Saphenous vein harvest wound complications: risk factors, identification, prevention, and management

Figures & data

Table 1 Risk factors for developing saphenous vein harvest site wound complication following coronary artery bypass grafting

Preoperative factors

Female Chronic and degenerative diseases – diabetes mellitus, chronic kidney disease, chronic heart failure Smoking Obesity (increased body mass, BMI >30) Preoperative anemia Malnutrition – serum albumin <4.5 g/dL Pre-existing peripheral vascular disease

Operative factors

Type of surgery – emergency surgery Use of intra-aortic balloon pump Operative technique Operative time Bleeding or need for blood transfusion

Abbreviation: BMI, body mass index.

Table 2 The ASEPSIS wound score

Wound characteristic	Proportion of wound affected (%)
	0	<20	20–39	40–59	60–79	>80
Serous exudate	0	1	2	3	4	5
Erythema	0	1	2	3	4	5
Purulent exudates	0	2	4	6	8	10
Separation of deep tissues	0	2	4	6	8	10
Criteria	Points
Additional treatment
Antibiotics	10
Drainage of pus under local anesthesia	5
Debridement of wound (general anesthesia)	10
Serous discharge	Daily 0–5
Erythema	Daily 0–5
Purulent exudates	Daily 0–10
Separation of deep tissues	Daily 0–10
Isolation of bacteria	10
Stay as inpatient prolonged over 14 days	5
Category of infection
Total score
0–10	Satisfactory healing
11–20	Disturbance of healing
21–30	Minor wound infection
31–40	Moderate wound infection
>40	Severe wound infection

Table 3 Saphenous vein harvest site wound complications

Dermatitis Cellulitis Abscess Hematoma Lymphocele Greater saphenous nerve neuropathy Nonhealing ulcer Gangrene

Table 4 Operative procedures for saphenous vein harvest wound complications

Prompt drainage of hematomas, lymphoceles, and abscesses Debridement Delayed closure of wound after VAC dressing Fasciotomy Thromboembolectomy with or without bypass Delayed wound closure with skin graft or rotational flap Free tissue transfer Amputation

Abbreviation: VAC, vacuum-assisted closure.

Table 5 Types and treatment of wound

Type of wound	Treatment
Dry and first intention	0.9 Normal saline, cover with sterile gauze. Change at least once a day or when dressing is soaked
Open and with little exudation	Saline solution jets, manual debridement, cover with gauze soaked in SS or medium chain triglycerides or hydrocolloid. Change daily or when soaked
Open and with abundant exudation	Saline solution jets, manual debridement, cover with gauze soaked in calcium alginate. Change daily or when soaked, VAC dressing

Abbreviations: SS, saline solution; VAC, vacuum-assisted closure.

Figure 1 Wound before application of VAC dressing.

Abbreviation: VAC, vacuum-assisted closure.

Figure 2 Application of VAC dressing on the wound.

Abbreviation: VAC, vacuum-assisted closure.

Figure 3 Wound after VAC dressing.

Abbreviation: VAC, vacuum-assisted closure.

Figure 4 Algorithm for the management of saphenous vein harvest site wound.

Abbreviation: VAC, vacuum-assisted closure.