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Gracilis Muscle Flap for groin infections: under Utilized by the Vascular Surgeons
Ahsan T. Ali, MD, Sarasijhaa Desikan, MS, J Gregory Modrall, M.D., Mohammad M. Moursi, M.D., John F. Eidt, M.D..
University of Arkansas for Medical Sciences, Little Rock, AR, USA.

OBJECTIVES:
The incidence of arterial infections in the groin area is on the rise. Treatment of arterial infection posses a challenge when multiple procedures have destroyed skin and soft tissue over the femoral artery. The femoral can be vulnerable due to lack of adequate coverage. It is hypothesized that the gracilis muscle flap can be successfully used as muscle pedicle flap to provide coverage of these wounds. This may be under utilized by the vascular surgeons. This series reviewed all the gracilis flaps performed over a 15-year period exclusively by vascular surgeons.
METHODS:
All reconstruction using muscle flaps were reviewed from 1997 through 2011
RESULTS:
n= 50(limbs= 54)
Age (yr.) / sex (M:F)64.3 ±11.4 / (39:8)
Presentation
Bleeding (n)2
Pseudoaneurysm (n)3
Groin sinus (n)27
Exposed graft (n)13
Mortality (%)13%
12-month mortality (%)22%
Microbiology (%)
No growth
Uni microbial
Poly microbial
16%
44%
32%
Recurrent infection8%
Procedure complication2%
Limb loss9%


Vacuum assisted drainage over the flap was used in 16 limbs whereas primary closure was performed in 11 limbs and wet to dry dressing changes were performed in 26. Three primary closures had to be converted to wet to dry saline dressing. One patient had flap necrosis needing a sartorius flap. Overall the flap survival rate was 98%. One flap necrosis occurred on post op day 8 from persistent infection. All procedures were done in conjunction with a infected graft excision and vascular reconstruction in 90% of the patients. Preioperative mortality was 13%. Mean follow-up of 28 months with a freedom from reinfection of 98%. All flap transposition was performed by vascular surgeons at the time of vascular reconstruction.
CONCLUSIONS:
Gracilis muscle is relatively uninvolved and provides for an excllent coverage in the groin area. It is durable and effective against infection. This procedure is technically feasible and can be easily be performed by vascular surgeons at the initial surgery.


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