Femoral Bölgedeki Prostetik Vasküler Greft Enfeksiyonlarının Gracilis Kas Flebleri ile Rekonstrüksiyonu

Amaç: Femoral bölgedeki prostetik vasküler greft (PVG) enfeksiyonlarındagracilis kas flebi kullanarak tedavi ettiğimiz hastalara ait erken ve orta dönemsonuçlarımızı sunmak.Materyal ve metot: Ocak 2012 ile Ağustos 2016 tarihleri arasında kliniğimizdefemoral bölgede PVG enfeksiyonu nedeniyle gracilis kas flebi kullanarak tedaviedilen 8 hasta çalışmaya alındı. PVG enfeksiyonu gelişen hastalarla ilgili bütündosya içerikleri incelenip kaydedildi. Tüm bu verilerin yanında rutinbiyokimyasal tetkikler, doppler ultrasonografi, bilgisayarlı tomografi, anjiografiyara yeri ve kan kültürü sonuçları da ayrıntılı olarak değerlendirildi.Bulgular:Çalışmamızda gracilis kas flebi kullanarak tedavi ettiğimiz 8 hastanın5’ i erkek 3’ ü bayan idi. Ortalama yaş 58±8,9 (39-67) yıl idi. Tüm hastalarda ciltatı dokular ile birlikte greft enfekte idi (Szilagyi III). Bunun yanında, prostetikgreft 2 hastada Dacron iken 6 hastada ise Polytetrafluoroethylene (PTFE) idi.Enfeksiyon 6 hastada erken dönemde oluşurken 2 hastada ise geç dönemdeoluştu. Greft enfeksiyonuna neden olan patojenler; staphylococcus aureus (3hasta), staphylococcus epidermidis (1 hasta) ve polimikrobiyal (4 hasta) idi. Birhastada greft oklüzyonu, bir diğer hastada ise cilt kesisinin distal tarafındayaklaşık 2 cm bir açılma oldu. Hiçbir hastada ekstremite kaybı veya mortaliteolmadı. En önemlisi, hastaların tamamında tam iyileşme sağlandı.Sonuç: PVG enfeksiyonlarında gracilis kas flebi rekonstriksiyonu, enfeksiyonamaruz kalan alanı örtmek ve prostetik greft materyalini kurtarmak için etkili veuygulanabilir bir alternatiftir.

Reconstruction of Prosthetic Vascular Graft Infections in the Femoral Region Using Gracilis Muscle flaps

Aim: To present early and midterm results of our patients treated using gracilis muscle flap for prosthetic vascular graft (PVG) infections located in the femoral region. Materials and Methods: Eight patients admitted to our clinic between January 2012 and August 2016 and treated using gracilis muscle flap owing to PVG infection in the femoral region were included in the present study. The contents of hospital files of the patients with PVG infection were thoroughly evaluated and recorded. Additionally, routine biochemical tests, Doppler ultrasonography, computed tomography; angiography wound site and blood culture results pertaining to the patients were also evaluated in detail. Results: In the present study, we treated 8 patients (5 males and 3 females) using gracilis muscle flap. Their average age was 58 ± 8.9 (39-67) years. All the patients suffered from the graft infections spreading to the subcutaneous tissues (Szilagyi grade III). While the prosthetic grafts used in 6 patients were Polytetrafluoroethylene (PTFE), they were Dacron in 2 patients. Moreover, 6 patients developed infections in the early period while 2 patients showed infections in the late period. The pathogens causing graft infections were identified to be staphylococcus aureus in 3 patients, staphylococcus epidermidis in 1 patient and polymicrobial agents in 4 patients. Furthermore, while graft occlusion was noted in one of the patients, a 2 cm opening was noticed distal to the skin incision in another patient. There was no loss of limb and mortality in any of the patients we presented here and more importantly they were fully recovered. Conclusion: The present results indicate that gracilis muscle flap reconstruction in PVG infections is an effective and feasible alternative to cover the area exposed to infection and rescue prosthetic graft material.

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