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Rectus Femoris Flap As The Preferred Salvage Procedure For The Management Of Vascular Graft Groin Complications
Kaley Coffey, MD.
western reserve health education, warren, OH, USA.
Objective:
Groin wound complications account for significant morbidity and mortality in vascular surgery patients. Notably, graft infections within the proximity of the groin can lead to graft failure, thrombosis, aneurysm formation, limb loss, or death. In addition to the substantial contribution these infections pose on patient mortality and morbidity, there are innumerable financial burdens placed upon healthcare systems and patients themselves. Current management of such groin infections involves systemic antibiotics, local wound care, debridement, and pressure therapies; however, failure is common, often necessitating excision of the infected graft and performing an autologous or extra-anatomical bypass.This study aimed to demonstrate the efficacy and safety of the rectus femoris flap as the salvage procedure for managing groin complications following vascular surgery.
Methods: A retrospective review utilizing electronic medical record data identified 47 patients that underwent a rectus femoris flap salvage procedure for vascular groin graft complications between 2015 and 2021.
Results: A total of 47 patients required 50 muscle flaps to cover 50 groin reconstruction sites. At a six-month follow-up, the groin flap success rate was 98%, and the vascular graft salvage rate was 100%. The overall complication rate was 22% (Figure 1). Groin flap complications occurred at a rate of 6%, with only one flap failure due to thrombosis, necessitating removal and reconstruction with a sartorius flap. Other complications included seromas, donor site infections, and mild flap necrosis. Five seromas were managed with local wound care, while two required additional operative intervention. One seroma complication necessitated a split-thickness skin graft, and the other involved a donor site seroma that extended to the groin, requiring reconstruction with a vastus lateralis flap and sartorius flap.
Conclusions: The rectus femoris flap is a reliable and effective management strategy for groin complications following vascular surgery. This approach allows for expedited recovery and preservation of functional status relative to graft excision. Consequently, the rectus femoris flap should be considered as an effective alternative to the current standard of care.
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