Vacuum-Assisted Incisional Closure Therapy After Groin Reconstruction With Muscle Flap.

Maryclare E Taylor,Khanjan Nagarsheth,Ledibabari M Ngaage,Philip Wasicek,Yvonne M Rasko,John Karwowski,Michael Ha,Shahab A Toursavadkohi

doi:10.7759/cureus.14954

Abstract

BackgroundGroin reconstruction with muscle flap coverage is associated with high wound complication rates. Incisional vacuum-assisted closure (iVAC) therapy may lower wound complications. We evaluated the impact of iVAC on postoperative outcomes in patients following groin reconstruction with muscle flap coverage.MethodsWe conducted a retrospective review of patients who underwent groin reconstruction with muscle flap coverage in 2012-2018. Patients were divided into those who received iVAC therapy and those who received standard sterile dressings (SSD).ResultsOf the 57 patients included, most received iVAC therapy (71%, n = 41) and the rest received SSD (28%, n = 16). The iVAC group had higher rates of diabetes, hypertension, coronary artery disease, and peripheral artery disease (p < 0.05). However, iVAC patients had comparable length of hospital stay (12 vs 8.5 days p = 0.0735), reoperations (34% vs 31%, p = 0.8415), and readmissions (32% vs 37%, p = 0.6801) with SSD patients. iVAC placement was less likely in prophylactic flaps (odds ratio 0.08, p = 0.0049).ConclusionPatients with a prophylactic flap were less likely to receive vacuum therapy, which may highlight a selection bias where surgeons pre-emptively use iVAC therapy in surgical candidates identified as high risk. The pre-emptive use of iVAC may minimize adverse postoperative outcomes in high-risk patients.

Highlights

Wound complications after major surgery on the groin are a serious problem associated with significant morbidity and cost
IVAC patients had comparable length of hospital stay (12 vs 8.5 days p = 0.0735), reoperations (34% vs 31%, p = 0.8415), and readmissions (32% vs 37%, p = 0.6801) with standard sterile dressings (SSD) patients. Incisional vacuum-assisted closure (iVAC) placement was less likely in prophylactic flaps
Patients were divided into two groups: vacuum-assisted incisional closure (Figure 2) and standard sterile dressing (SSD), which consisted of a dry gauze dressing

Summary

Introduction

Wound complications after major surgery on the groin are a serious problem associated with significant morbidity and cost. Complication rates as high as 44% have been reported in infra-inguinal vascular procedures [1,2,3]. Surgery on the groin puts a patient at particular risk of infection, wound dehiscence, lymphatic leaks, and hematomas [2,4]. Vascular patients with the presence of comorbidities such as obesity, cigarette use, diabetes, and prior groin surgery are at increased risk of complications [1]. In addition to causing pain and distress to the patient, complications are a significant source of healthcare costs. Groin reconstruction with muscle flap coverage is associated with high wound complication rates. We evaluated the impact of iVAC on postoperative outcomes in patients following groin reconstruction with muscle flap coverage

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