Abstract
We encountered a case of post-operative graft infection where vacuum-assisted closure (VAC) therapy proved markedly effective and the graft was successfully salvaged. A 78-year-old man developed graft infection and perigraft abscess one year after left subclavian artery and bilateral common femoral artery bypass surgery, and he underwent an emergency incision drainage procedure. The abscess was present in the form of a tunnel along the graft, centered at a T-shaped branch of the graft in the left thoracoabdominal area. The wound was cleaned with a large amount of distilled water, and debrided as much as possible. The causative bacteria was MSSA. Symptoms were temporarily alleviated, but on day 5 after surgery, the infection recurred and VAC therapy was started immediately. The wound was incised, up to about 5 cm away from each anastomosis, along the graft leading from the left axillary area to the two thighs, and packed with sponge, then low-pressure sustained suction was applied. Fever, white blood cell count (WBC), and C-reactive protein (CRP) level were all alleviated and the leachate was greatly reduced, but MSSA continued to be detected from wound cultures. The wound incisions were thus expanded to the anastomoses, and VAC therapy was continued. On day 33, the sutures were successfully closed. More than 3 years have passed after surgery, and the bypasses have retained patency with out sign of recurrent infection.
