Reconstruction of complex groin defects with inferior epigastric artery-based rectus abdominis muscle flaps: report of two cases

Kuvat, Samet Vasfi; Yanar, Hakan; Bi̇çer, Ahmet; Tunçer, Serdar; Özalp, Burhan; Topalan, Murat

doi:10.5505/tjtes.2011.32848

Cited by 3 publications

(4 citation statements)

References 16 publications

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“…Twenty-two studies, including 538 patients, reported on inguinal reconstruction following vascular surgery: cannulation of femoral artery or vein, aorto-femoral or femoro-popliteal bypass, and often not specified (2,. Others causes leading to inguinal defect requiring reconstructive surgery involved trauma (four papers of 11 patients) (26)(27)(28)(29), infections (three papers of 10 patients) (2,26,30), post burn contractions (one paper of 1 patient) (31), and one paper of a strangulated inguinal hernia with parietal abscess and necrosis of 23 patients (40). All flap types used for each subgroup are presented in Table I.…”

Section: Resultsmentioning

confidence: 99%

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

Sörelius

Schiraldi

Giordano

et al. 2018

In Vivo

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Background/Aim: This study aimed to evaluate the literature regarding surgical etiology demanding inguinal reconstructive surgery, associated reconstructive techniques and outcomes. Materials and Methods: A systematic literature search was performed according to the PRISMA statement between 1996-2016. Results: A total of 64 articles were included, comprising 816 patients. Two main subgroups of patients were identified: Oncological resections (n=255, 31%), and vascular surgery (n=538, 66%). Oncological resection inguinal defects were treated with pedicled myocutaneous flaps (n=166, 65%), fasciocutaneous flaps (77, 31%), muscle flaps (7, 3%) and direct closure (3, 1%). Vascular surgery complications were treated with muscle flaps (n=513, 95%). Complications for the respective subgroup (oncological resections, vascular surgery) were: infection (24%, 14%), seroma (34%, 7.5%), flap dehiscence/delayed healing (20.6%, 40.8%,). The total reintervention rate was 20%. Conclusion: Reconstruction of inguinal defects should be addressed on a case-by-case basis. Myocutaneous flaps were favoured after oncological resections, while muscle flaps were preferred after vascular surgery. The inguinal region represents a crucial intersection of fundamental anatomical structures, such as the femoral artery, vein, nerve, the inguinal node stations and the inguinal canal. This makes the inguinal carrefour a common surgical site for interventions that range from surgical lymphadenectomy, diverse oncological resections to a number of vascular, visceral and urological surgical procedures. Such procedures may result in soft tissue defects and exposure of key anatomic elements, requiring reconstruction. However, if radical inguinal oncological surgery is more likely to produce a primary defect or dead space, vascular and general surgery procedures, may incur wound dehiscence, delayed healing, and abscess formation, finally requiring radical aggressive debridement leading to a secondary soft tissue and skin defect. The anatomical features of inguinal defects in the particular location between the abdominal and the thigh, and in the vicinity of the anogenital region, make the reconstruction of the inguinal region challenging for the plastic surgeon. The poor healing of wounds in the inguinal region has been attributed to wide defects with bacterial contamination, noncollapsible dead spaces, lymphatic leaks and the healing difficulties related to a low vascularized, or eventually irradiated field (1, 2), depending on the primary pathology. The post-operative morbidity associated with inguinal surgery is well documented in the literature, with an incidence of complications as high as 40% (3). The aims of this systematic literature review were to comprehensively review the last two decades of literature concerning inguinal reconstructions, focusing on etiology, and associated reconstruction techniques and outcomes with complications associated with respective etiology and 1 This article is freely accessible online.

