Muscle Flaps By Vascular Surgeons For Aggressive Limb Salvage
Nicholas Russo, MD, Tigran Divanyan, MD, Neil Patel, MD, Jeffrey Hnath, MD, R Clement Darling III, MD.
Albany Medical Center / Albany Medical College, Albany, NY, USA.
OBJECTIVES: Complex groin wounds after revascularization are not uncommon and are associated with potentially lethal complications. Several muscle flap options offer bypass and wound coverage, however these techniques have been losing emphasis in vascular surgery education. Our goal was to evaluate the outcomes of muscle flaps performed by the vascular surgery service. METHODS: A single vascular group’s database was queried for all patients who received a lower extremity revascularization and a muscle flap performed by a vascular surgeon in the setting of infection or wound from 2009-2019. Demographics, indications, operative details, and long-term results were recorded and compared. Groups were compared utilizing standard statistical approach. RESULTS: 6107 lower extremity reconstructions (4695 infrainguinal, 826 aortobifemoral, 586 axillo-bifemoral) were performed between 2009 and 2019. Of these patients a total of 114 patients met inclusion criteria. Demographics were similar to historic data; mean age 71.2 (40-95), BMI 29.9 (16-53), diabetes 45% (51/114), hypertension 83% (95/114), CAD 47% (54/114), COPD 13% (15/114), current smoker 31% (35/114), former smoker 27% (31/114), hyperlipidemia 67% (76/114), ESRD 10% (11/114), previous bypass 57% (65/114), previous amputation 17% (19/114). Muscle flap coverage included sartorius muscle 90% (103/114), rectus femoris 4.5% (5/114), gastrocnemius/soleus 4% (5/114), gracilis <1% (1/114). Index operations included 17 aortic based, 80 infrainguinal reconstructions, 12 extra-anatomical and 4 combined inflow/outflow. Most common bacteria were MSSA (majority), MRSA, e-faecalis, klebsiella, e-coli and enterobacter. Dressing choice post-operatively was negative pressure wound therapy in 78% (89/114), wet-to-dry gauze dressing 22% (25/114). Survival at 30 days, 6 months and 1 year was 97%, 88%, 86% respectively. Limb salvage achieved at 30 days, 6 months and 1 year was 95%, 88%, 86% respectively. CONCLUSIONS: Muscle flap coverage is an integral aspect of aggressive management for complex vascular reconstruction related wounds. The teaching of muscle flap techniques is an important component of vascular surgery education that should not be overlooked as it has proven to be crucial for limb salvage in complex wound care.
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