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The Journal of Thoracic and Cardiovascular Surgery, Vol 81, 403-407, Copyright © 1981 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
GA DeLaria, JA Hunter, MD Goldin, C Serry, H Javid and H Najafi
One percent of 2,545 patients undergoing coronary revascularization with
the saphenous vein over a 5 year period sustained leg wound complications
which necessitated extra care. Fourteen complications were minor and
required only drainage, a new antibiotic, and dressing changes. Thirteen
major wound complications required wide debridement and, of these, five
could be closed only with skin grafts. Eight wounds were infected, two with
Staphylococcus aureus and six with mixed gram- negative flora. Ninety-three
percent of these wounds were in the thigh. Average weight of patients with
leg wound complications was 73.5 +/- 3.5 kg and not different from that of
a randomly selected control group (73.8 +/-1.2 kg). However, 40% of the
patients were women, a much higher incidence than control (p less than
0.005). Hospital stay increased significantly from 12.1 +/- 0.5 days for
the control group to 24 +/- 2.6 days for the group with wound complications
(p less than 0.005). Average hospital stay was 33.6 +/- 3.8 days (p less
than 0.001) in those patients with major wound complications (estimated
hospital cost $9,900). Leg wound complications of saphenous vein harvest
are infrequent but serious. Efforts to prevent this complication should
include minimal dissection, careful hemostasis, and closure in layers.
Development of skin slough, infection, and necrosis necessitating
debridement and drainage is a major and expensive complication. Wide
excision and direct closure are necessary to minimize hospital stay and
reduce the requirement for skin grafting.
ARTICLES
Leg wound complications associated with coronary revascularization
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