Purpose: Report the treatment of a descending thoracic aortic graft infection with a pedicle rectus muscle “wrap around” (hot dog flap).

Materials/Methods: A thirty-five year old hypertensive male developed a thoracic aortic aneurysm associated with a type B dissection of the descending aorta. The patient underwent a dacron tube graft repair from the left subclavian artery to the level of the diaphragm. Post-operatively he developed an acute graft infection complicated by necrotizing fasciitis and sepsis. Aggressive wound debridement over twenty-three days resulted in exposure of the aortic graft. Definitive management utilized a rectus abdominis flap based on the superior epigastric artery. The rectus muscle was wrapped around the exposed thoracic graft. Patient follow-up included clinical exams and serial cat-scans for five years without evidence of graft deterioration or chronic infection.

Conclusions: Infections of thoracic aortic grafts constitute a life-threatening complication and their management remains a challenge. Traditional measures involved excision and replacement with extra-anatomic bypass through unaffected tissue. Recent literature has documented alternatives to graft excision including soft tissue coverage with muscle flaps; however, to date salvage of an infected descending thoracic aortic graft with a rectus muscle pedicle has not been reported.