Incision Depth As A Predictor for Infrainguinal Wound Complications
Charles A. Hartranft, D.O1, Matt Goldman, MD1, Nitin Garg, MD1, Matthew Edwards, MD1, Matthew Corriere, MD2.
1Wake Forest University, Winston-Salem, NC, USA, 2University of Michigan, Ann Arbor, MI, USA.
Objective: Post-operative wound complications are common following infrainguinal vascular surgery leading to increased morbidity, risk of limb loss, readmissions, length of stay, and health care costs. While several modifiable and non-modifiable risk factors have been reported for post-operative wound complications, incision depth remains unstudied. We hypothesized a greater depth from skin level to femoral vessel would be associated with increased wound complications.
Methods: Using an IRB-approved Vascular Surgery registry, patients undergoing common femoral artery exposure who had received a pre-operative CT scan within 90 days were reviewed. Demographics, medical comorbidity, operative, and outcomes data were abstracted from the electronic medical record. Incision depth was measured as the distance from skin to anterior surface of the distal most common femoral artery on CT scan. End points included surgical site infections (SSI) and non-infectious wound complications (NIWC), including clinically apparent hematomas and seromas.
Results: Fifty-six patients with a mean age 66 years (range 46-92) underwent a total of 77 femoral incisions. Thirteen (23%) patients were female, mean BMI was 25.6, and 16 (29%) patients were diabetic. Operations included lower extremity bypass (50%), femoral artery exposure for thoracic and abdominal endovascular procedures (25%), femoral endarterectomy (13%), cross-femoral bypass (11%), and aortobifemoral bypass (1%). Thirty-nine percent of patients had previous infrainguinal vascular surgery and 25% of operations were performed for tissue loss or infectious indications. SSI and NIWC occurred in 8 and 4 incisions, respectively. Mean incision depth for patients with SSI was 4.5cm compared to 3.6cm for those without (p=0.0296) and for NIWC was 4.2cm compared to 3.7cm for those without (NS). Overall wound complications, both SSI and NIWC, occurred with a mean incision depth of 4.4cm compared to 3.6cm for those without complication (p=0.0088). There was no statistically significant correlation between BMI and SSI or NIWC. On multivariate analysis, incision depth remained a significant predictor of post-operative wound complications when controlling for age, gender, race, history of diabetes, and BMI.
Conclusion: Depth of incision was associated with the occurrence of postoperative wound complications affecting femoral access sites in patients undergoing vascular surgery. A similar association was not observed for BMI.
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