Sartorius Muscle Flap Research Articles

The Utility of Prevena Negative Pressure Wound Therapy on Groin Incisions for Critical Limb-Threatening Ischemia: A Single Institution Experience.

Incisional negative pressure wound therapy (iNPWT) is an adjunctive treatment that uses constant negative pressure suction to facilitate healing. The utility of this treatment modality on vascular operations for critical limb-threatening ischemia (CLTI) has yet to be elucidated. This study compares the incidence of postoperative wound complications between the Prevena Incision Management System, a type of iNPWT, and standard wound dressings for vascular patients who also underwent plastic surgery closure of groin incisions for CLTI. We performed a retrospective cohort study of 40 patients with CLTI who underwent 53 open vascular surgeries with subsequent sartorius muscle flap closure. Patient demographics, intraoperative details, and wound complications were measured from 2015 to 2018 at the University of California San Francisco. Two cohorts were generated based on the modality of postoperative wound management and compared on wound healing outcomes. Of the 53 groin incisions, 29 were managed with standard dressings, and 24 received iNPWT. Patient demographics, comorbidities, and operative characteristics were similar between the 2 groups. Patients who received iNPWT had a significantly lower rate of infection (8.33% vs 31.0%, P = 0.04) and dehiscence (0% vs 41.3%, P < 0.01). Furthermore, the iNPWT group had a significantly lower rate of reoperation (0% vs 17.2%, P = 0.03) for wound complications within 30 days compared with the control group and a moderately reduced rate of readmission (4.17% vs 20.7%, P = 0.08). Rates of infection, reoperation, and dehiscence were significantly reduced in patients whose groin incisions were managed with iNPWT compared with standard wound care. Readmission rates were also decreased, but this difference was not statistically significant. Our results suggest that implementing iNPWT for the management of groin incisions, particularly in patients undergoing vascular operations for CLTI, may significantly improve clinical outcomes.

Coverage of lateral soft tissue defects with sartorius muscle flap after distal femoral replacement for malignant bone tumors.

To prevent infection after limb-sparing surgery for primary malignant bone tumors, it is important to cover the megaprosthesis with muscle tissue that has sufficient blood flow. Coverage with a lateral gastrocnemius flap has been reported in cases of distal femoral replacement in which the vastus lateralis and vastus intermedius muscles have been resected; however, the risk of peroneal nerve palsy is reportedly high because the muscle flap passes near the peroneal head. This study was performed to examine the postoperative outcomes of patients with primary malignant bone tumors of the distal femur who underwent wide resection (including the vastus lateralis and vastus intermedius muscles) followed by reconstruction with a megaprosthesis and coverage of the lateral side of the prosthesis with a sartorius muscle flap. We retrospectively analyzed three patients who underwent reconstruction with a megaprosthesis after wide resection of a primary malignant bone tumor of the distal femur involving the vastus lateralis and vastus intermedius muscles and reconstruction of the soft tissue defect on the lateral side of the prosthesis with a sartorius muscle flap. The average defect size was 6×13cm, the average time required for a sartorius muscle flap was 100min, and the average implant coverage was 93%. The average postoperative follow-up period was 35 months, during which no postoperative complications such as infection, skin necrosis, or nerve palsy occurred. The distally based sartorius muscle flap is easy to elevate in the supine position, has minimal functional loss after harvesting, and has minimal risk of nerve palsy. It can be advocated as the first option for coverage of soft tissue defects lateral to distal femoral replacement.

Risk factors and consequences of wound complications following sartorius flap reconstruction

