Page 325 (image) |
Previous | 200 of 711 | Next |
|
|
small (250x250 max)
medium (500x500 max)
Large
Extra Large
large ( > 500x500)
Full Resolution
|
Loading content ...
1. Infected prosthesis must be removed. 2. Exposed prosthesis = infected prosthesis. 3. Rupture occurs at suture line. 4. Infection spreads faster in thrombosed graft. Fig. 4. Principles of managing infected arterial prostheses. 1. Isolate and defunctionalize infected segment. 2. Exclude defunctionalized segment from clean field. 3. Restore vascular continuity with bypass graft. 4. Remove infected prosthesis and institute wound care. Fig. 5. Principles of managing infected arterial prostheses using bypass graft. 5. Ligate the infected vessels, preferably out of the contaminated area. 6. Treat the contaminated wound with local measures. Regarding the infected vascular prosthesis, several general statements can be made (Fig. 4): 1. An infected prosthesis must be removed. 2. An exposed prosthesis is infected. 3. Infection spreads to a suture line where rupture occurs. 4. Infection spreads faster in a thrombosed graft than in a patent one. When removing an infected prosthesis the following steps should be taken (Fig. 5): 1. The infected segment of graft should be isolated and defunctionalized by division of the uninfected artery or graft proximally and distally through clean incisions. 2. The ends of the defunctionalized segment are then excluded from the clean fields. 3. Vascular continuity is restored by means of a bypass graft, and the clean incisions are closed. 4. The infected graft is removed and the area treated appropriately. Infections involving vessels or vascular prostheses present problems peculiar to the site at which they occur. For example, an infected aortic bifurcation graft is associated with a very high mortality from the massive hemorrhage which inevitably occurs. The presence of this type of infection often makes itself known before the rupture occurs. These infections most commonly occur weeks or months after operation, and often present with signs of ureteral obstruction in addition to those of a smoldering infection. Treatment must be prompt once the condition is recognized, if life and limb are to be salvaged. Several routes have been used successfully to detour blood to the lower extremities while removing the infected prosthesis6-10 (Fig. 6). Blaisdell and associates described the use of the descending thoracic aorta,6 and subsequently the use of the axillary artery7 as extra-abdominal sites for originating bypass grafts to the femoral artery in treating cases where aortic bifurcation prostheses had to be removed. Shaw,s Veith,0 Wolf,10 and their co-workers have described various approaches to the upper abdominal aorta where bypass grafts could originate, then be tunneled extraperitoneally to a femoral artery. Wylie11 has suggested turning up the iliac (external or internal) artery to bridge the vascular gap following removal of the prosthesis. He also recommended using catgut sutures for the anas-tamoses. Each of the aforementioned procedures usually requires a simultaneous femoral-to-femoral cross-leg graft to the opposite leg. All these techniques have been successfully applied; and the approach used in individual cases depends upon existing conditions. Perhaps the most common site for infection of a prosthetic graft is the femoral area. In this location the condition is treated most easily by using a bypass graft from the ipsilateral iliac artery to a site in the femoral-popliteal system distal to the septic area. This area can be avoided by passing the graft through the obturator foramen (Fig. 7) and posteriorly to part of the adductor muscles.2- 12-14 Any and all prosthetic material in the area of infection must be removed, according to the principles already mentioned. Procedures of this type are also useful in conditions other than infections, such as postirradiation fibrosis,1 malignant diseases,2- 12 and high risk patients.7 Autologous tissues such as saphenous vein should be used for the bypass graft whenever possible. However, it has been erroneously assumed by many surgeons that saphenous vein autographs can be placed in infected areas. Necrotizing infections can, and do, destroy the wall of the autograft, possibly leading to massive hemorrhage.3- 15'17 Simi- 0>4 I April 1972, NCMJ 325
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-2001] |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1972 |
Identifier | NCHH-17-033 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 33 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-033.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-033 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Description
Fixed Title * | Page 325 (image) |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1972 |
Identifier | NCHH-17-033-0207 |
