USE OF PROSTHETIC GRAFT MATERIAL

Pearls

- ePTFE (Gortex) or Dacron used for central torso vascular injuries (aorta, great vessels).
- Prosthetic conduit acceptable as last resort in extremities when there are no shunts, the vein is being preserved for definitive care at a later time, or the vein cannot be harvested.
- If prosthetic used in extremity injury, notify higher levels of care to facilitate surveillance.
- Prosthetic graft materials such as ePTFE (Gortex) or Dacron should be reserved for open reconstruction of the aorta and large torso vessels and used very rarely as conduit for extremity vascular injury. Wartime experience has demonstrated poor incorporation of prosthetic grafts in extremity wounds and a propensity for infection compared to saphenous vein. Additionally, extrapolation of civilian data suggests improved patency of vascular reconstructions using saphenous vein. In the rare instance (i.e. damage control) when prosthetic conduit is used for extremity vascular injury, communication with higher levels of care should occur so that appropriate surveillance or even removal of the graft and replacement with vein can occur. 3

ANASTOMOTIC CONSIDERATIONS

Spatulate or Bevel the Conduit

Purpose: to prevent stenosis and mitigate size mismatch between conduit and in situ vessel

Bevel: to cut the edge of the conduit and in situ vessel (Figure 4)

Spatulate: to open the vessel to increase diameter (Figure 5)