The impact of superficial femoral artery (SFA) occlusion on the outcome of proximal sartorius muscle transposition flaps in vascular surgery patients

Abstract

Biologic protection procedures as local muscle flaps are vital adjuncts to vascular surgery techniques in the treatment of complicated wounds in the groin. Occlusion of the SFA in the presence of a patent PFA is not associated with an increased risk of flap loss in proximal sartorius muscle rotational flaps.

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections

“…When the deep femoral artery is patent, the patency of superficial femoral artery does not affect the viability of the SMF. 241,242 However, SMF viability is compromised when the deep femoral artery is occluded. In such cases, revascularisation of the deep femoral artery is needed, either directly or indirectly (obturator bypass).…”

The Marriage of Sartorius and Tensor Fasciae Latae in Treating Vascular Prosthetic Graft Infections

“…Those who support the notion of a type 4 segmental supply remain cautious using the muscle in circumstances where the superficial femoral vessel is compromised. However, in a study by Töpel et al, 13 a sample group of 53 patients with 56 SM flap transpositions were observed for flap viability, 23 of which had patent superficial femoral arteries and 33 were occluded. The deep femoral artery was classified as patent in all 56 cases.…”

“…After an average follow-up time of 6.4 months, 54 viable flaps were documented. Much like Ramasastry et al, 34 Töpel et al 13 proposed that the patency of the superior femoral artery has little to do with flap viability, provided the deep femoral artery remains open and undiseased. In all the 5 of our patients, a viable SM flap could be harvested.…”

“…2,3,11,12 There is a growing use of prosthesis-sparing interventions advocated, albeit in specific patients, namely systemic and local antibiotic infiltration, catheter irrigation and drainage, muscle flap transposition, and negative wound pressure therapy (NWPT), in variable combinations with one another. 1,10,13–16 Although NWPT has shown to be a valuable treatment option, there are situations where stable wound coverage cannot be obtained with such a modality alone. In a case report from 1979, Hill et al 17 used a combination of sartorius muscle (SM) flap and tensor fascia lata (TFL) musculocutaneous flap to cover the femoral vessels and close a groin wound after tumor resection.…”

Management of Infected Femoral Artery Pseudoaneurysm Repair: Rectus Abdominis Flap as Second-Line Management after Sartorius Flap Failure

“…The blood supply to the rectus femoris muscle is also largely from the profunda femoris artery [15]. Ligation of the superficial femoral artery (SFA) may not affect the viability of the sartorius muscle flap, but this possibility may not extend to cases in which both the SFA and the profunda femoris arteries have been ligated [16].…”