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Section: Resultsmentioning

confidence: 99%

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

Sörelius

Schiraldi

Giordano

et al. 2018

In Vivo

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“…Medial Thigh ap was used for scrotal reconstruction in 5 cases (20%) out of which 4 patients had soft tissue defects due to Fournier's gangrene whereas 1 patient had a groin defect following tumor excision. Various authors in their studies have utilized a variety of aps for coverage of soft tissue 11,15,21,22,23,24,25 defects of the groin and genitalia.…”

Section: Discussionmentioning

confidence: 99%

Management of Acquired Soft Tissue Defects of Groin and Genitalia

Sharma

Samad

Dogra

et al. 2020

IJAR

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Background: The defects of the groin and the genitalia are complex and pose a challenge to the reconstructive surgeon. These defects may arise out of a variety of insults which include – extirpative oncologic surgeries, necrotizing fasciitis, post burn defects, post traumatic defects including road traffic accidents and animal bites etc. Objectives: To study the epidemiology of the acquired soft tissue defects of the groin and genitalia. To evaluate the role of various reconstructive modalities for the acquired soft tissue defects of groin and genitalia. Materials & Methods: This study was conducted in the Department of Surgery, Govt. Medical College Jammu, J&K, India and included 25 patients admitted with acquired soft-tissue defects of groin and genitalia over a period extending from November 2018 to October 2019 (Prospective study). Personal and demographic data of the patient was noted. A detailed history regarding the cause of the defect along with history of trauma, discharge and bleed from the site was taken. Any past history of surgery and irradiation of the region was noted. The patients having soft tissue defects of the groin and genitalia secondary to the release of post burn contracture were subjected to the detailed history as regards cause of burn, treatment taken and time taken for burn wounds to heal. Examination included general physical examination along with the local wound condition which included site, size, discharge, slough, granulation tissue and any exposed vital structures such as vessels/ nerves. A hemogram, assessment of blood sugar, renal function (blood urea nitrogen and serum creatinine), coagulation profile, blood grouping, viral markers, chest x-ray and ECG were done as a part of routine pre-operative investigations. Wound swab was sent for culture. Biopsy was taken wherever required. Analysis of report of any previously taken biopsy was done. Split thickness skin grafting was the modality of coverage utilized in 56% cases followed by flap coverage in 32% cases. 12% of the defects were closed primarily. Results: Majority of the patients had durable coverage of the defects of groin/genitalia and the coverage modality was acceptable to the patient as regards aesthesis and functional outcome. No major complication was encountered in any of the patients. Conclusion: The reconstruction of the soft tissue defects of groin and genitalia need a meticulous examination and planning of reconstructive modality which may include skin grafting or a flap coverage.

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“…Rectus abdominis flap based on inferior epigastric vessels can be used with success to cover large groin defect [ 9 , 17 , 18 ]. The vessel stump from groin defect can also be covered by transposition of sartorius muscle [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…The groin large defect resulting from excision of complicated inguinal metastases of penile cancer can be cover by local and distant flaps [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

How to Deal With Penile Carcinoma Inguinal Metastasis Invading Femoral Vessels

Fodor

Petruț

Fodor

2017

Medicine and Pharmacy Reports

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Penile cancer accounts for 1–10% of men neoplastic diseases and 30–60% of patients have inguinal metastases at the time of diagnosis. Inguinal metastases of penile cancer with femoral vessel involvement could lead to vascular fistula and hemorrhagic shock. We present 3 consecutive patients with inguinal metastases of penile cancer complicated by infection and hemorrhage from femoral vessels invaded by the tumor. Simultaneous extra-anatomical axillo-femoral bypass graft, wide excision of tumor and groin defect reconstruction was used to achieve “tumor-free” oncologic aim and to save the lower limb. We consider the extra-anatomic axillo-femoral bypass associated with wide inguinal tumor excision and defect covering a feasible surgical solution for improving the life quality and extend life expectancy in patients with lymph node metastasis of penile cancer complicated by necrosis, infection and femoral vessel involvement.

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Reconstruction of complex groin defects with inferior epigastric artery-based rectus abdominis muscle flaps: report of two cases

Cited by 3 publications

References 16 publications

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

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

Management of Acquired Soft Tissue Defects of Groin and Genitalia

How to Deal With Penile Carcinoma Inguinal Metastasis Invading Femoral Vessels

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