Vein Donor Site Morbidity after Coronary Bypass Surgery: An Overlooked but Important Issue

Abstract

Leg morbidity after harvest of veins for coronary artery bypass grafts (CABG) is a significant and under-recognized problem. Although it is not usually life-threatening compared with mediastinal wound infections, the absolute number of limb complications reported annually in North America is approximately double the rate of sternal wound infections. A review of the data in the Cardiac Registry at The Lehigh Valley Hospital (Allentown, Pennsylvania) for 4880 CABG patients from the past five years showed that sternal infections occurred in 48 patients (1%) compared with a reported lower limb morbidity in 31 (0.6%) hospitalized patients. This substantiates the point that morbidity is an important problem, especially if limb-threatening. Whereas many surgical protocols have been established for the treatment of mediastinal infections, there has been virtually no discussion on the management of the problematic donor limb. Plastic surgery consultation in this hospital was requested for only five (16%) patients with leg wounds, whereas it was the norm for the majority of sternal wounds (42 [87.5%]). Minimal debridement and expectant healing was the most common approach for these lower extremity wounds. An acceptable vascular profile in these patients, who often have coexistent atherosclerotic peripheral vascular disease, should be an initial priority. In those with limb complications, this had often been overlooked preoperatively. Because the failure of a wound to heal can result in limb amputation, early intervention by plastic surgeons must be emphasized.