The problematic inguinal wound in vascular surgery–What is the optimal treatment?

Problems of wound healing following vascular surgery through inguinal incisions include hematoma formation, infection, lymphocele and lymph fistula, and occur in up to 20% of the cases. Closure of chronic wounds is sometimes obtained only after plastic reconstructions such as muscle flaps. We have examined if the use of the less invasive method of vacuum-assisted closure (VAC) may be beneficial. Between January 1999 and May 2002, 36 (2.6%) inguinal wound healing problems were retrospectively identified among 1410 operations originally involving inguinal dissection. There were 15 (42%) females and 21 (58%) males, with a median age of 72 years (range 46–98 years). The indication for the initial operation was arterial surgery in 31 (86%), including aortofemoral reconstruction, arterial reconstruction or endarterectomy with a patch plasty of the femoral artery. Three patients (8%) were operated on for pseudoaneurysm after radiological intervention, two (6%) because of a lymph fistula. Of the 36 patients, 13 (36%) had a frank infection, 12 (33%) were deemed clinically contaminated, and 11 (31%) were non-infected. Operative strategy included vacuum-assisted closure of the wound. Change of the vacuum system was performed a median of 1.8 times (range 1–9) in the operating room. The median length of therapy was 9.2 days (range 3–29). Direct delayed secondary suture was possible in 25 (69%) cases. In 9 (25%) the defect was covered with a split-skin graft. Two patients (6%) required a secondary plastic reconstruction. One leg (2.8%), originally treated for phlegmasia coerulea dolens was amputated. One patient (2.8%) with an infected aortofemoral Dacron graft died from intractable bleeding after homograft reconstruction. No grafts were lost. Vacuum-assisted wound management led to healing of 34 (94%) wounds during initial hospitalisation. Initial strategy was changed twice (6%). Vacuum-assisted closure system is one of the most efficient tools in the treatment of problematic groin wounds in vascular surgery as well as endovascular interventions.