Abstract
Purpose Problems of wound healing following vascular surgery through inguinal incisions include hematoma formation, infection, lymphocele and lymph fistula, and occur in up to 20% of the cases. Closure of chronic wounds is sometimes obtained only after plastic reconstructions such as muscle flaps. We have examined if the use of the less invasive method of vacuum-assisted closure (VAC) may be beneficial.
Material and methods Between January 1999 and May 2002, 36 (2.6%) inguinal wound healing problems were retrospectively identified among 1410 operations originally involving inguinal dissection. There were 15 (42%) females and 21 (58%) males, with a median age of 72 years (range 46–98 years). The indication for the initial operation was arterial surgery in 31 (86%), including aortofemoral reconstruction, arterial reconstruction or endarterectomy with a patch plasty of the femoral artery. Three patients (8%) were operated on for pseudoaneurysm after radiological intervention, two (6%) because of a lymph fistula. Of the 36 patients, 13 (36%) had a frank infection, 12 (33%) were deemed clinically contaminated, and 11 (31%) were non-infected. Operative strategy included vacuum-assisted closure of the wound. Change of the vacuum system was performed a median of 1.8 times (range 1–9) in the operating room. The median length of therapy was 9.2 days (range 3–29).
Results Direct delayed secondary suture was possible in 25 (69%) cases. In 9 (25%) the defect was covered with a split-skin graft. Two patients (6%) required a secondary plastic reconstruction. One leg (2.8%), originally treated for phlegmasia coerulea dolens was amputated. One patient (2.8%) with an infected aortofemoral Dacron graft died from intractable bleeding after homograft reconstruction. No grafts were lost.
Conclusion Vacuum-assisted wound management led to healing of 34 (94%) wounds during initial hospitalisation. Initial strategy was changed twice (6%). Vacuum-assisted closure system is one of the most efficient tools in the treatment of problematic groin wounds in vascular surgery as well as endovascular interventions.