Form General | Periodicals |
Page Type | all; all images; diagram; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | ncarolinamed331972medi_0207.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 33 |
Issue Number | 4 |
Page Number | 325 |
Health Discipline | Medicine |
Full Text | 1. Infected prosthesis must be removed. 2. Exposed prosthesis = infected prosthesis. 3. Rupture occurs at suture line. 4. Infection spreads faster in thrombosed graft. Fig. 4. Principles of managing infected arterial prostheses. 1. Isolate and defunctionalize infected segment. 2. Exclude defunctionalized segment from clean field. 3. Restore vascular continuity with bypass graft. 4. Remove infected prosthesis and institute wound care. Fig. 5. Principles of managing infected arterial prostheses using bypass graft. 5. Ligate the infected vessels, preferably out of the contaminated area. 6. Treat the contaminated wound with local measures. Regarding the infected vascular prosthesis, several general statements can be made (Fig. 4): 1. An infected prosthesis must be removed. 2. An exposed prosthesis is infected. 3. Infection spreads to a suture line where rupture occurs. 4. Infection spreads faster in a thrombosed graft than in a patent one. When removing an infected prosthesis the following steps should be taken (Fig. 5): 1. The infected segment of graft should be isolated and defunctionalized by division of the uninfected artery or graft proximally and distally through clean incisions. 2. The ends of the defunctionalized segment are then excluded from the clean fields. 3. Vascular continuity is restored by means of a bypass graft, and the clean incisions are closed. 4. The infected graft is removed and the area treated appropriately. Infections involving vessels or vascular prostheses present problems peculiar to the site at which they occur. For example, an infected aortic bifurcation graft is associated with a very high mortality from the massive hemorrhage which inevitably occurs. The presence of this type of infection often makes itself known before the rupture occurs. These infections most commonly occur weeks or months after operation, and often present with signs of ureteral obstruction in addition to those of a smoldering infection. Treatment must be prompt once the condition is recognized, if life and limb are to be salvaged. Several routes have been used successfully to detour blood to the lower extremities while removing the infected prosthesis6-10 (Fig. 6). Blaisdell and associates described the use of the descending thoracic aorta,6 and subsequently the use of the axillary artery7 as extra-abdominal sites for originating bypass grafts to the femoral artery in treating cases where aortic bifurcation prostheses had to be removed. Shaw,s Veith,0 Wolf,10 and their co-workers have described various approaches to the upper abdominal aorta where bypass grafts could originate, then be tunneled extraperitoneally to a femoral artery. Wylie11 has suggested turning up the iliac (external or internal) artery to bridge the vascular gap following removal of the prosthesis. He also recommended using catgut sutures for the anas-tamoses. Each of the aforementioned procedures usually requires a simultaneous femoral-to-femoral cross-leg graft to the opposite leg. All these techniques have been successfully applied; and the approach used in individual cases depends upon existing conditions. Perhaps the most common site for infection of a prosthetic graft is the femoral area. In this location the condition is treated most easily by using a bypass graft from the ipsilateral iliac artery to a site in the femoral-popliteal system distal to the septic area. This area can be avoided by passing the graft through the obturator foramen (Fig. 7) and posteriorly to part of the adductor muscles.2- 12-14 Any and all prosthetic material in the area of infection must be removed, according to the principles already mentioned. Procedures of this type are also useful in conditions other than infections, such as postirradiation fibrosis,1 malignant diseases,2- 12 and high risk patients.7 Autologous tissues such as saphenous vein should be used for the bypass graft whenever possible. However, it has been erroneously assumed by many surgeons that saphenous vein autographs can be placed in infected areas. Necrotizing infections can, and do, destroy the wall of the autograft, possibly leading to massive hemorrhage.3- 15'17 Simi- 0>4 I April 1972, NCMJ 325 |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-033.pdf |
Document Sort | all; nchh-17 |
Article Title | Principles In The Management Of Contaminated Arterial Wounds And Infected Arterial Prostheses |
Article Author | William A. Gay |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-033 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Tags
Comments
Post a Comment for Page 325 (image)