This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Thomas, T. A Articles by Cull, D. L Search for Related Content PubMed PubMed Citation Articles by Thomas, T. A Articles by Cull, D. L Social Bookmarking                   What's this?

An analysis of limb-threatening lower extremity wound complications after 1090 consecutive coronary artery bypass procedures

Vascular Surgery Service, Department of Surgical Education, Greenville Hospital System, Greenville, South Carolina, USA

Spence M Taylor

Vascular Surgery Service, Department of Surgical Education, Greenville Hospital System, Greenville, South Carolina, USA

Martin M Crane

Department of Research, Greenville Hospital System, Greenville, South Carolina, USA

Wendy R Cornett

Vascular Surgery Service, Department of Surgical Education, Greenville Hospital System, Greenville, South Carolina, USA

Eugene M Langan, III

Vascular Surgery Service, Department of Surgical Education, Greenville Hospital System, Greenville, South Carolina, USA

Bruce A Snyder

Vascular Surgery Service, Department of Surgical Education, Greenville Hospital System, Greenville, South Carolina, USA

David L Cull

Vascular Surgery Service, Department of Surgical Education, Greenville Hospital System, Greenville, South Carolina, USA

The objective of this study was to examine and characterize limb-threatening lower extremity wound or soft tissue complications after coronary artery bypass (CABG) and determine risk factors for their cause. While minor wound problems of the leg after CABG are not uncommon, serious limb-threatening complications, though less frequent, do occur and are often de-emphasized in the surgical literature.

A review of 1090 consecutive CABG procedures performed from January 1, 1995 through December 31, 1995 was instituted, which screened for limb-threatening lower extremity wound or soft tissue complications defined as wounds that: required additional surgery for treatment; prolonged the length of stay; or which required lengthy home health nursing for treatment. Minor lymph leaks, leg swelling, infections or wound problems treated as an outpatient were excluded.

Of 1090 patients, 54 (5.0%) experienced a limb-threatening lower extremity complication. Complications were categorized as vein harvest incision non-healing (n = 36, 66.7%), decubitus ulceration (n = 11, 20.4%), forefoot ischemia/embolization (n = 10, 18.5%), groin hematoma/abscess (n = 6, 11.1%), severe cellulitis (n = 3, 5.6%), or a combination (n = 12, 22.2%). Statistically significant risk factors by univariate and bivariate analysis for a complication included older age (68 years vs 62 years, p = 0.007), female sex (57% vs 28%, p, 0.001), diabetes (57% vs 33%, p = 0.005) and longer pump time (129 min vs 114 min, p = 0.009). These complications necessitated five major lower extremity amputations and nine revascularization procedures. Chronic lower extremity ischemia from peripheral vascular disease (PVD) was a major contributing factor for the development of wounds in at least 23 (42.6%) of these patients, though suspected in only 10 (43.5%) preoperatively. A non-healing vein harvest incision below the knee of a patient retrospectively found to have inadequate distal circulation for healing occurred in 17 (31.5%) of the total 54 cases.

It was concluded that non-healing vein incisions, decubitus ulcers and forefoot ischemic lesions frequently occurring in older diabetic females with undetected pre-existing PVD, comprise the majority of limb-threatening leg complications after CABG. Nearly one-third of the complications may have been avoided had the vein harvest incision not been made at the ankle of a patient with unappreciated PVD.

Key Words: coronary bypass complications • leg wounds

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				C. K L Ho, M. P. Sun, T. W K Au, and C. S W Chiu Pneumatic Pump Reduces Leg Wound Complications in Cardiac Patients Asian Cardiovasc Thorac Ann, December 1, 2006; 14(6): 452 - 457. [Abstract] [Full Text] [PDF]

				M. A. M. Rogers, K. M. Langa, C. Kim, B. K. Nallamothu, L. F. McMahon Jr, P. N. Malani, B. E. Fries, S. R. Kaufman, and S. Saint Contribution of infection to increased mortality in women after cardiac surgery. Arch Intern Med, February 27, 2006; 166(4): 437 - 443. [Abstract] [Full Text] [PDF]

				R. Garland, F.A. Frizelle, B.R. Dobbs, and H. Singh A retrospective audit of long-term lower limb complications following leg vein harvesting for coronary artery bypass grafting Eur. J. Cardiothorac. Surg., June 1, 2003; 23(6): 950 - 955. [Abstract] [Full Text] [PDF]