Salvage of Exposed Groin Vascular Grafts with Early Intervention Using Local Muscle Flaps

Abstract

Background:Peripheral vascular surgery may be complicated by wound infection and potential graft exposure in the groin area. Muscle flap coverage of the graft has been promoted to address these wound complications. The authors present their findings regarding graft salvage rates and patient outcomes using local muscle flaps to address vascular graft complications of the groin.Methods:Data were obtained by retrospective cohort study of patients who underwent a local muscle flap procedure by a single surgeon following vascular graft complication in the groin.Results:Seventeen patients undergoing local muscle flap coverage of a vascular graft were reviewed. Six men and 9 women, 51–80 years old, were included in the study. Wound complications in the groin occurred anywhere from 3 days to 3.5 years following graft placement. Graft exposure was the most common presenting complication (14 of 17 patients). Muscle flap coverage occurred within 15 days of complication presentation in all patients (average, 6.4 days). Seven of the 15 patients experienced postoperative complications within 6 months of the procedure, most commonly wound dehiscence. However, analysis demonstrated that vascular grafts were successfully salvaged in 10 of the 17 patients (59%) over the course of follow-up (range, 104–1748 days). Average time to muscle flap coverage was 4.2 days in patients who retained the graft and 9.6 days in patients who ultimately lost their vascular graft.Conclusion:The authors demonstrate improved vascular graft salvage rate when local muscle flap procedure is performed early after initial wound complication presentation.

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.…”

Salvage of Infected Prosthetic Grafts at the Groin or Thigh Using Muscle Flap Coverage

“…14,15) Conversely, May et al reported that six of seven patients with graft losses underwent NPWT before MFC and concluded that MFC performed soon after initial wound complication presentation improved vascular graft salvage. 16) Svensson et al reported 2 early bleeding and 3 late pseudoaneurysms in 33 patients with vascular groin infections who were treated by NPWT and concluded that vascular graft infections of the groin treated with NPWT were at greater risk of developing infection-related complications, which were associated with higher rates of amputation and death. 17) We did not always attempt graft salvage by MFC in patients with PGIs.…”

Primary selection of a pedicled rectus femoris flap for protection of aortic graft

“…A 2015 study of 244 patients undergoing either prophylactic or salvage muscle flap coverage concluded that sartorius muscle flaps are better suited in prophylactic settings and salvage procedures in which the wound bed is small, whereas rectus femoris flaps are more appropriate for larger salvage operations 6 . However, this study and the majority of available literature describe the use of muscle flaps in the presence of active infection at the groin site 6 . We could find no case of a rectus muscle flap for aortic graft coverage to prevent infection.…”