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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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