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Ann Thorac Surg 2000;70:492-497
© 2000 The Society of Thoracic Surgeons

Original articles: cardiovascular

Major leg wound complications after saphenous vein harvest for coronary revascularization

Christian E. Paletta, MDa, David B. Huang, MDa, Andrew C. Fiore, MDb, Marc T. Swartz, BAb, Francisco L. Rilloraza, MDa, Jan E. Gardner, MDa

a Divisions of Division of Plastic and Reconstructive Surgery, St. Louis University School of Medicine, St. Louis, Missouri, USA
b Division of Cardiothoracic Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA

Address reprint requests to Dr Paletta, Division of Plastic and Reconstructive Surgery, Saint Louis University Health Sciences Center, 3635 Vista Ave at Grand Blvd, PO Box 15250, St. Louis, MO 63110-0250;
e-mail: palettac{at}slu.edu

Background. Major leg wound complications after coronary artery bypass graft procedures are infrequent and few are reported in the literature. We present our experience in treating 23 patients with major leg wound complications after coronary revascularization procedures.

Methods. A retrospective review of 3,525 bypass procedures with saphenous vein grafts performed over a 10-year period was conducted. Ten potential risk factors for those who developed major leg wound complications were analyzed and compared with the entire cohort of patients undergoing similar bypass procedures during the same period.

Results. Lower extremity wound complications occurred in 145 patients (4.1%), 23 of whom (0.65%) required additional surgical interventions (62 total). There were 32 wound debridements, 8 skin grafts, 11 vascular procedures, 5 amputations, 3 fasciotomies, 2 free tissue transfers, and 1 fasciocutaneous flap. Of ten variables evaluated by multivariate analysis, female gender, peripheral vascular disease, and postoperative intraaortic balloon pump use were identified as significant independent predictors of major leg wound complications (p < 0.0001).

Conclusions. The causes of major leg wound complications after saphenous vein harvest for coronary artery bypass graft procedures are multifactorial. To minimize these complications, we recommend vascular evaluations before saphenous vein harvest, attention to proper surgical technique, and careful harvest site selection.




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