Morasch Mark D, Sam Albert D, Kibbe Melina R, Hijjawi John, Dumanian Gregory A
Division of Vascular Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Northwestern Memorial Hospital, Suite 10-105, 201 E. Huron Street, Chicago, IL 60611, USA.
J Vasc Surg. 2004 Jun;39(6):1277-83. doi: 10.1016/j.jvs.2004.02.011.
Management of a nonhealing femoral wound after vascular surgery can pose a challenging problem, particularly when there is prosthetic material involved. We prefer to use pedicled gracilis muscle flaps (PGMFs) to cover problematic groin wounds when more conventional management is not possible.
We describe the technique for using PGMFs to provide groin coverage, report a summary of our short-term and long-term results, and describe why we prefer this reconstructive technique.
Twenty PGMFs were placed in 18 patients to treat nonhealing and infected groin wounds. Exposed prosthetic vascular reconstructions were covered with the PGMF in 14 wounds, and in situ autogenous vascular reconstructions were covered in four. Seven wound infections were polymicrobial, 10 had a single gram-positive organism, and one had a single gram-negative organism. Pseudomonas cultured out in four wounds, and Candida in one wound. Two patients had a virulent combination of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus. Complete healing was initially achieved in all wounds, and no patient died within 30 days of surgery. Two PGMFs failed, at 2 weeks and 2 months, respectively, one from tension on the flap pedicle and one from acute inflow occlusion. Underlying prosthetic reconstruction was salvaged in 12 of 14 wounds; the remaining wounds with autogenous reconstructions or exposed femoral vessels all closed successfully. At a mean follow-up of 40 +/- 10 months there were no recurrent groin infections. Seven patients died, at 2.5, 3, 8, 12, 14, 22, and 28 months, respectively.
PGMF transposition is an effective option to cover infected or exposed femoral vessels or salvage prosthetic graft material in the groin. In appropriately selected patients, when complete graft removal and extra-anatomic bypass is not an acceptable option, gracilis muscle flap coverage is a viable alternative. The technique is relatively simple, and morbidity from PGMF harvest is minimal.
血管手术后股部伤口不愈合的处理可能是一个具有挑战性的问题，尤其是当涉及假体材料时。当无法采用更传统的处理方法时，我们更倾向于使用带蒂股薄肌肌皮瓣（PGMF）来覆盖有问题的腹股沟伤口。
我们描述了使用PGMF提供腹股沟覆盖的技术，报告了我们的短期和长期结果总结，并阐述了我们偏爱这种重建技术的原因。
18例患者共植入20个PGMF以治疗不愈合和感染的腹股沟伤口。14个伤口中，暴露的人工血管重建物用PGMF覆盖，4个伤口中，原位自体血管重建物用PGMF覆盖。7个伤口感染为多种微生物感染，10个伤口有单一革兰氏阳性菌，1个伤口有单一革兰氏阴性菌。4个伤口培养出铜绿假单胞菌，1个伤口培养出念珠菌。2例患者感染了耐甲氧西林金黄色葡萄球菌和耐万古霉素肠球菌的毒性组合。所有伤口最初均实现完全愈合，且无患者在手术后30天内死亡。2个PGMF分别在2周和2个月时失败，1个因皮瓣蒂部张力，1个因急性血流阻塞。14个伤口中有12个成功挽救了其下方的人工血管重建物；其余自体血管重建或暴露股血管的伤口均成功愈合。平均随访40±10个月时，腹股沟无复发性感染。7例患者分别在2.5、3、8、12、14、22和28个月时死亡。
PGMF移位是覆盖感染或暴露的股血管或挽救腹股沟假体移植物材料的有效选择。在适当选择的患者中，当完全移除移植物和解剖外旁路不可行时，股薄肌肌皮瓣覆盖是一种可行的替代方法。该技术相对简单，且取PGMF的并发症极少。
