Infected Grafts Flashcards
MC organism responsible for infected grafts
Staph aureus
What other organisms are common in infected grafts
MRSA, E coli, Enterobacter, Klebsiella, Proteus, Psuedomonas
Late infections are commonly caused by which organisms
S. epidermidis
What organism produces a polysaccharide biofilm
S. epidermidis
How can local infection present
sinus tract, perigraft fluid collection, anastomotic pseudoaneurysm, aortoenteric fistula
Define late graft infection
greater than 4 months after graft implantation
If a patient presents with GI hemorrhage and known intraabdominal graft what diagnosis should be assumed
aortoenteric fistula
Where can an aortoenteric fistula be located
anywhere within the bowel, MC 3rd and 4th portion of the duodenum
Diagnostic imaging of aortoenteric fistula
Duplex US, CT, MRI
What test should be promptly performed in a patient with UGI hemorrhage and a graft
upper endoscopy
When complete excision of a graft is required what are the surgical options
- ax-bifem, 2. bilateral ax-profunda, 3. bilateral ax-popliteal 4. bilateral ax-superficial femoral bypass
If UGI is negative for aortoenteric fistula should further workup be done
yes
Is the risk of limb loss greater with an infrainguinal prosthetic graft
yes
When can graft salvage be considered
if no systemic sepsis, thrombosis, septic emboli or Psuedomonas
What is the approach to graft salvage
local debridement, IV abx and local abx, muscle flaps for coverage
What is the reinfection rate in graft salvage
35%
What are options for muscle flaps of the groin
rectus abdominis, rectus femoris, tensor fascia lata, gracilis
What are options for muscle flaps of the knee
gastrocnemius and soleus
What are graft options for the chest
pec major, latissimus dorsi
What are graft options for head and neck
SCM
Why are muscle flaps used
well vascularized tissue raise local oxygen tension and fascilitate delivery of abx to the infected region