ObjectiveGroin wound complications are common following vascular surgery and can lead to significant patient morbidity. Sartorius muscle flap coverage may help to prevent vascular graft infection in the setting of wound dehiscence or infection. However, risk factors and consequences of wound complications following sartorius flap reconstruction remain incompletely investigated. MethodsWe retrospectively queried all patients who underwent sartorius flap reconstruction at a tertiary academic medical center. Data collected included patient demographics, medical comorbidities, surgical indication, index vascular procedure, and postoperative outcomes. The primary outcome was wound complication following sartorius flap procedure, which was defined as groin wound infection, dehiscence, or lymphocutaneous fistula. ResultsFrom 2012 to 2022, a total of 113 patients underwent sartorius flap reconstruction. Of these, 66 (58.4%) were performed after the development of a prior groin complication, and 47 (41.6%) were prophylactic. A total of 88 patients (77.9%) had a prosthetic bypass graft adjacent to the flap. Twenty-nine patients (25.7%) suffered a wound complication following sartorius flap reconstruction, including 14 (12.4%) with wound dehiscence, 13 (11.5%) with wound infection, and two (1.8%) with lymphocutaneous fistula. Patients with wound complications had a higher body mass index (28.8 vs 26.4 kg/m2; P =.03) and more frequently active smokers (86.2% vs 66.7%; P = .04). Additionally, patients with wound complications had a higher unplanned 30-day hospital readmission rates (72.4% vs 15.5%; P < .001), reintervention rates (75.9% vs 8.3%; P < .001), and re-do flap reconstruction rates (13.8% vs 2.4%; P = .02). On multivariable analysis, higher body mass index was independently associated with post-flap wound complications (adjusted odds ratio [aOR], 1.01; 95% confidence interval [CI], 1.001-1.03; P = .037). Consequently, wound complications were associated with both surgical reintervention (aOR, 35.4; 95% CI, 9.9-126.3; P < .001) and unplanned hospital readmission (aOR, 17.8; 95% CI, 5.9-54.1; P < .001). ConclusionsSartorius flap reconstruction is an effective adjunct in facilitating wound healing of groin wounds. However, wound complications are common following sartorius flap reconstruction and may be associated with reintervention and unplanned hospital readmission. These data support the judicious and thoughtful utilization of sartorius flap procedures among high-risk patients.

Groin wound management after decannulation of veno-arterial extracorporeal membrane oxygenation in heart transplantation: Role of sartorius muscle flap.

The management of complex groin wounds following VA-ECMO after heart transplant (HT) is uncertain due to limited experience. Sartorius muscle flaps (SMF) have been used in vascular surgery for groin wound complications. However, their use in HT recipients with perioperative VA-ECMO is unclear. This study aims to describe characteristics and outcomes of HT patients with groin complications after arterial decannulation for femoral VA-ECMO. We retrospectively reviewed HT patients who underwent peri-transplant femoral VA-ECMO at our institution from April 2011 to February 2023. Patients were categorized into two groups based on the presence of cannulation-related wound complications. Among the 34 patients requiring VA-ECMO peri-transplant, 17 (50%) experienced complications at the cannulation site. Baseline characteristics including duration of VA-ECMO support were comparable in both groups. Patients with complications presented mostly with open wounds (41.1%) after a median duration of 22 days post-transplant. Concurrent groin infections were observed in 52.3% of patients, all caused by gram-negative bacteria. Wound complications were managed with 12 (70.6%) undergoing SMF treatment and 5 (31.2%) receiving conventional therapy. Four SMF recipients had preemptive procedures for wound dehiscence, while eight underwent SMF for groin infections. Among the SMF group, 11 patients had favorable outcomes without recurrent complications, except for one patient who developed a groin infection with pseudoaneurysm formation. Conventional therapy with vacuum assisted closure (VAC) and antibiotics were utilized in four patients without infection and one patient with infection. Three patients required additional surgeries with favorable healing of the wound. Complications related to femoral VA-ECMO are common in HT patients, with infection being the most frequent complication. SMFs can be a useful tool to prevent progression of infection and improve local healing.

Clinical outcomes of different muscle flap reconstruction after inguinal tumor resection: A case series

PurposeTo introduce the clinical outcomes of adductor longus and sartorius muscle transfer alone and combined application for reconstruction of the inguinal region. MethodsThis is a retrospective study of patients between January 2019 and December 2022 who underwent adductor longus flap transfer, sartorius muscle flap transfer, and combined transfer of adductor longus and sartorius muscle. The demographic data and surgical details were recorded. ResultsSixteen patients were included, with a mean age of 57.5 years. Nine patients performed adductor longus flap transfers, three patients performed sartorius muscle flap transfers, and four patients performed combined transfers. The average operation time was 238 min. The average length of stay was 6.7 days. The average follow-up period was 9.6 months (range 6–16). The overall early postoperative complication rate was 12.5% (one patient had excessive wound exudation and one patient had a wound infection). No delayed postoperative complications occurred during the follow-up. ConclusionThe sartorius muscle flap, the adductor longus flap, and the combined application are suitable techniques for inguinal region reconstruction under different conditions. The combined application of the two flaps can fill the dead space and cover the neurovascular bundle efficaciously.

