Staged concept for treatment of severe postsaphenectomy wound infection

Abstract

The saphenous vein remains the most commonly used conduit in coronary artery bypass surgery. Vein harvest is a critical component with significant morbidity associated with leg wounds from open technique. Occurring complications are hematoma, postoperative pain, skin changes, neuropathy, and septic or nonseptic wound complications. Within the context of a recent case, we present our approach to postsaphenectomy wound management.

Figure 1

Post-saphenectomy wound complication before debridement: Infected hematoma and complete dehiscence of the cutaneous suture line.

Figure 2

Wound appearance after extensive debridement, at the upper wound pole, the gastrocnemius muscle is exposed.

Figure 3

Appearance after 3 weeks of treatment with a vacuum dressing, intermittent suction of 75 mm Hg: Clean, well-granulated wound surfaces are evident, and the muscle is completely covered with granulation tissue.

Figure 4

Wound appearance 7 days after split-thickness skin grafts and treatment with a light vacuum dressing to stabilize the skin grafts. A cosmetically acceptable result has been achieved, without functional limitations.

Figure 5

Staged schema for treatment of severe wound complications with escalation to skin graft coverage, depending on findings. With good progress of wound healing, a de-escalation of the therapy is possible at each level.