Data di Pubblicazione:
2012
Citazione:
Ultrasonic Debridement for the Treatment of Infected Vascular Graft / I. Barbetta, M. Carmo, A.M. Settembrini, M. Fumagalli, S. Roveri, D.P. Mazzaccaro, L. Tassinari, P. Settembrini. ((Intervento presentato al convegno European Society for Vascular and endovascular surgery : Annual Meeting tenutosi a Bologna nel 2012.
Abstract:
Introduction :
Vascular surgical site infection (SSI) is a feared complication of major vascular surgery procedures. Depending on the
virulence of the infectious pathogen and the site of surgery, its presentation is extremely variable, ranging from severe
sepsis to slow-evolving prosthetic colonisation by bacterial biofilm. Usually it is associated with poor patients’
prognosis and low rates of limb salvage. Medical treatment alone is not effective, given the very low penetration of
antibiotic into the bacterial biofilm. Radical surgical treatment is the current mainstay, consisting of complete graft
removal and reconstruction with autogenous or extra-anatomic conduits. Unfortunately it is burdened by high morbidity
and mortality rates, especially in those patients who are unfit for open major vascular procedures, furthermore recurrent
SSI is not to be ruled out. Less invasive surgical techniques, allowing partial or no graft excision, have therefore been
recently introduced. Aim of our study is to evaluate the results of a novel SSI treatment consisting of associated
ultrasonic debridement and antibiotic therapy in a subset of patients considered at extremely high risk for major surgery.
We used this technique to achieve the best tissue and or graft debridement while minimising the invasiveness of
surgery.
Materials/Methods
Ultrasound (US) technology and its interaction with living tissues has been already studied: the largest experience
comes from dentistry for cleansing purpose and lately ultrasonic debridement has gained a role in the treatment of nonhealing chronic leg ulcers. When applied to infected wounds, US generate mechanical and cavitational energy that
preferentially disrupts necrotic tissues, due to their lower tensile strength, and stimulate formation of granulation tissue.
Besides, US enhancement of antibiotic action against bacterial biofilms associated with implant infection has been well
documented by several in-vivo experimental studies. We used an ultrasonic generator operating through a piezoelectric
probe vibrating at 26 KHz with a vibratory amplitude of 15-30 µm and irrigating normal saline. Patients with a
prosthetic vascular graft infection and poor medical condition or unavailable autogenous graft underwent an extensive
US debridement on the graft and wound tissues to allow a less invasive reconstruction. Non incorporated vascular
prostheses and surrounding tissues were treated with this device by moving the probe over their surfaces until all
necrotic parts and fibrin were removed and the colour of the graft and tissue returned to appear normal. Ultrasonic
debridement was followed by local antibiotic irrigation and was associated to antibiogram-oriented systemic
antimicrobial treatment. Graft removal and Sartorius muscle flap to cover the inguinal region were selectively employed
Patients’ charts were reviewed to extract their history, lab data, operative details, cultures and follow up.
Results
Our study involved 12 patients with a mean age of 73 years (range 57-92) composed of 7 males and 5 females. SSI
onset was early in 8 cases and late in 4. Possible clinical presentations were draining sinus tract (5 patients), wound
dehiscence (5 patients) and acute hemorrhage due to prosthesis’ detachment (2 patients). Prosthetic materials were
Dacron (8 patients), PTFE (1 patient), composite Dacron-PTFE (2 patients) and bovine pericardium (1 patient). US
debridement was performed after partial graft excision in order to allow an in situ reconstruction with a Silver prosthetic
graft in 5 patients, while 7 patients underwent US debridement without graft removal. A Sartorius flap to cover the
groin was carried out in 5 cases. Cultures reveal
Tipologia IRIS:
14 - Intervento a convegno non pubblicato
Keywords:
graft infections ; ultrasonic debridement
Elenco autori:
I. Barbetta, M. Carmo, A.M. Settembrini, M. Fumagalli, S. Roveri, D.P. Mazzaccaro, L. Tassinari, P. Settembrini
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