Management of Infected Groin Wounds after Vascular Surgery

Abstract

Management of an infected groin wound after vascular surgery may be a challenge. We report a retrospective series of cases of the management of groin defects and an algorithm for their management based on our own experience and related literature. We conducted a retrospective chart review from June 2008 to February 2012 of patients with infected groin wounds after vascular surgical procedures. The review disclosed six patients with a history of femoral cannulation or extracorporeal membrane oxygenation (ECMO), one patient with a femorofemoral bypass, one patient with an intra-aortic balloon pump (IABP), and one patient with a thoracoabdominal aneurysm following stent implantation. Exposure of femoral vessels was noted in seven of these nine patients, and wound cultures of all nine patients yielded positive results. The mean age of the nine patients (five males and four females) was 54.6 years (range 17-79 years). The mean follow-up was 13.6 months (range 8-30 months). Four of the patients were treated with a pedicled gracilis flap; one with a local flap; one with a myocutaneous flap of the anterolateral thigh (ALT) combined with a partial tensor fascia lata (TFL) flap; one with primary closure; and two with a myocutaneous island pedicle flap of the ALT. No donor-site complications were noted. There was partial skin cyanosis in the patient treated with a myocutaneous flap of the ALT combined with a TFL flap, which resolved after one week. The scheduled follow-up of the patients showed that all of their groin wounds had healed well. A pedicled flap of gracilis muscle is an ideal and effective option for covering infected groin wounds of <10 cm with exposure of femoral vessels. According to a literature review, a sartorius muscle flap is another option for accomplishing this. A myocutaneous island flap of the ALT is indicated for infected groin wounds>10 cm with exposure of femoral vessels. The literature indicates that myocutaneous flaps of rectus abdominis (RA) muscle and flaps of rectus femoris (RF) muscle are also suitable for groin wounds larger than 10 cm. Bilateral flaps of ALT and bilateral myocutaneous flaps of RA or RF muscle are suggested for the reconstruction of bilateral groin wounds. For infected groin wounds without exposure of femoral vessels, a local flap or primary closure are suggested, depending on the size of the defect.