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Eur J Cardiothorac Surg 2004;25:144
© 2004 Elsevier Science NL

Letter to the Editor

Reply to Beyersdorf et al.

R. Garlanda, F.A. Frizelleb*, B.R. Dobbsa, H. Singha

a Department of Cardiothoracic Surgery, Christchurch Hospital, Riccarton Ave, Christchurch, New Zealand
b Department of General Surgery*, Christchurch Hospital, Riccarton Ave, Christchurch, New Zealand

Received 12 October 2003; accepted 17 October 2003.

* Corresponding author. Tel. +64-3-3640-640; fax: +64-3-3640-352
e-mail: frank.frizelle{at}chmeds.ac.nz

Key Words: Wound infection • Coronary artery by-pass grafting • Leg-vein harvesting

Thank you for your useful comments and observations about our paper [1]. As you say we have described the longer term complications after leg vein harvest. In regard to your comments however we would make the following comments.

We feel that you are correct, in that minimal invasive techniques are the way forward in regard to leg vein harvest and sternontomy wounds, however, good quality prospective multicentre randomised controlled trails are needed to provide level one evidence that can lead to practise change. These studies must not only consider leg-related complications, but conduit quality aspects of the vein harvest, such as early graft occlusion.

Surgeons underestimate wound complications, as they are often managed out of hospital by family doctors. In a recent study of ours of 1964 surgical clean wounds with 98.5% follow-up to 30 days we found the overall clean wound infection rate was 12.6%, of which two-thirds of infections occurred after discharge from hospital [2]. The usual factors associated with wound infection were no longer found to be significant, when taking into account the post discharge wound infections.

The ‘learning curve’ associated with a new technique is not usually related to time alone (you say 2 months), but usually related to number of cases [3]. Your point, however, is clear, that this is not a difficult technique to learn.

There will never be no leg vein complications whatever the method used to harvest the vein. While it is important to prospective audit your own results what ever the method one uses, and to try and reduce these complications, it is, however, also important to advise patients preoperatively of the possibility of these complications and help manage them when they occur as best as we can.

Thank you for the chance to comment on the letter.

References

  1. Garland R., Frizelle F.A., Dobbs B.R., Singh H. A retrospective audit of longterm lower limb complications following leg vein harvesting for coronary artery bypass grafting. Eur J Cardio-thorac Surg 2003;23:9505.
  2. Reid R., Simcock J.W., Chisholm L., Dobbs B.R., Frizelle F.A. Post discharge clean wound infections; Incidence underestimated and risk factors over estimated. Aust NZ J Surg 2002;72:339-343.[CrossRef]
  3. Parry B.R., Williams S.M. Competency and the colonoscopist: a learning curve. Aust NZ J Surg. 1991;61:419-422.[Medline]




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