Rajput Sanjna, Kuruoglu Doga, Salinas Cristina A, Sen Indrani, Kalra Manju, Moran Steven L
Mayo Clinic Alix School of Medicine, Rochester, MN.
Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.
J Plast Reconstr Aesthet Surg. 2023 Mar;78:38-47. doi: 10.1016/j.bjps.2023.01.028. Epub 2023 Feb 8.
Groin dehiscence following vascular procedures results in morbidity for patients with peripheral vascular disease. Controversy exists around the indications for flap coverage. We present an institutional experience with flap reconstruction of groin wounds after vascular procedures to identify predictors of beneficial outcomes.
A retrospective review of patients who had flap coverage for infected/nonhealing groin wounds following a vascular procedure between 1998 and 2021 was performed. Demographics and clinical characteristics, including flap and vascular graft type, were collected along with major complications. Univariate and multivariable logistic regression analyses were performed to assess the associations between procedures and major complications.
A total of 270 flaps were transferred to 237 patients. Thirty-three patients had bilateral wounds. The mean age and BMI were 67 ± 11 years and 27.9 ± 6.3 kg/m, respectively. Flaps included rectus femoris (n = 142), sartorius (n = 118), rectus abdominis (n = 7), and gracilis (n = 3). Covered vascular grafts included prosthetic materials (n = 200) and autografts (n = 70). The median length of hospital stay after surgery was 10 days (interquartile range=12), and the mean follow-up was 29.1 ± 39.2 months. The major complication rate was 38.5% with wound infection being the most common. Flaps successfully prevented the infection-related removal of the grafts in 98.9% of cases. Multivariable analysis revealed no significant associations between variables and having a major complication.
Flap coverage of the inguinal vessels can be performed safely with favorable limb salvage. Wound complications were high, but graft salvage was excellent. Rectus femoris and sartorius muscle flaps were the most common flaps, yielding comparable outcomes.
血管手术后腹股沟裂开可导致外周血管疾病患者出现并发症。关于皮瓣覆盖的适应证存在争议。我们介绍了本机构在血管手术后腹股沟伤口皮瓣重建方面的经验，以确定有益结果的预测因素。
对1998年至2021年间因血管手术后感染/不愈合腹股沟伤口接受皮瓣覆盖的患者进行回顾性研究。收集人口统计学和临床特征，包括皮瓣和血管移植物类型以及主要并发症。进行单因素和多因素逻辑回归分析，以评估手术与主要并发症之间的关联。
共对237例患者转移了270个皮瓣。33例患者有双侧伤口。平均年龄和体重指数分别为67±11岁和27.9±6.3kg/m²。皮瓣包括股直肌（n = 142）、缝匠肌（n = 118）、腹直肌（n = 7）和股薄肌（n = 3）。覆盖的血管移植物包括人工材料（n = 200）和自体移植物（n = 70）。术后中位住院时间为10天（四分位间距 = 12），平均随访时间为29.1±39.2个月。主要并发症发生率为38.5%，伤口感染最为常见。皮瓣在98.9%的病例中成功预防了与感染相关的移植物移除。多因素分析显示变量与发生主要并发症之间无显著关联。
腹股沟血管的皮瓣覆盖可以安全进行，并能有效挽救肢体。伤口并发症发生率高，但移植物挽救效果良好。股直肌和缝匠肌皮瓣是最常用的皮瓣，效果相当。
