Cutaneous vascularization of the femoral triangle in respect to groin incisions

Abstract

The classic incisions could disrupt the cutaneous blood supply and thus increase the risk of tissue necrosis around the wound, explaining the observed postsurgical complications and infections. We propose to lower the vertical incision to start 2 cm under the inguinal ligament to reduce lesions of the cutaneous arteries and the potential devascularization of the wounds.

Deep and superficial circumflex iliac arteries and their relationship to the ultrasound‐guided femoral nerve block procedure: A cadaver study

“…Thus, at least one arterial branch originated from the femoral artery and headed toward the lateral part of the thigh between the level of the inguinal ligament and the first bifurcation of the femoral artery in 94 of 100 (94%) femoral triangles. Overall, the DCIA located around the inguinal ligament and the SCIA were usually identified about 2 cm distal to the inguinal ligament ( (Tremblay et al, 2016). The external diameters of the SCIA and DCIA at their origin were approximately 2 and 3 mm, respectively ( Table 5).…”

“…Overall, the DCIA located around the inguinal ligament and the SCIA were usually identified about 2 cm distal to the inguinal ligament (Table , Figs. and ) (Tremblay et al, ). The external diameters of the SCIA and DCIA at their origin were approximately 2 and 3 mm, respectively (Table ).…”

“…Likewise, the SCIA can also be visualized during USG‐FNB using the in‐plane lateral to medial approach because >90% of SCIA heading toward the lateral part of the thigh arose cephalad to the first bifurcation of the femoral artery. However, it can be difficult to identify the SCIA by ultrasonography because its external diameter (about 2 mm) (Sinna et al, ) is smaller than that of the DCIA and it tends to have a winding configuration (Tremblay et al, ). When multiple discontinuous hypoechoic structures are found between the fascia iliaca and fascia lata or superficial to the fascia lata (Fig.…”

“…). The superficial (SCIA) and deep (DCIA) circumflex iliac arteries are considered to originate from the lateral aspects of the femoral and external iliac arteries, respectively, and run laterally to the ipsilateral anterior superior iliac spine (ASIS) along with the inguinal ligament (Neil and Jeremiah, ; He et al, ; Tremblay et al, ). Therefore, the SCIA or DCIA can be visualized and can be inadvertently punctured during USG‐FNB using the in‐plane lateral to medial approach.…”

Tensor fascia lata flap is a workhorse for defects after inguinal lymph node block dissection

“…A significantly reduced rate of cellulitis [18], wound dehiscence, and chronic lymph edema was found, and among other things it was shown that ligation of great saphenous vein did not significantly impact the development of mentioned complications, including the limb lymphedema formation, even on long-term follow-up [19]. In terms of vascular anatomy, as suggested by other authors, the vertical incision of the region should be placed 2 cm distal to the inguinal ligament to maintain the vascular supply, when possible, in order to prevent the tissue devascularization and consequent tissue necrosis [20].…”