Outcome analysis of 244 consecutive flaps for managing complex groin wounds

Fischer, John P.; Mirzabeigi, Michael N.; Sieber, Brady A.; Nelson, Jonas A.; Wu, Liza C.; Kovach, Stephen J.; Low, David W.; Serletti, Joseph M.; Kanchwala, Suhail

doi:10.1016/j.bjps.2013.06.014

Cited by 34 publications

(50 citation statements)

References 19 publications

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“…12 Gravvanis A et al and Fischer JP et al frequently utilized the Sartorius muscle flap for groin prophylaxis. 2,7,12,17,22 This match with our point of view on which this study was designed based on the principle of prophylaxis is better than treatment. We believe that it will decrease the morbidity and the bill for medical service.…”

Section: Discussionmentioning

confidence: 66%

“…7 Fischer JP et al in their studies showed higher or equal complication rate with control groups and less complication rate when used prophylactic muscle flaps. 12,17 The explanation of this may be as in present study the patients were composite of vascular causes and post inguinal lymphadenectomy patients. The latter which by nature have higher complication rate that raised the total overall rates compared to Fischer JP et al who worked on vascular causes only.…”

Section: Discussionmentioning

confidence: 72%

“…The latter which by nature have higher complication rate that raised the total overall rates compared to Fischer JP et al who worked on vascular causes only. 12,17 This is supported by the higher rate of complications of Faut M et al who worked over lymphadenectomy patients without prophylactic flaps, they described on 244 lymphadenectomy patients the overall complication rate was 51.2 % with wound infection 29.8 %, seroma 21.5 %, skin necrosis 13.6 %, and hematoma 5 %.…”

Section: Discussionmentioning

confidence: 91%

“…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. 20 Financial wise, all these actions quickly translate into healthcare costs.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

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

et al. 2017

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Background: Groin vascular infections are potentially catastrophic situations as limb loss or even death may occur in a high percentage of patients. A growing evidence support the benefit of muscle flap covering for these non-healing or infected wounds with stressing on their increased efficacy when used prophylactically. Sartorius muscle flap is granted here by its anatomical characteristics.Methods: Fifty Sartorius muscle flaps were done for 39 patients. Flaps were done routinely on prophylactic basis for protection of native femoral vessels or vascular grafts either for oncological or vascular causes in conjunction with inguinal lymphadenectomy or femoral bypass graft. Great care was taken to preserve the first segmental branch to the muscle and avoided its injury.Results: Prophylactic Sartorius muscle flap was done for oncological causes in 46% while for vascular causes in 54% of total flap number. The operative time ranged from 14-20 minutes for every flap with mean 16 minutes with negligible blood loss and no any donor site morbidity. The complication rate was 26%, including mild skin infection 12%, seroma 6%, partial superficial skin necrosis 6%, and hematoma 2%.Conclusions: Sartorius muscle flap has versatile benefits. Its role has been proved as a shield protecting and covering the femoral vessels or vascular grafts and resulted in decreased rate of overall complications. We recommend prophylactic Sartorius muscle flap coverage on routine basis considering it the workhorse of efforts done to vascular protection.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

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

et al. 2017

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Vastus lateralis versus rectus femoris muscle flaps for recalcitrant hip joint infection: An anatomical study comparing the effectiveness of acetabular dead space control

et al. 2022

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Eliminating recalcitrant prosthetic hip joint infections remains one of the greatest challenges in orthopedic surgery. In such cases, the salvage procedure of femoral head excision (the Girdlestone procedure) is often performed. There has been emerging surgical interest in filling the resulting acetabular dead space with a pedicled muscle flap, to enable antibiotic delivery. Both vastus lateralis (VL) and rectus femoris (RF) muscle flaps have been described for this purpose with good success. This study is the first anatomical investigation comparing VL and RF as candidates for interposition myoplasty following hip joint excision. Following standard surgical technique, the Girdlestone procedure and interposition myoplasty of both RF and VL were performed on 10 cadavers. The primary aim was to determine which muscle flap eliminated a greater volume of acetabular dead space. Secondary aims were to characterize the blood supply to RF and assess additional metrics indicative of the likelihood of flap success. The VL flap eliminated more dead space than RF. However, the use of the RF flap was feasible in all cases and has several benefits, including ease of harvest, mobility, and aesthetics. The location of the inferior vascular pedicle into RF was relatively consistent and the most effective predictor of flap success. Both VL and RF are effective in reducing acetabular dead space. While VL can fill a greater volume, the RF flap has technical advantages, related to the predictability of the blood supply.

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Pedicled chimeric sensitive fasciocutaneous anterolateral thigh (ALT) and vastus lateralis muscle (VLM) flap for groin defect reconstruction: A case report

2017

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The anterolateral thigh (ALT) flap is one of the most commonly used flap worldwide, as both free flap and pedicled local flap. Here, we report the use of a pedicled chimeric sensitive ALT and vastus lateralis muscle (VLM) flap in a patient with a 12 cm × 8 cm contaminated soft tissue defect of the right inguinal region with exposed femoral vessels. The flap was harvested based on two perforators, one musculocutaneous and one pure muscular, each nourished separately a sensitive fasciocutaneous component and a vastus lateralis muscle component, respectively. The muscle part was tailored to wrap around the exposed vascular structures, while the innervated skin and fascia component of the flap provided a tension-free closure of the wound. The post-operative course was uneventful and the patient was discharged at 1 week post-operative. Even though it requires technical skills and experience in perforator dissection, we believe that the pedicled chimeric sensitive ALT and VLM flap may be one of the best solutions in case of exposed femoral vessels in contaminated wounds.

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Outcome analysis of 244 consecutive flaps for managing complex groin wounds

Cited by 34 publications

References 19 publications

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

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

Vastus lateralis versus rectus femoris muscle flaps for recalcitrant hip joint infection: An anatomical study comparing the effectiveness of acetabular dead space control

Pedicled chimeric sensitive fasciocutaneous anterolateral thigh (ALT) and vastus lateralis muscle (VLM) flap for groin defect reconstruction: A case report

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