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“To Cover or Not To Cover, That Is the Question”; Rectus Femoris Muscle Flaps in Groin Defects after Vascular Surgery

2016; Elsevier BV; Volume: 52; Issue: 3 Linguagem: Inglês

10.1016/j.ejvs.2016.07.073

1532-2165

Jurek Z.M. Conings, Jan-Willem Daemen, Ilse Mostaert, Jan-Willem Elshof, Marc R. Scheltinga, Barend Mees,

Reconstructive Surgery and Microvascular Techniques

Introduction: Vascular surgery complications in the groin can lead to significant soft tissue defects and serious life threatening infections and are therefore challenging for surgeons. Worldwide the sartorius flap is the most used and described technique for coverage of groin defects. The rectus femoris flap is an alternative technique to cover these defects without any tension. For this technique, a distal incision is made on the upper leg in the musculus rectus femoris to detach the muscle, tunnel it subcutaneously and cover the groin. The aim of this study was to evaluate the results of the rectus femoris flap as a tool in treating groin defects. Methods: In the Netherlands, data was collected in three centers of all patients undergoing rectus femoris flap coverage of groin defects between 2000 and 2015. In total, 77 groin defects were treated in 70 patients. Outcomes were defined as clinical success (recovery and hospital discharge without major bleeding, sepsis or amputation), survival, 30-day complication rate and reintervention after the index operation of the rectus femoris flap. Results: Indications for rectus femoris muscle flap coverage of groin defect were hematoma or bleeding, blow-out, false aneurysm, wound infection, infected non-human implant, and re-do bypass surgery. Initial procedures included a large variety of bypasses and endovascular procedures. The average number of previous operations in the groin of interest was 2.1 (range 1–6). Clinical success was 76% (53/70 patients). A total of 17 patients died because of sepsis (n = 8), postoperative unsuccessful reanimation (n = 1), massive bleeding (n = 1), heart failure (n = 1) and other causes than vascular or flap related (n = 6). No amputations were described. A total of 23 groin complications was seen after rectus femoris flap coverage including infection (n = 8), graft loss (n = 15), bleeding (n = 6), blow-out (n = 2) and necrosis of the muscle flap (n = 1). In 1 patient there was a donor site complication due to bleeding. Conclusion: This is the largest European series of rectus femoris flaps for vascular surgery groin complications and demonstrates that this technique is an effective treatment for coverage of large groin defects. The outcomes confirm the significant morbidity and mortality of this patient group. Disclosure of Interest: None Declared.