The aim of the study was to evaluate the benefit of
vacuum-assisted closure (VAC)
therapy in the management of deep, alloplastic graft
infections (Szilagyi grade III) in the groin. From 2000 to 2009, we identified and included in our study 72 deep inguinal
infections in 68 patients, involving native as well as synthetic graft or patch material. There were 29 early graft
infections (<30 days after implantation) and 43 late
infections (≥30 days after implantation). Among these, 17 cases involved native grafts/patches (12 grafts and 5 patches), while 55 cases involved non-native grafts/patches [26 polytetrafluorethylene (
PTFE) grafts and 24
Dacron grafts (Haemashield, Meadox Medical, Boston Scientific Corporation, Natick, NY; Gelsoft graft, Vascutek, Inchinnan, Renfrewshire, Scotland, UK; Intervascular, Mahwah, NJ); INVISTA, and 5 Vascu-Guard(™) bovine pericardial patches; Synovis Surgical Innovation]. All patients were treated with
multiple wound debridements, graft salvage, sartorius myoplasty, intravenous
antibiotics and VAC
therapy until thorough surface healing was achieved. Exclusion criteria were an alloplastic graft
infection with proximal expansion above the inguinal ligament, blood culture positive for septicaemia or septic anastomotic herald or overt
bleeding. Nine months after initiation of
therapy, overall, graft/patch salvage was achieved in 61 of 72 (84·7%) cases. Of the native graft/patch group, infected graft material was replaced with an autogenous great saphenous vein graft or patch in four patients (23·5%). In the non-native group, vein or synthetic graft preservation without revision was achieved in 48 of 55 (87·3%) patients. The mean duration of VAC
therapy was 16 ± 7·7 days, and postoperative mean
hospital stay was 25·3 ± 8·5 days. In 23 of 72 (31·9%) cases, a secondary closure of the
wound was achieved; in the other 49 cases, wound healing was achieved by meshed split-thickness
skin grafting. Mean wound healing time for all
wounds was 24·3 ± 12·5 days. Specific complications during VAC
therapy were
wound fluid retention in 2 cases and an increased need for
analgesics in 12 cases (16·66%).
Negative pressure wound therapy (NPWT) has been reported to be useful in the treatment of severe
wound infections. Even in the presence of synthetic vascular graft material, NPWT can greatly simplify challenging wound-healing problems leading to
wound dehiscence and its sequelae. Our long-term experience demonstrates the safety and effectiveness of VAC
therapy in the management of deep graft
infections.