The Pedicled Flap of Adductor Longus, a New Technique for Inguinal Reconstruction.

Hong Zhang,Zhenfeng Li,Lei Zhu,Yakubu Ibrahim,Jianmin Li

doi:10.3389/fsurg.2021.639893

Abstract

Introduction: Reconstruction surgeries of the inguinal area pose a challenge for oncological and orthopedic surgeons, especially after radical local resection (RLR), radical inguinal lymph node dissection (RILND), or both. Although numerous surgical procedures have been reported, there is no report about a pedicle adductor longus flap method. The aim of this work is to show our experience about inguinal reconstruction with pedicled adductor longus flap and associated outcomes.Patients and Methods: A retrospective study of 16 patients with localized inguinal region interventions and reconstructed by adductor longus flap from March 2016 to July 2020. Patients' average age was 60.0 years (range = 38–79 years) and had postoperative follow-up of 10 months (ranging 2–19 months). All patients had unilateral inguinal region involvement—seven cases on the left and nine cases on the right. The patients' clinical course, operative course, and postoperative follow-up data were evaluated.Results: All 16 patients recovered well post-operatively and did not require any re-intervention. Four patients experienced negligible discomfort around the groin area. Five patients experienced a minor strength deficit in thigh adduction compared with that of preoperative strength in the same or contralateral leg. The aforementioned complications resolved during the postoperative course and had no functional impact on their activity of daily living. All adductor longus flaps survived, completely filled the inguinal dead space, and wounds healed uneventfully within 3 weeks except for three patients who suffered delayed wound healing for more than 4 weeks. Other common complications such as infection, seroma, or wound dehiscence were not encountered in this series.Conclusion: The adductor longus flap is a reliable alternative method for inguinal region reconstruction following radical local resection (RLR), radical inguinal lymph node dissection (RILND), or both.

Highlights

Reconstruction surgeries of the inguinal area pose a challenge for oncological and orthopedic surgeons, especially after radical local resection (RLR), radical inguinal lymph node dissection (RILND), or both
The aim of this work is to show our experience about inguinal reconstruction with pedicled adductor longus flap and associated outcomes
This study aims to share our experience of using adductor longus flap as a muscle-only pedicled flap for reconstruction of the inguinal region after diverse oncological resections, lymphadenectomy, or both simultaneously, and presents pertinent real-world cases of its applications as a tool for orthoplastic reconstruction

Summary

Introduction

Reconstruction surgeries of the inguinal area pose a challenge for oncological and orthopedic surgeons, especially after radical local resection (RLR), radical inguinal lymph node dissection (RILND), or both. The inguinal region is a crucial intersection of fundamental anatomical structures, such as the femoral artery, vein, nerve, the inguinal node stations, and the inguinal canal. This makes the inguinal region a common surgical site for many different interventions of different departments, in which the surgical lymphadenectomy and diverse oncological resections are the most common. These may result in soft tissue defects and exposure of vital anatomic structures in this region. The postoperative morbidity related to inguinal surgeries documented in the literature indicate a high incidence rate of complications of 40% [3]

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