Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
Surg Infect (Larchmt). 2013 Jun;14(3):325-30. doi: 10.1089/sur.2011.123. Epub 2013 Mar 14.
Management of an infected groin wound after vascular surgery may be a challenge. We report a retrospective series of cases of the management of groin defects and an algorithm for their management based on our own experience and related literature.
We conducted a retrospective chart review from June 2008 to February 2012 of patients with infected groin wounds after vascular surgical procedures. The review disclosed six patients with a history of femoral cannulation or extracorporeal membrane oxygenation (ECMO), one patient with a femorofemoral bypass, one patient with an intra-aortic balloon pump (IABP), and one patient with a thoracoabdominal aneurysm following stent implantation. Exposure of femoral vessels was noted in seven of these nine patients, and wound cultures of all nine patients yielded positive results.
The mean age of the nine patients (five males and four females) was 54.6 years (range 17-79 years). The mean follow-up was 13.6 months (range 8-30 months). Four of the patients were treated with a pedicled gracilis flap; one with a local flap; one with a myocutaneous flap of the anterolateral thigh (ALT) combined with a partial tensor fascia lata (TFL) flap; one with primary closure; and two with a myocutaneous island pedicle flap of the ALT. No donor-site complications were noted. There was partial skin cyanosis in the patient treated with a myocutaneous flap of the ALT combined with a TFL flap, which resolved after one week. The scheduled follow-up of the patients showed that all of their groin wounds had healed well.
A pedicled flap of gracilis muscle is an ideal and effective option for covering infected groin wounds of <10 cm with exposure of femoral vessels. According to a literature review, a sartorius muscle flap is another option for accomplishing this. A myocutaneous island flap of the ALT is indicated for infected groin wounds>10 cm with exposure of femoral vessels. The literature indicates that myocutaneous flaps of rectus abdominis (RA) muscle and flaps of rectus femoris (RF) muscle are also suitable for groin wounds larger than 10 cm. Bilateral flaps of ALT and bilateral myocutaneous flaps of RA or RF muscle are suggested for the reconstruction of bilateral groin wounds. For infected groin wounds without exposure of femoral vessels, a local flap or primary closure are suggested, depending on the size of the defect.
血管手术后感染性腹股沟伤口的处理可能具有挑战性。我们报告了一系列基于我们自身经验和相关文献的腹股沟缺损处理病例，并提出了一种处理此类缺损的算法。
我们对 2008 年 6 月至 2012 年 2 月期间接受血管手术后出现感染性腹股沟伤口的患者进行了回顾性图表审查。回顾性研究发现，9 例患者中有 6 例存在股动脉插管或体外膜肺氧合（ECMO）病史，1 例存在股-股旁路术病史，1 例存在主动脉内球囊泵（IABP）病史，1 例存在胸-腹主动脉瘤支架植入术后病史。这 9 例患者中有 7 例股血管显露，9 例患者的伤口培养均呈阳性。
9 例患者（5 例男性，4 例女性）的平均年龄为 54.6 岁（17-79 岁）。平均随访时间为 13.6 个月（8-30 个月）。4 例患者接受了带蒂股薄肌皮瓣修复，1 例接受了局部皮瓣修复，1 例接受了股前外侧肌（ALT）联合部分阔筋膜张肌（TFL）皮瓣的肌皮瓣修复，1 例接受了一期缝合修复，2 例接受了 ALT 带蒂岛状肌皮瓣修复。供区无并发症。1 例接受了 ALT 联合 TFL 皮瓣修复的患者出现部分皮肤发绀，1 周后缓解。患者的计划随访显示，所有患者的腹股沟伤口均愈合良好。
带蒂股薄肌皮瓣是一种理想且有效的选择，可用于覆盖<10cm 伴股血管显露的感染性腹股沟伤口。根据文献回顾，股直肌肌皮瓣也是一种选择。股前外侧肌带蒂岛状肌皮瓣适用于>10cm 伴股血管显露的感染性腹股沟伤口。文献表明，腹直肌肌皮瓣和股直肌肌皮瓣也适用于>10cm 的腹股沟伤口。双侧股前外侧肌皮瓣和双侧腹直肌肌皮瓣或股直肌肌皮瓣可用于重建双侧腹股沟伤口。对于无股血管显露的感染性腹股沟伤口，根据缺损大小，建议选择局部皮瓣或一期缝合。
