Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC.
Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC.
J Vasc Surg. 2024 Feb;79(2):323-329.e2. doi: 10.1016/j.jvs.2023.09.033. Epub 2023 Oct 4.
Groin wound complications are common following vascular surgery and can lead to significant patient morbidity. Sartorius muscle flap coverage may help to prevent vascular graft infection in the setting of wound dehiscence or infection. However, risk factors and consequences of wound complications following sartorius flap reconstruction remain incompletely investigated.
We retrospectively queried all patients who underwent sartorius flap reconstruction at a tertiary academic medical center. Data collected included patient demographics, medical comorbidities, surgical indication, index vascular procedure, and postoperative outcomes. The primary outcome was wound complication following sartorius flap procedure, which was defined as groin wound infection, dehiscence, or lymphocutaneous fistula.
From 2012 to 2022, a total of 113 patients underwent sartorius flap reconstruction. Of these, 66 (58.4%) were performed after the development of a prior groin complication, and 47 (41.6%) were prophylactic. A total of 88 patients (77.9%) had a prosthetic bypass graft adjacent to the flap. Twenty-nine patients (25.7%) suffered a wound complication following sartorius flap reconstruction, including 14 (12.4%) with wound dehiscence, 13 (11.5%) with wound infection, and two (1.8%) with lymphocutaneous fistula. Patients with wound complications had a higher body mass index (28.8 vs 26.4 kg/m; P =.03) and more frequently active smokers (86.2% vs 66.7%; P = .04). Additionally, patients with wound complications had a higher unplanned 30-day hospital readmission rates (72.4% vs 15.5%; P < .001), reintervention rates (75.9% vs 8.3%; P < .001), and re-do flap reconstruction rates (13.8% vs 2.4%; P = .02). On multivariable analysis, higher body mass index was independently associated with post-flap wound complications (adjusted odds ratio [aOR], 1.01; 95% confidence interval [CI], 1.001-1.03; P = .037). Consequently, wound complications were associated with both surgical reintervention (aOR, 35.4; 95% CI, 9.9-126.3; P < .001) and unplanned hospital readmission (aOR, 17.8; 95% CI, 5.9-54.1; P < .001).
Sartorius flap reconstruction is an effective adjunct in facilitating wound healing of groin wounds. However, wound complications are common following sartorius flap reconstruction and may be associated with reintervention and unplanned hospital readmission. These data support the judicious and thoughtful utilization of sartorius flap procedures among high-risk patients.
血管手术后腹股沟伤口并发症很常见，可导致患者出现明显的发病率。股薄肌皮瓣覆盖有助于防止伤口裂开或感染时血管移植物感染。然而，股薄肌瓣重建后伤口并发症的危险因素和后果仍不完全清楚。
我们回顾性查询了在一家三级学术医疗中心接受股薄肌瓣重建的所有患者。收集的数据包括患者人口统计学、合并症、手术指征、指数血管手术和术后结果。主要结局是股薄肌瓣手术后的伤口并发症，定义为腹股沟伤口感染、裂开或淋巴皮肤瘘。
2012 年至 2022 年，共有 113 例患者接受了股薄肌瓣重建。其中，66 例（58.4%）是在先前发生腹股沟并发症后进行的，47 例（41.6%）是预防性的。共有 88 例（77.9%）患者股薄肌瓣旁有假体旁路移植。29 例（25.7%）患者股薄肌瓣重建后发生伤口并发症，包括 14 例（12.4%）伤口裂开、13 例（11.5%）伤口感染和 2 例（1.8%）淋巴皮肤瘘。发生伤口并发症的患者体重指数更高（28.8 与 26.4kg/m2；P=0.03），吸烟者更多（86.2%与 66.7%；P=0.04）。此外，发生伤口并发症的患者 30 天内无计划再入院率（72.4%与 15.5%；P<0.001）、再干预率（75.9%与 8.3%；P<0.001）和再做皮瓣重建率（13.8%与 2.4%；P=0.02）更高。多变量分析显示，较高的体重指数与皮瓣后伤口并发症独立相关（调整优势比[aOR]，1.01；95%置信区间[CI]，1.001-1.03；P=0.037）。因此，伤口并发症与手术再干预（aOR，35.4；95%CI，9.9-126.3；P<0.001）和无计划住院再入院（aOR，17.8；95%CI，5.9-54.1；P<0.001）均相关。
股薄肌瓣重建是促进腹股沟伤口愈合的有效辅助手段。然而，股薄肌瓣重建后伤口并发症很常见，可能与再次干预和无计划住院再入院有关。这些数据支持在高危患者中谨慎、有针对性地使用股薄肌瓣手术。
