Salvage of infected prosthetic grafts of the great vessels via muscle flap reconstruction

Objective: The infection of an aortic prosthetic graft presents a difficult challenge for surgeons. Conservative treatments such as debridement and antibiotic irrigation routinely fail, and patient survival rates are low. Literature has indicated that flap procedures often provide better treatment. In the present article, we report our experience utilizing pectoralis major muscle flaps, occasionally coupled with latissimus dorsi, rectus abdominis, and/or serratus anterior flaps, to wrap infected grafts and fill dead space. Patients: Between 1990 and 2004, 10 patients were brought to our attention with infections of prosthetic grafts of the great vessels (7 men and 3 women; mean age, 53 years). Infections in nine patients involved an ascending aortic graft, while one patient had an infected pulmonary artery graft. Design: Following diagnosis and exploration, an initial debridement is performed, followed by 48 h of antibiotic irrigation. A definitive muscle flap procedure is then utilized to fill dead space and clear the infection, followed by an appropriate antibiotic regimen. Results: The infections in all 10 patients were cleared using the muscle flap procedure. Two patients required a tapered-dose regimen of oral steroids, one of whom also required a secondary flap procedure due to the advanced stage of infection. Two other patients later died due to unrelated complications; however, autopsies revealed that operative sites had healed successfully. Patients were followed up for a period of 2 months to 2 years, and recurrence was not found. Conclusions: Our outcomes suggest that muscle flap procedures, specifically utilizing the pectoralis major and regional muscles, should be kept in mind in the management of life-threatening infections of aortic grafts. Due to the limited number of patients in this study, we feel more research with a larger volume of cases is warranted.