Outcomes Of Gracilis And Sartorius Muscle Flap In Vascular Groin Complications
Patrick Albert, Chiranjiv Virk, Zachary Conolly, Terry Lairmore, Muzammil Aziz
Louisiana State University, Shreveport, LA
INTRODUCTION: Complications following open groin surgery are common and associated with significant morbidity. Vascularized muscle flaps have proven to be a valuable tool for management of these complications.
METHODS: A retrospective chart review including patients who underwent either a gracilis or sartorius muscle flap was performed. Patients demographics, comorbidities and indications of a muscle flap were recorded. The healing time, use of negative wound pressure therapy or skin grafts, microbiology and antibiotic therapy was examined and compared between different muscle flap types using a paired t test. Additionally, index operations, prosthetic implantation and need for removal of vascular grafts were calculated. All muscle flaps were performed by vascular surgeons.
RESULTS: Twenty nine flaps were studied on 24 different patients. Twenty-two of the flaps were sartorius muscle flaps and 7 were gracilis muscle flaps. The mean age of the patients was 60.3 ± 7.1. Ten patients were female, 14 were male. The average BMI was 24.5 ± 5.8. The mean healing time was 6.2 ± 2.5 weeks and all wounds healed. The mean healing time of the gracilis muscle flap group was 5.3 ±2.7 weeks vs 6.5 ± 2.4 weeks in the sartorius muscle flap group (p=0.26) and was not different between genders (P=0.51). In tabulating the patient comorbidities, 93% had HTN, 52% CAD, 17% CKD, 34% DM, 10% CHF, 100% PAD, 93% tobacco abuse, 21% COPD, and 7% were immunocompromised. Sixty nine percent of the wounds required wound vacs (p=0.46), 10% required skin grafts (p=0.71) and 41% were closed primarily after muscle flap creation (p=0.06) (Figure 2). Indications for muscle flap included lymphatic leak (24%), leaking hematoma (17%), prophylactic (10%), and wound infection (48%) (Figure 1). Mean antibiotic administration duration was 5.5 ± 2.0 weeks although many of the cultures were sterile. Forty five percent of the operations were done in native groins and 55 percent were re-do groins (p=0.44). Twenty-six of the patients (90%) had prosthetic placed during their index operation and 28% of those patients required prosthetic removal during the muscle flap creation (P<0.0001). Seventy two percent of the patients had PTFE prosthetics and 24% of the patients had bovine prosthetics (p<0.0001). One patient later required an amputation from a septic knee.
CONCLUSIONS: Muscle flaps prove to be an effective treatment option for wound complications in both native and re-do groin operations in vascular surgery, with high limb salvage rates and low prosthetic removal rates. Vascular surgeons should familiarize themselves with these techniques.
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