Society For Clinical Vascular Surgery

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Rectus Femoris Flap: the vascular surgeon's parachute
John N. Dussel, MD, Jonathan Thoens, MD, Parth Shah, MD, RVPI.
Hartford Hospital, Hartford, CT, USA.

OBJECTIVES: Rotational rectus femoris flap coverage is a proven strategy to manage postoperative groin complications in the vascular patient. Interestingly, the data since 2004 has been compiled by plastic surgeons and mixes vascular patients with general population. Thus creation of flaps in vascular patients by vascular surgeons specifically needs elaboration. The objective of this study was to show that complex groin infections can be managed by means of rotational rectus femoris flaps performed by vascular surgeons. METHODS: A retrospective EMR review was conducted including Hartford Health System data from 2004 to 2011. All patients with CPT code 15738 were included. Frequency tables were used to characterize demographic profile, index procedures, and long-term survival rate. RESULTS: 16 patients were identified with CPT code 15738, representing a total of 20 rectus femoris flap repairs. 1 vascular surgeon performed 19 of the 20. Femoral popliteal bypasses and femoral reconstructions accounted for 50% of the index procedures. One AVF was performed and became infected. On average, the flap procedures were performed within 14.4 days of the index procedures, with a range of 2 -35 days in between procedures. All groin infections healed with no perioperative mortality and no morbidity associated with either the groin infections of the graft sites. The survival rate at one year post-procedure was 100%. CONCLUSIONS: Vascular patients are a unique population with no margin for error when it comes to their surgical care. Despite meticulous technique, complications occur which threaten limb and life. As of 2004 the literature suggested rotational rectus femoris flaps as a way to decisively manage complex groin infections. These papers proved its efficacy but at the hands of plastic surgeons and in patient populations which included procedures of both vascular and non-vascular varieties. This cohort shows a group of patients operated on for vascular disease and whose care was universally helmed by vascular surgeons. This procedure is an appropriate therapeutic option for groin complications.

Rectus Flap Frequency Table
Age66 (28 -88)
Male8 (50.0%)
Female8 (50.0%)
Current Smoker7 (43.7%)
Obese6 (37.5%)
Diabetic6 (37.5%)
Hypertension16 (100.0%)
Hyperlipidemia16 (100.0%)

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