Femoral Vein Interposition Graft and Rectus Femoris Muscle Flap for Management of Infected Bovine Pericardial Patch Following Femoral Endarterectomy
Evan J. Ryer, MD, Jessica Green, MD, PhD, Josiah E. Miller, BA, Matthew C. Cindric, MD, James R. Elmore, MD.
Geisinger Medical Center, Danville, PA, USA.
Groin wound complications following femoral artery reconstructions are highly morbid, limb threatening and potentially lethal. Successful techniques to manage this condition include long term antibiotic therapy, serial operative debridements and eventually muscle flap coverage. Historically, the management of these complex wounds has been performed by plastic and reconstructive surgeons. In contrast, many vascular surgeons now perform rotational muscle flaps for coverage of complex groin wounds with excellent outcomes. In this video, we perform an emergent femoral vein interposition graft followed by rectus femoris muscle flap coverage for an infected bovine pericardial patch following iliofemoral endarterectomy for critical limb ischemia. Advantages of the rectus femoris muscle is that it provides a large donor muscle with a consistent blood and nerve supply. The disadvantage of harvest is some mild loss of strength with knee extension. The rectus femoris muscle flap is a dependable option for the management of complex groin wounds even in the presence of peripheral vascular disease and can be expertly performed by vascular surgeons. We believe that the rectus femoris muscle flap is the flap of choice for a complex groin wound reconstruction highlighted in this video.
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