastomosis was the popliteal artery in 113 patients, tibial artery in 20 patients, and sequential bypass in two patients. Autogenous vein was used for 79 grafts (59%), polytetrafluoroethylene for 53 grafts (39%), and a composite for three grafts (2%). Perioperative antibiotics were administered to 130 patients (96%). Wound complications were separated into four categories: class 1, erythema or seroma without tissue breakdown; class 2, ischemic necrosis along an incision without infection; class 3, wound breakdown with infection; and class 4, open wound with exposed graft. Ninety incisions (67%) healed without incident. There were 21 class 1 (15%), 17 class 2 (13%), four class 3 (3%), and three class 4 (2%) complications. Serious wound problems were more frequent after bypasses with polytetrafluoroethylene grafts compared with vein grafts. Three prosthetic graft infections resulted in two amputations. Eight other factors were not predictive of wound breakdown. Wound complications after infrainguinal bypass are frequent. Management should be selective, based on the degree of severity.

(Arch Surg 1988;123:859-862)

Author Affiliations
From the Department of General and Vascular Surgery, Gundersen/Lutheran Medical Center, La Crosse, Wis.

Footnotes
Accepted for publication Feb 25, 1988.

Read before the 95th Annual Meeting of the Western Surgical Association, Dallas, Nov 18, 1987.

Reprint requests to Department of Surgery, Gundersen Clinic Ltd, 1836 South Ave, La Crosse, WI 54601 (Dr Cogbill).

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