The Sartorius Muscle Flap: An Important Adjunct for Complicated Femoral Wounds Involving Vascular Grafts

Abstract

Conclusion: Healing of complicated femoral wounds with maintenance of graft patency and graft salvage can be facilitated with the use of sartorius muscle flaps. Summary: Femoral wound complications frequently complicate groin incisions. A variety of muscle flaps can be used, along with wide local débridement, to facilitate wound healing and salvage of vascular grafts in a setting of a femoral wound complication. Sartorius, gracilis, rectus femoris, and rectus abdominus flaps have all been used in the treatment of femoral wounds. Sartorius flaps are relatively technically easy to perform and involve anatomy and exposure familiar to vascular surgeons. The sartorius muscle flap is performed by mobilizing the muscle along its lateral edge to preserve the medially based blood supply. (The most cephalad vascular supply is approximately 6.5 cm distal to the anterior superior iliac spine.) The muscle is then divided at its origin from the anterior superior iliac spine. It is rotated 180° on its medial axis, preserving the medial vascular bundle. The tendinous portion of the muscle can then be secured to the inguinal ligament, facilitating coverage of the femoral vessels by the muscular flap. This study reports the results of 21 sartorius muscle flaps performed for treatment of infected or threatened femoral wounds. The original operations were femoral endarterectomy in 8 patients, aortofemoral grafts in 6, femoral distal bypass in 3, and axillofemoral grafts in 4. After sartorius muscle flaps, complete wound healing occurred in 86%. Primary wound closure was achieved in 7 patients and secondary wound closure in 11 patients, with a mean healing time of 2.3 months. There was no loss of vascular reconstructions with a 9.5-month median follow-up. Of the three patients who did not have primary wound healing, two died of unrelated causes before completing wound healing, and the third required a rectus femoris flap because of continued nonhealing of the wound after the sartorius flap placement. Comment: A sartorius muscle flap is a safe, simple, and effective treatment for complex femoral wounds. However, if the patient is systemically septic, if the graft suture line is involved, or if the graft is grossly surrounded by purulence, extreme caution must be used with any type of myoplasty in the groin. Removal of a prosthetic graft in such a setting is still probably the most conservative, effective, and reliable treatment.