Limb-threatening ischemia complicated by perigenicular infection

Bernard Timothy Baxter, Charles L. Mesh, Gregory S. McGee, Walter J. McCarthy, William H. Pearce, William R. Flinn, James S.T. Yao

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

When graft infection or infection of the medial leg or popliteal fossa precludes a standard approach to revascularization of the ischemic leg, the literature suggests amputation may be the most prudent course because of excessive perioperative mortality and morbidity of attempts to reestablish axial flow. The purpose of this study is to define the outcome of revascularization when limb-threatening ischemia is complicated by perigenicular infection. Of 1020 infrainguinal reconstructions performed since 1984, nine (0.9%) presented with limb-threatening ischemia and graft or wound infections involving the popliteal fossa (6) or medial thigh or calf wounds (3) which precluded standard revascularization in the five women and four men. Risk factors for infection included diabetes mellitus (5/9), wound hematoma at initial operation (2/9), and intravenous drug abuse (1/9); Staphylococcus aureus was the predominant organism in all infected wounds and two popliteal fossa infections. The other deep infections grew group D streptococci, Enterococcus, and Salmonella. Extraanatomic reconstruction was performed from the femoral (7) and iliac vessels (2) extending to the below-knee popliteal (2), the anterior tibial (4) and the peroneal (3) arteries using vein (5), and PTFE (4) in a lateral tunnel which avoiding the plane of the infection. Postoperative complications included MI (1), early graft thrombosis (2), and osteomyelitus of the femur (1); there were no deaths. With a mean follow-up of 19 months (3-57 months), primary graft patency was 66% and secondary patency was 78%, resulting in salvage of 66% of extremities at risk. These data demonstrate the safety and efficacy of extraanatomic reconstruction for maintaining axial flow when limb-threatening ischemia is complicated by perigenicular infection. We recommend an aggressive approach to this problem.

Original languageEnglish (US)
Pages (from-to)163-167
Number of pages5
JournalJournal of Surgical Research
Volume54
Issue number2
DOIs
StatePublished - Jan 1 1993

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Ischemia
Extremities
Infection
Transplants
Thigh
Leg
Wounds and Injuries
Intravenous Substance Abuse
Enterococcus faecalis
Enterococcus
Polytetrafluoroethylene
Wound Infection
Amputation
Salmonella
Hematoma
Femur
Staphylococcus aureus
Veins
Knee
Diabetes Mellitus

ASJC Scopus subject areas

  • Surgery

Cite this

Baxter, B. T., Mesh, C. L., McGee, G. S., McCarthy, W. J., Pearce, W. H., Flinn, W. R., & Yao, J. S. T. (1993). Limb-threatening ischemia complicated by perigenicular infection. Journal of Surgical Research, 54(2), 163-167. https://doi.org/10.1006/jsre.1993.1026

Limb-threatening ischemia complicated by perigenicular infection. / Baxter, Bernard Timothy; Mesh, Charles L.; McGee, Gregory S.; McCarthy, Walter J.; Pearce, William H.; Flinn, William R.; Yao, James S.T.

In: Journal of Surgical Research, Vol. 54, No. 2, 01.01.1993, p. 163-167.

Research output: Contribution to journalArticle

Baxter, BT, Mesh, CL, McGee, GS, McCarthy, WJ, Pearce, WH, Flinn, WR & Yao, JST 1993, 'Limb-threatening ischemia complicated by perigenicular infection', Journal of Surgical Research, vol. 54, no. 2, pp. 163-167. https://doi.org/10.1006/jsre.1993.1026
Baxter, Bernard Timothy ; Mesh, Charles L. ; McGee, Gregory S. ; McCarthy, Walter J. ; Pearce, William H. ; Flinn, William R. ; Yao, James S.T. / Limb-threatening ischemia complicated by perigenicular infection. In: Journal of Surgical Research. 1993 ; Vol. 54, No. 2. pp. 163-167.
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