Groin wound infection after arterial surgery

Abstract

Fifty-six patients, 30 with superficial and 19 with deep groin wound infections, and seven with lymph fistulae with positive cultures within 30 days of arterial surgery, were identified after 661 operations (873 groins at risk) between September 1984 and August 1988. The commonest infecting organisms were Staphylococcus aureus, Pseudomonas aeruginosa and Proteus spp. In 33 patients the infection settled completely after treatment with culture specific antibiotics. These were given intravenously then orally for up to 6 weeks. Sixteen patients required debridement and excision of necrotic wound edges, including one who had an antibiotic infusion into the wound. Graft excision was performed in seven patients of whom five received an extra anatomic bypass. The need for graft excision was much greater (six versus one) for Dacron® and/or polytetrafluoroethylene than for vein. In two lymph fistulae sartorius transposition and wound resuture were used. All groins healed, though three extremities were ischaemic following occlusion of the bypass. There were two deaths, one from myocardial infarction and one from pulmonary embolism and no major amputations. These results suggest that most infective groin problems may be successfully managed conservatively and that radical graft excision is only necessary for a few intractable cases.