Flap management of groin wounds following vascular procedures: A review of 270 flaps for vascular salvage

Groin dehiscence following vascular procedures results in morbidity for patients with peripheral vascular disease. Controversy exists around the indications for flap coverage. We present an institutional experience with flap reconstruction of groin wounds after vascular procedures to identify predictors of beneficial outcomes. A retrospective review of patients who had flap coverage for infected/nonhealing groin wounds following a vascular procedure between 1998 and 2021 was performed. Demographics and clinical characteristics, including flap and vascular graft type, were collected along with major complications. Univariate and multivariable logistic regression analyses were performed to assess the associations between procedures and major complications. A total of 270 flaps were transferred to 237 patients. Thirty-three patients had bilateral wounds. The mean age and BMI were 67±11 years and 27.9±6.3kg/m2, respectively. Flaps included rectus femoris (n=142), sartorius (n=118), rectus abdominis (n=7), and gracilis (n=3). Covered vascular grafts included prosthetic materials (n=200) and autografts (n=70). The median length of hospital stay after surgery was 10 days (interquartile range=12), and the mean follow-up was 29.1±39.2 months. The major complication rate was 38.5% with wound infection being the most common. Flaps successfully prevented the infection-related removal of the grafts in 98.9% of cases. Multivariable analysis revealed no significant associations between variables and having a major complication. Flap coverage of the inguinal vessels can be performed safely with favorable limb salvage. Wound complications were high, but graft salvage was excellent. Rectus femoris and sartorius muscle flaps were the most common flaps, yielding comparable outcomes.

A Pilot Randomized Clinical Trial of Early Ambulation after Groin Reconstruction with Sartorius Muscle Flaps

We performed a pilot randomized trial to analyze the effect of early ambulation on postoperative outcomes in patients who had groin reconstruction with sartorius muscle flaps following infrainguinal vascular surgery at our academic institution. Fourteen patients were randomized to standard ambulation (on postoperative day 6), and 14 patients were randomized to early ambulation (on postoperative day 2). The treatment arms were similar with respect to age, body mass index, risk category, smoking status, and comorbidities. Median length of stay was 6 days in the early group versus 7 days in the standard group. Immediate and long-term physical function and general health were better in the early group There were slightly more wound complications in the standard (57.1%) versus the early group (42.9%), and the early group had more lymphatic complications (35.7% versus 14.3%). The decision to ambulate a patient after this surgery continues to be a decision between the vascular and plastic surgeons. However, this pilot trial has shown the safety profile of early ambulation and that it should be considered for specific patients. Additionally, this trial has provided valuable information for performing a larger scale randomized controlled trial to determine the optimal postoperative protocol for patients with these reconstructions.

Reconstruction of a Prosthetic Vascular Graft Infections in the Femoral Region with Gracilis and Sartorius Muscle Flaps

Reconstruction of a Prosthetic Vascular Graft Infections in the Femoral Region with Gracilis and Sartorius Muscle Flaps

Reconstruction of the superficial femoral vessels with muscle flap coverage for soft tissue sarcomas of the proximal thigh.

