Abstract
Prosthetic graft infection after abdominal aortic graft replacement is a serious complication with high mortality. We report a successful two-staged treatment of an abdominal aortic graft infection caused by methicillin-resistant Staphylococcus aureus (MRSA). A 66-year-old man had undergone prosthetic graft replacement for an abdominal aortic aneurysm, but a MRSA graft infection occurred 3 months after surgery. Drainage was performed and the cavity was irrigated intermittently every day using electrolyzed strong acid solution for 2 months. However, MRSA was detected in a blood culture. The infected graft was removed and in situ reconstruction with an expanded polytetrafluoroethylene (e-PTFE) graft was performed. Because he had undergone a total gastrectomy, a pedicled omental flap could not be used. Moreover, the left rectus abdominis muscle had been transected because of the left retroperitoneal approach used in the graft replacement. Therefore, we wrapped an e-PTFE vascular prosthesis with a pedicled right rectus abdominis muscle flap. The postoperative course was uneventful and there has been no recurrence of the infection for 23 months. The present case shows that a pedicled rectus abdominis muscle is available as a backup flap instead of the omentum.
