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Omental Free Flap Coverage for Extracavitary Vascular Bypass Graft Salvage
BACKGROUND: Prosthetic vascular graft infection is a serious complication associated with significant morbidity and mortality often requiring graft excision and numerous additional operations. Pedicled flaps are often used for the coverage of exposed deep tissue or hardware for graft salvage. In the...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245108/ https://www.ncbi.nlm.nih.gov/pubmed/34235036 http://dx.doi.org/10.1097/GOX.0000000000003646 |
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author | Robinson, Jordan N. Marturano, Matthew N. Calarese, Adam Briggs, Charles Madjarov, Jeko Fisher, David C. Kulkarni, Snehankita G. |
author_facet | Robinson, Jordan N. Marturano, Matthew N. Calarese, Adam Briggs, Charles Madjarov, Jeko Fisher, David C. Kulkarni, Snehankita G. |
author_sort | Robinson, Jordan N. |
collection | PubMed |
description | BACKGROUND: Prosthetic vascular graft infection is a serious complication associated with significant morbidity and mortality often requiring graft excision and numerous additional operations. Pedicled flaps are often used for the coverage of exposed deep tissue or hardware for graft salvage. In the absence of pedicled options, the properties of omentum make it an excellent choice for free flap tissue coverage, particularly in cases involving implanted prostheses. METHODS: A 63-year-old woman developed a mycotic right subclavian arterial aneurysm requiring ligation and extra-anatomic bypass grafting to restore right-sided intracranial and right upper extremity arterial perfusion. Subsequent wound breakdown and poor healing left the grafts exposed, resulting in contamination. Given the profound risks associated with graft excision in this patient, salvage was attempted with IV antibiotics, serial wound/graft washouts, and graft coverage with an omental free flap. RESULTS: The patient tolerated the procedure well. The remainder of her hospital course was uneventful, and she was discharged home in good clinical condition. She will remain on long-term suppressive antibiotics per Infectious Disease recommendations. CONCLUSIONS: Contemporary literature reporting novel and effective applications of omental free flap coverage is rare. This report demonstrates that omental free flap coverage is safe and can provide healthy tissue to protect implanted grafts and even aid in the salvage of infected extra-anatomic bypass grafts. |
format | Online Article Text |
id | pubmed-8245108 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-82451082021-07-06 Omental Free Flap Coverage for Extracavitary Vascular Bypass Graft Salvage Robinson, Jordan N. Marturano, Matthew N. Calarese, Adam Briggs, Charles Madjarov, Jeko Fisher, David C. Kulkarni, Snehankita G. Plast Reconstr Surg Glob Open Reconstructive BACKGROUND: Prosthetic vascular graft infection is a serious complication associated with significant morbidity and mortality often requiring graft excision and numerous additional operations. Pedicled flaps are often used for the coverage of exposed deep tissue or hardware for graft salvage. In the absence of pedicled options, the properties of omentum make it an excellent choice for free flap tissue coverage, particularly in cases involving implanted prostheses. METHODS: A 63-year-old woman developed a mycotic right subclavian arterial aneurysm requiring ligation and extra-anatomic bypass grafting to restore right-sided intracranial and right upper extremity arterial perfusion. Subsequent wound breakdown and poor healing left the grafts exposed, resulting in contamination. Given the profound risks associated with graft excision in this patient, salvage was attempted with IV antibiotics, serial wound/graft washouts, and graft coverage with an omental free flap. RESULTS: The patient tolerated the procedure well. The remainder of her hospital course was uneventful, and she was discharged home in good clinical condition. She will remain on long-term suppressive antibiotics per Infectious Disease recommendations. CONCLUSIONS: Contemporary literature reporting novel and effective applications of omental free flap coverage is rare. This report demonstrates that omental free flap coverage is safe and can provide healthy tissue to protect implanted grafts and even aid in the salvage of infected extra-anatomic bypass grafts. Lippincott Williams & Wilkins 2021-06-29 /pmc/articles/PMC8245108/ /pubmed/34235036 http://dx.doi.org/10.1097/GOX.0000000000003646 Text en Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Reconstructive Robinson, Jordan N. Marturano, Matthew N. Calarese, Adam Briggs, Charles Madjarov, Jeko Fisher, David C. Kulkarni, Snehankita G. Omental Free Flap Coverage for Extracavitary Vascular Bypass Graft Salvage |
title | Omental Free Flap Coverage for Extracavitary Vascular Bypass Graft Salvage |
title_full | Omental Free Flap Coverage for Extracavitary Vascular Bypass Graft Salvage |
title_fullStr | Omental Free Flap Coverage for Extracavitary Vascular Bypass Graft Salvage |
title_full_unstemmed | Omental Free Flap Coverage for Extracavitary Vascular Bypass Graft Salvage |
title_short | Omental Free Flap Coverage for Extracavitary Vascular Bypass Graft Salvage |
title_sort | omental free flap coverage for extracavitary vascular bypass graft salvage |
topic | Reconstructive |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245108/ https://www.ncbi.nlm.nih.gov/pubmed/34235036 http://dx.doi.org/10.1097/GOX.0000000000003646 |
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