BackgroundSurgical resection of soft tissue sarcoma with a margin of healthy tissue may necessitate resection and reconstruction of major blood vessels together with soft tissues of the proximal thigh to preserve the limb. The long‐term functional outcomes of these reconstructions remain unestablished. The aim of this report was to assess the vascular and functional outcomes of soft tissue sarcoma patients with femoral vessel reconstructions.Patients and MethodsPatients who had undergone oncovascular reconstruction during the treatment of proximal thigh soft tissue sarcoma in 2014–2020 were reviewed for details of the vascular and soft tissue reconstructions, and the oncological and functional outcomes. This included eight patients of a median age 59 (range 19–77) years. All had a reconstruction of at least the superficial femoral artery and vein as well as soft tissue reconstruction with a muscle flap. All vessel reconstructions were done with either autologous vein (six grafts/four patients) or allograft (10 grafts/six patients). A microvascular latissimus dorsi flap, with a skin island, was incorporated to cover the vascular grafts in five patients. A pedicled sartorius or gracilis muscle flap was used to fill the defect in three patients.ResultsGraft patency was assessed in seven patients with a median follow‐up of 48 (1–76) months. The arterial graft was patent in 6/8 and the vein graft in 2/8 patients. The gait had returned to normal in five of the six patients assessed. The median MTSS was 70 (43–87)% and the TESS 90 (75–100)%. No local recurrence of the sarcoma was detected.ConclusionsVascular reconstruction combined with soft tissue reconstruction enables limb‐sparing surgery in patients with soft tissue sarcoma involving proximal femoral vessels. Although the surgeries are complex with high early morbidity, the achieved long‐term functional outcomes are worthwhile.

Use of Muscle Flaps for Salvage of Groin Wound Infection Following Vascular Surgery: A Systematic Review and Meta-Analysis.

Groin wound infections in vascular surgery are still a common complication and challenging problem. This systematic review aimed to establish a complete view of patient characteristics and clinical outcomes for infected groin wounds following vascular surgery reconstruction using muscle flaps and to evaluate the differences in outcomes between the sartorius muscle flap (SMF), rectus femoris muscle flap (RFF), and gracilis muscle flap (GMF). PubMed, Scopus, and Web of Science were systematically searched from inception to April 2021. Random-effects meta-analysis for comorbidities and outcomes and subgroup analyses for outcomes were performed. Thirty studies were included in qualitative and quantitative syntheses. Overall pooled data showed the following outcome rates: 4.5% muscle flap necrosis (95% confidence interval [CI], -3.4-12.3%; I2 = 0%), 21.8% overall complications (95% CI, 15.8-27.7%; I2 = 0%), 8.0% limb loss (95% CI, 1.9-14.1%; I2 = 0%), 15.4% graft loss (95% CI, 5.0-25.3%; I2 = 37.9%), and 7.4% 30-day mortality (95% CI, -.9-15.6%; I2 = 0%). The rates of overall complications were 20.3% (95% CI, 12.1-28.2%; I2 = 0%), 23.2% (95% CI, 11.2-34.5%; I2 = 10.2%), and 18.0% (95% CI, -3.537.8%; I2 = 0%) for the SMF, RFF, and GMF, respectively. The rate of limb loss was highest for the GMF (17.2%; 95% CI, -4.237.2%; I2 = 0%). The rate of graft loss for the RFF was the highest (20.7%; 95% CI, .6-39.1%; I2 = 53.9%). The rate of 30-day mortality was the lowest for the SMF (5.3%; 95% CI, -6.1-16.6%; I2 = 0%). The effectiveness and safety of muscle flap reconstruction for infected groin wounds following vascular surgery are clearly positive. This review indicated a tendency for lower complication rates with the SMF than with other muscle flaps.

Prophylactic Muscle Flaps in Primary Vascular Procedures of the Groin

Complications following vascular procedures involving the groin can lead to significant morbidity. Achieving stable soft tissue coverage over sites of revascularization can help mitigate complications. Prior evidence supports the use of muscle flaps in reoperative groins and in high risk patient populations to reduce postoperative complications. Data regarding the use of prophylactic muscle flap coverage of the groin is lacking. Therefore, the purpose of this study is to evaluate the effect of immediate prophylactic muscle flap coverage of vascular wounds involving the groin. A retrospective cohort study was performed on all patients undergoing primary open vascular procedures involving the groin for occlusive, aneurysmal, or oncologic disease between 2014 and 2020 at a single institution where plastic surgery was involved in closure. Patient demographics, comorbidities, surgical details, and postoperative complications were compared between patients who had sartorius muscle flap coverage of the vascular repair versus layered closure alone. A total of 133 consecutive groins were included in our analysis. A sartorius flap was used in 115 groins (86.5%) and a layered closure was used in 18 (13.5%). Wound breakdown was similar between groups (25.2% sartorius vs. 38.9% layered closure, P=0.26). However, the rate of reoperation was significantly higher in the layered closure group (50.0% vs. 12.2%, P < 0.01). Among patients who experienced wound breakdown (N=36), a larger proportion of layered closure patients required operative intervention (71.4% vs. 20.7%, P=0.02). Other rates of complications were not statistically different between groups. In patients undergoing primary open vascular procedures involving the groin, patients who underwent prophylactic sartorius muscle flap closure had lower rates of reoperation. Although incisional breakdown was similar between the groups overall, the presence of a vascularized muscle flap overlying the vascular repair was associated with reduced need for reoperation and allowed more wounds to be managed with local wound care alone. Consideration should be given to this low morbidity local muscle flap in patients undergoing vascular procedures involving the groin.

