Department of Surgical Oncology, Dr. BRA IRCH, All India Institute of Medical Sciences, New Delhi, India.
Gulf J Oncolog. 2023 May;1(42):53-760.
Groin dissection has been a nightmare for many surgeons due to its higher morbidity especially flap necrosis. Various modifications in incisions have been described in the literature to reduce the complications but with variable outcomes. By our novel "River Flow" incision technique, we have significantly reduced the procedure related complications without compromising onco surgical principles.
A prospective longitudinal clinical observational study was designed after Institutional Ethical Committee clearance, aiming to minimize the rate of complications, especially flap necrosis. All patients who underwent unilateral/bilateral ilio-inguinal block dissection (IIBD) from January 2014 to December 2021 were included in the study. The "River Flow" incision was made and standard ilio-inguinal block dissection was performed. Flap viability, seroma formation, lymphedema, infection, etc. were observed and noted during hospitalization and on followup. Clavien- Dindo classification was used to grade the postoperative complications. We have taken our historical data of 235 groin dissections as a control and compared them with the results of the present study. It is one of the largest studies on groin dissection so far.
A total of 138 patients underwent 240 groin dissections. The most common diagnosis was carcinoma penis (44.9%) followed by carcinoma vulva (22.4%). Overall, the outcome of all groin dissections showed no postoperative mortality. None of the patients had complete flap necrosis. But in our historical data, the flap necrosis rate was 38%. The most common complication observed was seroma formation in 13.7% of cases followed by surgical site infection (6.52%). All the complications were managed conservatively. The postoperative stay of the patients was also significantly less. The median hospital stay was 3 days.
"River Flow" incision technique is a simple but effective novel surgical technique for therapeutic ILND for any surgical setup without the learning curve. It can avoid flap necrosis, and decrease morbidity significantly without compromising the onco surgical principle of standard groin dissection.
Groin dissection, skin necrosis, river flow incision.
由于其较高的发病率，尤其是皮瓣坏死，腹股沟解剖一直令许多外科医生感到困扰。文献中已经描述了各种切口改良方法，以减少并发症，但结果各不相同。通过我们新的“河流流动”切口技术，在不影响肿瘤外科原则的情况下，显著降低了与手术相关的并发症。
在机构伦理委员会批准后，设计了一项前瞻性纵向临床观察研究，旨在最大限度地降低并发症，特别是皮瓣坏死的发生率。纳入 2014 年 1 月至 2021 年 12 月期间行单侧/双侧髂腹股沟阻断解剖（IIBD）的所有患者。采用“河流流动”切口，行标准髂腹股沟阻断解剖。观察并记录住院期间及随访期间皮瓣存活情况、血清肿形成、淋巴水肿、感染等情况。采用 Clavien-Dindo 分级对术后并发症进行分级。我们将 235 例腹股沟解剖的历史数据作为对照，并与本研究结果进行比较。这是迄今为止关于腹股沟解剖的最大研究之一。
共 138 例患者行 240 例腹股沟解剖。最常见的诊断是阴茎癌（44.9%），其次是外阴癌（22.4%）。所有腹股沟解剖术均无术后死亡。无一例患者发生完全皮瓣坏死。但在我们的历史数据中，皮瓣坏死率为 38%。观察到的最常见并发症是血清肿形成，占 13.7%，其次是手术部位感染（6.52%）。所有并发症均经保守治疗。患者的术后住院时间也明显减少。中位住院时间为 3 天。
“河流流动”切口技术是一种简单而有效的新手术技术，适用于任何手术环境，无需学习曲线，可避免皮瓣坏死，显著降低发病率，同时不影响标准腹股沟解剖的肿瘤外科原则。
腹股沟解剖、皮肤坏死、河流流动切口。
