Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.002816
Jornal Vascular Brasileiro
Therapeutic Challenge

Uso de curativo a vácuo como terapia adjuvante na cicatrização de sítio cirúrgico infectado

Using vacuum therapy as an adjunctive treatment for healing of infected surgical sites

Paula Angeleli Bueno de Camargo, Matheus Bertanha, Regina Moura, Rodrigo Gibin Jaldin, Ricardo de Alvarenga Yoshida, Rafael Elias Farres Pimenta, Jamil Victor de Oliveira Mariúba, Marcone Lima Sobreira

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Resumo

Infecções de sítios cirúrgicos com envolvimento de próteses sintéticas constituem grande desafio para tratamento. Apresentamos o caso de uma paciente com múltiplas comorbidades, histórico de enxerto aortobifemoral há 6 anos e reabordagem das anastomoses femorais por reestenoses há 5 anos. Apresentou dor inguinal esquerda e abaulamento súbitos com diagnóstico de pseudoaneurisma femoral roto e instabilidade hemodinâmica. Foi submetida a correção emergencial com interposição de prótese de dácron recoberta por prata e correção de grande hérnia incisional abdominal com tela sintética ao mesmo tempo. No pós-operatório, manteve-se por longo período sob terapia intensiva com dificuldade de extubação. Nesse ínterim, apresentou deiscência das suturas e fístula purulenta inguinal esquerda em contato com a prótese vascular. Optou-se pelo tratamento conservador, com desbridamento das feridas e aplicação de curativo a vácuo. A paciente evoluiu com melhora e cicatrização das feridas. Essa pode se constituir em ferramenta importante em casos similares.

Palavras-chave

terapêutica; cicatrização; técnicas de fechamento de ferimentos abdominais; infecção; prótese vascular.

Abstract

Infections at the sites of surgery involving synthetic prostheses are challenging to treat. We present a case of a patient with multiple comorbidities who had undergone an aortobifemoral bypass 6 years previously and then re-intervention at the femoral anastomoses for restenosis 5 years previously. The patient presented with acute left inguinal pain and swelling and was diagnosed with a ruptured femoral pseudoaneurysm and hemodynamic instability. A repair was conducted by interposition of a silver-coated Dacron graft in the emergency room, and a large abdominal incisional hernia was repaired with synthetic mesh during the same intervention. After surgery, the patient remained intubated in intensive care for a long period. Meanwhile, she presented dehiscence of sutures and a left inguinal purulent fistula that was in contact with the vascular prosthesis. Conservative treatment was chosen, with debridement of wounds and vacuum therapy. The patient improved and the wounds healed. This could be an important tool in similar cases.

Keywords

treatment; healing; abdominal injury closure techniques; infection; vascular prosthesis.

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