Infection-related exposure of the lower anastomosis of femorodistal bypass: salvage through use of pedicle muscle flaps.

Wound dehiscence with exposure of the lower anastomosis is a limb- and life-threatening complication of femorodistal bypass. Plastic surgeons consider pedicle flaps to be unreliable in patients with arterial disease. Despite this opinion, we attempted to treat exposure complications using pedicle muscle flaps after careful study of vascularization on control angiography. The purpose of this report is to describe our results. From 1994 to 1997, infection-related exposure of the distal anastomosis was observed in three men and two women with a mean age of 76 years (range, 66 to 89 years). The exposed anastomosis was located on the dorsalis pedis artery in three cases, the anterior tibial artery in the upper third of the leg in one, and the anterior tibial artery in the lower third of the leg in one. The bypass material was a vein graft in three cases and a cuffed PTFE prosthesis in two cases. Bacteriological examination identified Staphylococcus aureus in three cases, Pseudomonas aeruginosa in one case, and both in one case. Two patients were diabetics and one was undergoing corticosteroid treatment. The anastomosis was covered with a pedicle muscle flap fashioned from the extensor digitorum in four cases and the lateral head of the gastrocnemius in one case. Our results showed that anastomoses on the anterior tibial artery and dorsalis pedis artery are at higher risk for infection-related exposure but this complication can be treated using pedicle muscle flaps. This alternative should be considered before bypass removal or amputation.