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

Ahmed Fawzy; Ahmed Gaber; Hesham Abugruidah; Ahmed El Kased

doi:10.18203/2349-2902.isj20172577

Authors

Ahmed Fawzy Department of General Surgery, Faculty of Medicine, Al Menofia University, Egypt
Ahmed Gaber Department of General Surgery, Faculty of Medicine, Al Menofia University, Egypt
Hesham Abugruidah Department of General Surgery, Faculty of Medicine, Al Menofia University, Egypt
Ahmed El Kased Department of General Surgery, Faculty of Medicine, Al Menofia University, Egypt

DOI:

https://doi.org/10.18203/2349-2902.isj20172577

Keywords:

Femoral vascular grafts, Inguinal lymphadenectomy, Sartorius muscle flap

Abstract

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.

Metrics

Metrics Loading ...

Author Biography

Ahmed Gaber, Department of General Surgery, Faculty of Medicine, Al Menofia University, Egypt

Department of General Surgery, Faculty of Medicine, Al Menofia University.

References

Alkon JD, Smith A, Losee JE, Illig KA, Green RM, Serletti JM. Management of complex groin wounds: preferred use of the rectus femoris muscle Flap. Plast Reconstr Surg. 2005;115(3):776-83.

Fischer JP, Nelson JA, Shang EK, Wink JD, Wingate NA, Woo EY, et al. Predicting the need for muscle flap salvage after open groin vascular procedures: a clinical assessment tool. J Plast Surg Hand Surg. 2014;48:389-95.

Williams IM, Milling MA, Shandall AA. Vascularised muscular flaps and arterial graft infection in the groin. Eu J vasc endovas surg. 2003;25(5):390-5.

Alsisi AE, Al batanony AA, El-Saka D, Fawzy A. Immediate closure of groin wounds after inguinal lymphadenectomy using anterolateral thigh flap for the at-risk skin. Kasr El Aini J Surg. 2014;15(1):99-104.

El Kased AF. Use of inferiorly based rectus abdominis myocutaneous flap for reconstruction of large groin defects following tumour resection. Sc J Az Med Fac. 2002;23(2):741-57.

Gupta AK, Kingsly PM, Jeeth IJ, Dhanraj P. Groin reconstruction after inguinal block dissection. In J urol. 2006;22(4):355-9.

Gravvanis A, Caulfield RH, Mathur B, Ramakrishnan V. Management of inguinal lymphadenopathy immediate sartorius transposition and reconstruction of recurrence with pedicled ALT Flap. Ann Plast Surg. 2009;63(3):307-10.

Ravi R. Morbidity following Groin Dissection for Penile Carcinoma. British J Urol. 1993;12:941-5.

Baronofsky ID. Technique of inguinal node dissection. Surg. 1948;24:555-65.

Wu LC, Djohan RS, Liu TS, Chao AH, Lohman RF Song DH. Proximal vascular pedicle preservation for sartorius muscle flap transposition. Proximal vascular pedicle preservation. Plast Reconstr surg. 2006;117(1):253-8.

Méndezfernández MA, Quast DC, Geis RC, Henly WS. Distally based sartorius muscle flap in the treatment of infected femoral arterial prostheses. J Cardiovasc Surg. (Torino) 1980;21:628-31.

Fischer JP, Nelson JA, Mirzabeigi MN, Wang GJ, Foley PJ, Wu LC, et al. Prophylactic muscle flaps in vascular surgery. Vasc Surg. 2012;55:1081-6.

Stuiver MM, Djajadiningrat RS, Graafland NM, Vincent AD, Lucas C, Horenblas S. Early wound complications after inguinal lymphadenectomy in Penile Cancer: a historical cohort study and risk-factor analysis. Eur Urol. 2013;64(3):486-92.

Faut M, Heidema RM, Hoekstra HJ, van Ginkel RJ, Been SL, Kruijff S, et al. Morbidity after inguinal lymph node dissections: it is time for a Change. Ann Surgic Oncol. 2017;24(2):330-9.

Gopman JM, Djajadiningrat RS, Baumgarten AS, Espiritu PN, Horenblas S, Zhu Y, et al. Predicting postoperative complications of inguinal lymph node dissection for penile cancer in an international multicentre cohort. BJU Int. 2015;116:196 -201.

Ryu DY, Jung HJ, Ramaiah VG, Rodriguez-Lopez JA, Lee SS. Infected groin (graft/patch): managed with sartorious muscle flap. Vasc Spec Int. 2016;32(1):11-16.

Fischer JP, Mirzabeigi MN, Sieber BA, Nelson JA, Wu LC, Kovach SJ, et al. Outcome analysis of 244 consecutive flaps for managing complex groin wounds. J Plast Reconstr Aesthetic Surg. 2013;66:1396-404.

Khalil IM, Sudarsky L. Sartorius muscle "twist" rotation flap: an answer to flap necrosis. JVS. 1987;6(1):93-4.

Landry GJ, Carlson JR, Liem TK, Mitchell EL, Edwards JM, Moneta GL. The Sartorius muscle flap: an important adjunct for complicated femoral wounds involving vascular grafts. Am J Surg. 2009;197( 5):655-9.

Schutzer R, Hingorani A, Ascher E, Markevich N, Kallakuri S, Jacob T. Early transposition of the sartorius muscle for exposed patent infrainguinal bypass grafts. Vasc Endovasc Surg. 2005;39(2):159-62.

Menzin J, Marton JP, Meyers JL, Carson RT, Rothermel CD, Friedman M. Inpatient treatment patterns, outcomes, and costs of skin and skin structure infections because of staphylococcus aureus. Am J Infect Contr. 2010;38:44-9.

Fischer JP, Nelson JA, Rohrbach JI, Wu LC, Woo EY, Kovach SJ, et al. Prophylactic muscle flaps in vascular surgery: the penn groin assessment scale Plast Reconstr Surg. 2012;129:940e-9e.

Kotb H. Lower extremity vascular prosthesis infection - successful salvage with local muscular flap reconstruction. Bull Alex Fac Med. 2008;44(1):173-8.

Perez-Burkhardt JL, Gonzalez-Fajardo JA, Carpintero LA, Mateo AM. Sartorius myoplasty for the treatment of infected groins with vascular grafts. J Cardiovasc Surg. 1995;36(6):581-5.

Twine CP, Lane IF, Williams IM. Management of lymphatic fistulas after arterial reconstruction in the groin. Ann vasc surg. 2013;27(8):1207-15.

Mojallal A, Wong C, Shipkov C, Hocuoq C, Recchiuto J, Brown S, et al. Redefining the Vascular Anatomy and Clinical Applications of the Sartorius Muscle and Myocutaneous Flap. Plast Reconstr Surg. 2011;127(5):1946-57.

Calderon W, Chang N, Mathes SJ. Comparison of the effect of bacterial inoculation in musculocutaneous and fasciocutaneous flaps. Plast Reconstr Surg. 1986;77:785.

Silvestre L, Pedro LM, e Fernandes RF, Silva E, e Fernandes JF. Rectus femoris muscle flap based on proximal insertion mobilization to cover a groin infected vascular graft. J vasc surg. 2015;62(4):1064-7.

Chatterjee A, Kosowski T, Pyfer B, Fisher CS, Tchou JC, Maddali S. A cost-utility analysis comparing the sartorius versus the rectus femoris flap in the treatment of the infected vascular groin graft wound. Plast Reconstr surg. 2015;135(6):1707-14.