Infected Groin (Graft/Patch): Managed with Sartorious Muscle Flap

Abstract

Purpose:The purpose of this study was to review the natural history, clinical outcome and safety in patients undergoing sartorius muscle flap (SMF) for groin infection, including lymphocele.Materials and Methods:We retrospectively reviewed the records of patients who underwent SMF in a single center between 2000 and 2009.Results:Thirty patients (17 male, 13 female) underwent SMF for groin infection, which included infections of 22 artificial femoral bypass grafts (including 2 cryoveins) and 5 common femoral patch grafts, and 3 lymphocele infections (2 cardiac catheterizations and 1 penile cancer lymph node dissection). Wound isolates were most commonly Gram-positive organisms (n=22) with Gram-negative isolates and mixed infections accounting for 4 and 3 cases, respectively. In 9 patients there was no growth of organisms. Adjunctive wound vacuum-asssisted wound closure therapy was performed in 18 patients. Follow-up duration ranged from 8 days to 56 months (mean 14.1 months) after SMF. Reoperation was performed in 3 patients due to wound bleeding (n=1) and reinfection (n=1). One patient underwent graft excision with external bypass operation. There was 1 mortality case due to sepsis during the study period.Conclusion:We found that muscle flap surgery provides successful single-intervention therapy for groin infections including lymphocele. Graft ligation or aggressive excision with bypass surgery should be reserved for patients requiring rapid control of sepsis for lifesaving.

Reconstructive Surgery of Inguinal Defects: A Systematic Literature Review of Surgical Etiology and Reconstructive Technique

“…Hospital stay and follow-up. Fifteen papers reported on the length of hospitalisation (10,16,17,22,23,27,(32)(33)(34)(35)(36)(37)(38)(39)41). The average hospital stay after the reconstruction was in vivo 33: 1-10 (2019) 2 Table I.…”

Protection of femoral vessels and vascular grafts after inguinal lymphadenectomy or femoral bypass by using prophylactic routine sartorius muscle flap shield coverage

“…29 Ryu DY et al mentioned that Sartorius muscle flap lacks bulk and has a limited arc rotation, making it suboptimal for large wounds, in comparison to rectus femoris muscle flap, but the rectus femoris muscle flap needs a longer separate incision in the thigh. 16 They stated also that due to the segmental blood supply arising from superficial femoral artery, some vascular surgeons might hesitate to use the Sartorius muscle flap in patients with an occluded superficial femoral artery. Lastly despite this they concluded that the use of Sartorius muscle flap is recommended to treat groin wound infection, including lymphoceles.…”

“…Limb loss and mortality rates were reported as 10% -79% and 9% -58%, respectively. 16 Many of new researches suggest early initiation of targeted anti-microbial therapy and debridement, in conjunction with coverage of the femoral vessels by viable muscle flap, can help in achieving graft and limb salvage. [17][18][19] In 2005 Schutzer R et al recommended the early transposition of the Sartorius muscle for exposed patent infra-inguinal bypass grafts describing it as the viable alternative in the armament of the surgeons.…”

“…This is supported by many authors. 2,3,7,[10][11][12][16][17][18][19][20][22][23][24][25][26] Moreover Wu LC et al stated that well-vascularized muscle can deliver increased levels of oxygen, nutrients and antibiotics, as well as it conform and fill defects. 10 This is supported by Calderon W et al in their study on dogs, who stated that the bacterial count was significantly higher in fasciocutaneous flaps than muscular or musculocutaneous flaps with increased levels of the collagen and hydroxyproline inside the wound.…”

A systematic review on the use of muscle flaps for deep groin infection following vascular surgery

“…The 17 included articles were published between 1994 and 2017. 2,3,9,10,[16][17][18][19][20][21][22][23][24][25][26][27][28] Two studies were case reports 18,19 ; the other 15 were retrospective cohort studies. A summary of the most important study characteristics of the included articles and the methodological scores is provided in Table I.…”