Case Series: Pedicled Anterolateral Thigh Flaps for Groin Reconstruction

Abstract

Objective: Groin reconstruction poses a challenge to the plastic surgeon given the comorbidities and prior surgeries typically present in patients with groin wounds, as well as the coverage demands that exposed vascular graft prosthetics and/or native vessels require. Muscle flaps such as the sartorius, rectus abdominis, and rectus femoris have classically been used to reconstruct groin defects, however these require muscle sacrifice and potential donor site morbidity. The anterolateral thigh flap (ALT) has emerged as a versatile flap for locoregional and free flap reconstruction, in this case groin reconstruction, with minimal donor site morbidity. Methods: Patients of the Spectrum Health Plastic Surgery Residency Academic Service from 2017 to 2021 with groin wounds reconstructed with pedicled ALT flaps were retrospectively reviewed in this case series. Five patients were included. The etiology of their wounds, comorbidities, dimensions of flap, time from initial debridement to flap, complications, and outcomes were assessed. Results: The mean age of the patients was 68 years old (range 56 – 76 years). Two of the patients developed groin wounds after repair of ruptured femoral pseudoaneurysms, two presented after infected vascular prosthetic debridement, and one after wound dehiscence following liposarcoma excision with adjuvant radiation. Flap sizes ranged from 10cm x 5cm to 27 centimeters x 9 centimeters. A cuff of vastus lateralis muscle was included in all flaps to provide flap bulk and incorporate musculocutaneous perforators. All donor sites were closed primarily. One patient redeveloped a pseudoaneurysm rupture after groin reconstruction although the overlying ALT survived. One flap developed venous congestion requiring leech therapy and subsequent debridement. One patient developed post-operative cellulitis which resolved. All patients went on to heal their groin wounds. There were no donor site complications. Average follow-up time was 104 days. Conclusion: All five patients had successful groin wound reconstruction with pedicled ALT flaps. This case series demonstrates the utility of the pedicled anterolateral thigh flap in groin reconstruction as a reliable locoregional flap option with minimal donor site morbidity and accommodating flap size. The pedicled ALT should be a first line option for groin reconstruction even in patients with comorbidities or altered vascular anatomy. Corresponding Author: Matthew E. Braza, 100 Michigan Street NE, MC 188, Grand Rapids, MI 49503, [email protected], 414-218-0645