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Cardiopulmonary bypass: Ursalan A. Khan, Bhuvaneswari Krishnamoorthy, Osman Najam, Paul Waterworth, James Fildes, and Nizar Yonan A comparative analysis of saphenous vein conduit harvesting techniques for coronary artery bypass grafting - standard bridging versus the open technique Interactive CardioVascular and Thoracic Surgery published on Aug 20, 2009 as doi:10.1510/icvts.2009.209171 [Abstract] [Journal Format PDF]

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eComment. Leg wound morbidities after saphenous vein harvesting techniques. Which is better?

Rafet Gunay, Yavuz Sensoz, Ilyas Kayacioglu   (1 September 2009)

eComment. Leg wound morbidities after saphenous vein harvesting techniques. Which is better? 1 September 2009
Rafet Gunay Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey, Yavuz Sensoz, Ilyas Kayacioglu Send ecomment to journal: Re: eComment. Leg wound morbidities after saphenous vein harvesting techniques. Which is better? rafetgunay{at}hotmail.com Rafet Gunay, et al.	Interactive CardioVascular and Thoracic Surgery 2009, doi:10.1510/icvts.2009.209171A © 2009 European Association of Cardio-Thoracic Surgery Although it is widely accepted that arterial conduits should always be preferred, saphenous vein continues to be the most commonly used conduit for coronary artery bypass grafting surgery. However, wound-healing problems are commonly observed after these operations. Khan and colleagues conclude that saphenous vein harvesting by minimally invasive standard bridging technique reduces postoperative leg morbidity and increases patient satisfaction when compared to open technique [1]. First of all, we think that the term 'less invasive' is more appropriate than 'minimally invasive' for standard bridging technique. Secondly, the main reason for the reduction in wound morbidity following standard bridging technique may be the short skin incision. There are four important issues in the comparison of saphenous vein harvesting techniques: the harvesting time required, the quality of the conduit, leg wound related morbidities and the cost of different techniques including not only the cost of instruments which were used, but also the cost of postoperative hospital stay and leg care. The first three factors affect patient satisfaction and graft patency. Saphenous vein related morbidities are reported as pain, wound drainage, hematoma, diffuse ecchymosis, dehiscence, separation, necrosis, need for surgical debridement, seroma formation and superficial infection [2]. We understand that the authors focused on analysing the severity of pain, wound development, patient satisfaction, cosmetic outcome and length of the procedure. We think that those are important leg wound related morbidities affecting patient satisfaction. We recently reported that the incidence of leg wound morbidity increases with the length of the incision. The length of incision and female gender were determined as independent risk factors [3]. We agree with the authors that the standard bridging technique reduces postoperative leg morbidities. On the other hand, it is really interesting to see more neuropathies in saphenous vein harvested with the open technique. It would be nice to know what the authors attributed to see more neuropathies in this group. We would like to congratulate the authors for their report and conclusion pointing out the decrease of leg wound morbidity in the bridging technique. References [1] Khan UA, Krishnamoorthy B, Najam O, Waterworth P, Fildes J, Yonan N. A comparative analysis of saphenous vein conduit harvesting techniques for coronary artery bypass grafting - standard bridging versus the open technique. Interact CardioVasc Thorac Surg doi:10.1510/icvts.2009.209171. [2] Athanasiou T, Aziz O, Al-Ruzzeh S, Philippidis P, Jones C, Purkayastha S, Casula R, Glenville B. Are wound healing disturbances and length of hospital stay reduced with minimally invasive vein harvest? A meta-analysis. Eur J Cardiothorac Surg 2004;26:1015-1026. [3] Kayacioglu I, Camur G, Gunay R, Ates M, Sensoz Y, Alkan P, Idiz M, Yekeler I. The risk factors affecting the complications of saphenous vein graft harvesting in aortocoronary bypass surgery. Tohoku J Exp Med 2007;211:331-337.