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Prophylactic Muscle Flaps in Primary Vascular Procedures of the Groin
Adam Wallace, MD1, Michael Holland, MD1, Solomon Lee, MD1, Matthew Orringer1, Merisa Piper, MD1, Esther Kim, MD1, Scott Hansen, MD1

Background: Complications following vascular procedures involving the groin can lead to significant morbidity. Achieving stable soft tissue coverage over sites of revascularization can help mitigate complications. Prior evidence supports the use of muscle flaps in reoperative groins and in high risk patient populations to reduce postoperative complications. Data regarding the use of prophylactic muscle flap coverage of the groin is lacking. Therefore, the purpose of this study is to evaluate the effect of immediate prophylactic muscle flap coverage of vascular wounds involving the groin.

Methods: A retrospective cohort study was performed on all patients undergoing primary open vascular procedures involving the groin for occlusive, aneurysmal, or oncologic disease between 2014 and 2020 at a single institution where plastic surgery was involved in closure. Patient demographics, comorbidities, surgical details, and postoperative complications were compared between patients who had sartorius muscle flap coverage of the vascular repair versus complex closure alone.

Results: A total of 133 consecutive groins were included in our analysis. A sartorius flap was used in 115 groins (86%) and a complex closure was used in 18 (14%). The sartorius group had higher average BMI (27.3 vs. 22.4, p=0.02), and longer average length of postoperative days of bed rest (4.3 vs. 1.3, p<0.01). The remaining patient demographics and comorbidities were similar in each group. Wound breakdown was similar between groups (25.2% sartorius vs. 38.9% complex closure, p=0.26). However, the rate of reoperation was significantly higher in the complex closure group (50.0% vs. 12.2%, p<0.01). Among patients who experienced wound breakdown (N = 36), a larger proportion of complex closure patients required operative intervention (71.4% vs. 20.7%, p=0.02). Other rates of complications were not statistically different between groups.

Conclusion: In patients undergoing primary open vascular procedures involving the groin, patients who underwent prophylactic sartorius muscle flap closure had lower rates of reoperation. Although incisional breakdown was similar between the groups overall, the presence of a vascularized muscle flap overlying the vascular repair was associated with reduced need for reoperation and allowed more wounds to be managed with local wound care alone. Consideration should be given to this low morbidity local muscle flap in patients undergoing vascular procedures involving the groin.

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