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Abdominal-based adipocutaneous advancement flap for reconstructing inguinal defects with contraindications to standard reconstructive approaches: a simple and safe salvage reconstructive option

  • Schaffer, Clara (Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV)) ;
  • Haselbach, Daniel (Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV)) ;
  • Schiraldi, Luigi (Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV)) ;
  • Sorelius, Karl (Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University) ;
  • Kalbermatten, Daniel F. (Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Basel) ;
  • Raffoul, Wassim (Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV)) ;
  • di Summa, Pietro G. (Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV))
  • Received : 2019.11.23
  • Accepted : 2020.05.16
  • Published : 2021.07.15

Abstract

Background Groin wounds occurring after vascular surgical site infection, oncologic resection, or occasionally orthopedic surgery and trauma may represent a surgical challenge. Reconstruction of these defects by the usual workhorse flaps may be contraindicated following previous surgery and in patients with lower limb lymphedema or extreme morbidity. Methods This study included 15 consecutive patients presenting with inguinal wounds after vascular or general surgery that required debridement and soft tissue coverage. All cases had absolute or relative contraindications to conventional reconstructive techniques, including a compromised deep femoral artery network, limb lymphedema, scarring of potential flap harvesting sites, or poor overall condition. Abdominal adipocutaneous excess enabled the performance of adipocutaneous advancement flaps in an abdominoplasty-like fashion. Immediate and long-term outcomes were analyzed. Results Soft tissue coverage was effective in all cases. Two patients required re-intervention due to flap-related complications (venous congestion and partial flap necrosis). All patients fully recovered over a mean±standard deviation follow-up of 2.4±1.5 years. Conclusions Abdominal flaps can be an effective and simple alternative technique for inguinal coverage with reproducible outcomes. In our experience, the main indications are a compromised deep femoral artery network and poor thigh tissue quality. Relative contraindications, such as previous open abdominal surgery, should be considered.

Keywords

References

  1. Sorelius K, Schiraldi L, Giordano S, et al. Reconstructive surgery of inguinal defects: a systematic literature review of surgical etiology and reconstructive technique. In Vivo 2019;33:1-9. https://doi.org/10.21873/invivo.11431
  2. Evans GR, Francel TJ, Manson PN. Vascular prosthetic complications: success of salvage with muscle-flap reconstruction. Plast Reconstr Surg 1993;91:1294-302. https://doi.org/10.1097/00006534-199306000-00016
  3. Zelken JA, AlDeek NF, Hsu CC, et al. Algorithmic approach to lower abdominal, perineal, and groin reconstruction using anterolateral thigh flaps. Microsurgery 2016;36:104-14. https://doi.org/10.1002/micr.22354
  4. Fischer JP, Mirzabeigi MN, Sieber BA, et al. Outcome analysis of 244 consecutive flaps for managing complex groin wounds. J Plast Reconstr Aesthet Surg 2013;66:1396-404. https://doi.org/10.1016/j.bjps.2013.06.014
  5. Celik N, Wei FC, Lin CH, et al. Technique and strategy in anterolateral thigh perforator flap surgery, based on an analysis of 15 complete and partial failures in 439 cases. Plast Reconstr Surg 2002;109:2211-6. https://doi.org/10.1097/00006534-200206000-00005
  6. Chatterjee A, Kosowski T, Pyfer B, et al. A cost-utility analysis comparing the sartorius versus the rectus femoris flap in the treatment of the infected vascular groin graft wound. Plast Reconstr Surg 2015;135:1707-14. https://doi.org/10.1097/PRS.0000000000001267
  7. LoGiudice JA, Haberman K, Sanger JR. The anterolateral thigh flap for groin and lower abdominal defects: a better alternative to the rectus abdominis flap. Plast Reconstr Surg 2014;133:162-8. https://doi.org/10.1097/01.prs.0000436838.41936.af
  8. Alkon JD, Smith A, Losee JE, et al. Management of complex groin wounds: preferred use of the rectus femoris muscle flap. Plast Reconstr Surg 2005;115:776-83. https://doi.org/10.1097/01.PRS.0000152436.50604.04
  9. Scaglioni MF, Enrique Carrillo Jimenez L, Kuo YR, et al. Pedicled posteromedial thigh (PMT) flap: a new alternative for groin defect reconstruction. Microsurgery 2017;37:339-43. https://doi.org/10.1002/micr.30008
  10. Morasch MD, Sam AD 2nd, Kibbe MR, et al. Early results with use of gracilis muscle flap coverage of infected groin wounds after vascular surgery. J Vasc Surg 2004;39:1277-83. https://doi.org/10.1016/j.jvs.2004.02.011
  11. Mathes SJ, Nahai F. Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg 1981;67:177-87. https://doi.org/10.1097/00006534-198167020-00007
  12. Johnson TG, Von SJ, Hope WW. Clinical anatomy of the abdominal wall: hernia surgery. OA Anatomy 2014;2:3.
  13. Tabatabaei S, McDougal WS. Primary skin closure of large groin defects after inguinal lymphadenectomy for penile cancer using an abdominal cutaneous advancement flap. J Urol 2003;169:118-20. https://doi.org/10.1016/S0022-5347(05)64049-9
  14. Sisti A, Tassinari J, Cuomo R, et al. A case of extramammary inguinal Paget disease in a male patient: surgical treatment with an abdominal advancement cutaneous flap. Acta Biomed 2017;88:79-81.
  15. Rutherford RB, Baker JD, Ernst C, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 1997;26:517-38. https://doi.org/10.1016/S0741-5214(97)70045-4
  16. Eagle KA, Berger PB, Calkins H, et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). J Am Coll Cardiol 2002;39: 542-53. https://doi.org/10.1016/S0735-1097(01)01788-0
  17. Weimann A, Braga M, Carli F, et al. ESPEN guideline: clinical nutrition in surgery. Clin Nutr 2017;36:623-50. https://doi.org/10.1016/j.clnu.2017.02.013
  18. Le Louarn C, Pascal JF. High superior tension abdominoplasty. Aesthetic Plast Surg 2000;24:375-81. https://doi.org/10.1007/s002660010061
  19. Erba P, di Summa PG, Raffoul W, et al. Tip anchor flap in decubital surgery. Aesthetic Plast Surg 2011;35:1133-6. https://doi.org/10.1007/s00266-011-9721-0
  20. Revest M, Camou F, Senneville E, et al. Medical treatment of prosthetic vascular graft infections: review of the literature and proposals of a Working Group. Int J Antimicrob Agents 2015;46:254-65. https://doi.org/10.1016/j.ijantimicag.2015.04.014
  21. Seify H, Moyer HR, Jones GE, et al. The role of muscle flaps in wound salvage after vascular graft infections: the Emory experience. Plast Reconstr Surg 2006;117:1325-33. https://doi.org/10.1097/01.prs.0000204961.32022.ab
  22. Schutzer R, Hingorani A, Ascher E, et al. Early transposition of the sartorius muscle for exposed patent infrainguinal bypass grafts. Vasc Endovascular Surg 2005;39:159-62. https://doi.org/10.1177/153857440503900205
  23. Ouriel K. Peripheral arterial disease. Lancet 2001;358:1257-64. https://doi.org/10.1016/S0140-6736(01)06351-6
  24. Chan M, Yusuf E, Giulieri S, et al. A retrospective study of deep sternal wound infections: clinical and microbiological characteristics, treatment, and risk factors for complications. Diagn Microbiol Infect Dis 2016;84:261-5. https://doi.org/10.1016/j.diagmicrobio.2015.11.011