Department of Surgery, Riverside University Health System, Moreno Valley, CA.
Department of Vascular Surgery, Loma Linda University School of Medicine, Loma Linda, CA.
Ann Vasc Surg. 2024 Aug;105:282-286. doi: 10.1016/j.avsg.2024.02.009. Epub 2024 Apr 8.
Groin wound dehiscence and infection are a common complication of femoral artery exposure. In patients with prosthetic conduits placed in the groin, these complications can lead to graft infection or anastomotic dehiscence with hemorrhage. Sartorius flaps can be useful in preventing graft infections or anastomotic breakdown in the setting of wound infections. Prophylactic sartorius flaps have been suggested to be a useful adjunct in patients who are at high risk for groin complications. Standard sartorius flaps can be difficult to perform and increase the operative time. We present our experience with a modified sartorius flap, a Transversely Hemisected Sartorius (THT), which avoids dissection to the anterior superior iliac spine. Patients who received femoral artery exposure and a modified prophylactic sartorius flap were included in this case series. The Penn Groin Assessment Scale (PGAS) was calculated for each patient and our primary outcome was the rate of deep space wound infections. Fifteen patients received a THT muscle flap. The average age of the cohort was 67.5 (35-86) years. Eight (50%) were male. The mean PGAS was 2.5 (0-6). Eight (50%) groins had a prosthetic conduit underlying the flap. Four (25%) patients had infrainguinal bypass, 3 (18.8%) for femoral-femoral bypass, and 1 (6.3%) patient received aortic-bifemoral bypass. Eight (50%) patients received sartorius flap after femoral artery exposure for thromboembolectomy, endarterectomy, or access complications. Six (37.5%) patients developed superficial surgical site infections however no deep space infections or prosthetic graft excisions resulted. This procedure was effective in preventing graft infections in all patients with high-risk features for groin infection in our retrospective case series. The segmental blood supply is maintained while providing good coverage of the femoral vessels with this rotational flap.
腹股沟伤口裂开和感染是股动脉显露的常见并发症。在腹股沟处放置人工管道的患者中，这些并发症可导致移植物感染或吻合口裂开伴出血。旋髂肌皮瓣可用于预防感染或吻合口破裂。预防性旋髂肌皮瓣已被建议用于腹股沟并发症风险较高的患者。标准的旋髂肌皮瓣手术难度较大，会增加手术时间。我们介绍了一种改良的旋髂肌皮瓣，即横断半旋髂肌（Transversely Hemisected Sartorius，THT）的经验，该皮瓣避免了对髂前上棘的解剖。本病例系列纳入了接受股动脉显露和改良预防性旋髂肌皮瓣的患者。每位患者均计算了宾夕法尼亚腹股沟评估量表（Penn Groin Assessment Scale，PGAS），我们的主要结局是深部伤口感染的发生率。15 例患者接受了 THT 肌瓣。队列的平均年龄为 67.5（35-86）岁。8 例（50%）为男性。平均 PGAS 为 2.5（0-6）。8 个腹股沟部位的皮瓣下方有假体管道。4 例（25%）患者接受了下肢动脉旁路移植术，3 例（18.8%）为股-股旁路移植术，1 例（6.3%）患者接受了主动脉-双股动脉旁路移植术。8 例（50%）患者在股动脉显露后因血栓切除术、内膜切除术或通路并发症接受了旋髂肌皮瓣。6 例（37.5%）患者发生了浅表手术部位感染，但无深部感染或假体移植物切除。在我们的回顾性病例系列中，该手术在所有具有腹股沟感染高危特征的患者中均有效预防了移植物感染。这种旋转皮瓣在保持节段性血液供应的同时，为股血管提供了良好的覆盖。
