DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Infected left axillofemoral bypass, defunctionalized.
POSTOPERATIVE DIAGNOSIS: Infected left axillofemoral bypass, defunctionalized.
OPERATION PERFORMED: Excision of infected left axillofemoral bypass.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General, orotracheal intubation.
DRAINS: None.
SPECIMENS: Swab to microbiology. Graft to microbiology.
INDICATIONS FOR OPERATION: This is a patient with aortoiliac arterial occlusive disease who has undergone an aortobifemoral bypass in the distant past. The patient at some point underwent a femorofemoral bypass and a left axillofemoral bypass. The patient then presented with a draining sinus in his left groin and eventually underwent a redo aortobipopliteal bypass via the obturator foramen. The patient is approximately three years out from that procedure. The patient presented with erythema and drainage from his left flank over the previously defunctionalized left axillofemoral bypass.
DESCRIPTION OF OPERATION: The patient was placed supine with the left flank slightly elevated. A large Tegaderm was placed over the draining purulent wounds in the left flank. The left upper extremity, chest, left flank, and lateral abdomen were then prepped and draped in the usual aseptic fashion. Ioban was placed over the previous left axillary incision site.
The patient’s previous left infraclavicular incision was opened. The fibers of the pectoralis major muscle were split. The pectoralis minor was retracted laterally. The thrombosed left axillofemoral graft was identified. The graft was clamped. The graft was not filled with blood, suggesting a more proximal occlusion. The graft was transected. The distal aspect of the graft was advanced down the tunnel. The stump of the graft was oversewn with 3-0 Prolene suture in the standard fashion. The wound was irrigated. The wound was closed in layers using 2-0 and 3-0 Vicryl sutures. The skin was closed with staples. A dry sterile dressing was applied and covered with an occlusive adhesive dressing. This area was then covered with a towel.
The left flank was exposed. The previously placed Tegaderm was removed, and the area was prepped with ChloraPrep. A longitudinal incision was made connecting the draining sinuses. A DeBakey aortic clamp was advanced through the tunnel, and the tract was opened longitudinally. The distal end of the graft had previously been transected. The graft was removed. A swab of the area was sent for microbiology. A portion of the graft was sent to microbiology. The tract was irrigated and examined for hemostasis. The tract was scraped, removing loose granulation tissue. The area was treated with a pulsed irrigation system. The wound was packed with dry gauze. The patient tolerated the procedure well. There were no apparent complications.
