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Introduction Prosthetic graft infection (PGI) is associated with low patient survival rates. The effectiveness of ultrasound debridement in chronic wound healing has been previously reported; however, data on the use of ultrasound technology and its effect on the treatment of PGI are still lacking. We report a case in which PGI in the groin was managed by graft removal using ultrasound debridement. Presentation of case A 70-year-old man was diagnosed with chronic limb-threatening ischemia and underwent a femoral-femoral bypass with a polytetrafluoroethylene graft. Eight months postoperatively, he developed an infection at the femoral incision site. Graft removal was performed using ultrasound debridement. The estimated blood loss was 10 mL. The wound healed, and the patient has remained in good health for 2 years postoperatively. Discussion When the ultrasonic probe is applied to the wound, ultrasonic energy penetrates into the tissue, and a fibrinolytic action removes necrotic or infected tissue without removing healthy tissue, thereby minimizing bleeding. Using this technique, we were able to perform effective debridement at not only the wound but also the anastomosis. Conclusion It is our opinion that this technique can be used to achieve adequate debridement with little bleeding during graft removal and may provide a new option for the treatment of PGI., Highlights • Prosthetic graft infection (PGI) is associated with low patient survival rates. • We present a case in which PGI in the groin was managed by graft removal using ultrasound debridement (UD). • Ultrasonic energy penetrates into the tissue and cleaves dead tissue without removing healthy tissue. • UD can be used to achieve adequate debridement during graft removal and may provide a new option for the treatment of PGI.

Background A groin wound associated with a vascular graft infection is associated with significant morbidity. Management of groin wounds is often challenging due to their anatomical location that renders them difficult to visualize and keep clean. Case This case report describes the use of a concentrated surfactant-based gel dressing for an infected groin wound. Conclusions Because of their location and complex topography, groin wounds are difficult to keep clean and maintain dressing integrity. This case study describes the use of a concentrated surfactant-based gel dressing that remained in place and promoted healing of an infected groin wound.

The objectives of this retrospective investigation were to determine the accuracy of 99mTc-fanolesomab, an antigranulocyte antibody, for diagnosing prosthetic vascular graft infection, ascertain optimum imaging times for this indication, and assess safety of this agent.Eighteen patients with 19 prosthetic vascular grafts were included. Indications for graft placement included peripheral vascular disease (8), haemodialysis (7), and aneurysm (4). Patients were imaged 2-5 h and 18-30 h after injection of 555-740 MBq (75-125 microg) 99mTc-fanolesomab. One experienced nuclear physician reviewed images in three separate sessions, early alone, late alone and early plus late images together. When early and late images were read alone, graft activity more intense than native blood pool activity was classified as positive for infection. When early and late images were interpreted together, graft activity which persisted or which increased in intensity over time was classified as positive for infection. Patient records were reviewed for adverse events up to 30 days after injection.Five (26%) prosthetic grafts were infected. Early, late and early plus late imaging were equally sensitive (1.00). Early images were significantly less specific (0.50), than late and early plus late images (0.93) (P0.05, analysis of proportions). Accuracy of late imaging and early plus late imaging were the same: 0.93. No patient experienced adverse events following radiopharmaceutical injection.99mTc-fanolesomab imaging, performed 18-30 h after injection, diagnosed prosthetic vascular graft infection safely and accurately (95%). (Although safety was not an issue in this investigation, following reports of serious, including two fatal, events after administration, 99mTc-fanolesomab was withdrawn from the United States market).

A 78-year-old man with a more than 10-year-old aortobifemoral vascular graft was referred for inguinal tumefaction suspicious of abscess. Planar whole-body In-111-labeled leukocyte scan only revealed mild increased activity in the right iliac fossa. In contrast, the SPECT study clearly demonstrated aortobifemoral prosthesis uptake extending to the left inguinal region and the right iliac fossa. A contrast-enhanced abdominal CT scan confirmed the presence of a right distal pseudoaneurysm as well as the presence of a periprosthetic collection. The inguinal abscess was drained and the aortobifemoral vascular graft was removed after ligation of the subrenal aorta. Then, an axillobifemoral vascular graft was implanted. The surgical procedure was further associated for 6 weeks with vancomycin targeted against the suspected staphylococcal pathogen with subsequent complete clinical and biologic responses. One year after this infectious event, the patient is still in complete recovery.