Evaluation of sartorius muscle flap versus tensor fascia lata to cover exposed groin vascular grafts: which is better?

Purpose To focus on the importance of tensor fascia lata or sartorius muscle flaps to improve wound healing and to save exposed groin vascular grafts with minimal complications and to evaluate which is better. Background Treatment of an exposed groin vascular grafts after vascular interventions may be challenging. Saving these grafts saves a patient’s limb. Patients and methods A prospective, randomized clinical trial was conducted on 54 patients suffering from exposed groin vascular grafts to compare postoperative outcomes using tensor fascia lata flap [group A; 28 (51.8%) cases] versus sartorius muscle flap [group B; 26 (48.2%) cases]. Postoperative follow-up was for 6 months. Results No flap loss was recorded in any of the procedure. Minor complications, such as skin graft was lost partially, were seen in group A in five (17.9%) cases at the donor area, but partial loss of skin graft was noticed only in one (3.8%) case in group B (P=0.0022). Small hematoma was noticed in in six (21.4%) cases in group A but only in two (7.6%) cases in group B (P=0.0036). Finally, overall wound healing was noticed in 22 (78.6%) cases in group A and 24 (92.3%) cases in group B (P=0.014). Conclusion Both tensor fascia lata and sartorius muscle flaps for exposed groin vascular grafts are considered a protective weapon to save these exposed grafts and to help to ensure good wound healing. Sartorius muscle flaps are easily rotated from the same incision, are more effective, and are safe, with minimal postoperative complications.

The use of vascularised muscle flaps for treatment or prevention of wound complications following arterial surgery in the groin.

Wound complications following arterial surgery in the groin are relatively common and can result in significant morbidity and mortality. Vascularised muscle flaps (VMF) may be used as an adjunct to aid healing, either to manage complications or prophylactically. This series describes 46 patients who received sartorius or gracilis muscle flaps, of which 70% were performed as a salvage procedure to treat complications ranging from wound breakdown to vascular graft infection. The remaining 30% were performed at the time of the arterial surgery in patients with risk factors such as re‐do surgery or immunosuppression. The peri‐operative mortality rate was 9% and the major amputation rate was 26%, reflecting the complexity of patients that require intervention. Overall, 85% achieved successful healing in the groin without the need for further treatment following VMF. Only one case of flap necrosis occurred. Wound healing complications occurred more commonly after sartorius muscle flaps. The gracilis muscle offers a bulkier mass and greater mobility and so may be preferable, particularly for larger groin defects. This series has shown that VMF offer a safe and reliable option for selected cases to achieve wound healing in the groin in patients with often significant co‐morbidities.

Outcome of rectus femoris muscle flaps for groin coverage after vascular surgery

ObjectiveThe aim of this retrospective cohort study was to investigate the outcome of rectus femoris muscle flaps (RFFs) for deep groin wound complications in vascular surgery patients and to compare the outcome with a cohort of sartorius muscle flaps (SMFs) because the RFF is a promising alternative technique for groin coverage. MethodsAll RFFs and SMFs performed by vascular surgeons in a regional collaboration in The Southern Netherlands were retrospectively reviewed. Primary outcomes were muscle flap survival, overall and secondary graft salvage, and limb salvage. Secondary outcomes were 30-day groin wound complications and mortality, donor site and vascular complications, 1-year amputation-free survival, overall patient survival, impaired knee extensor function, and length of hospital stay. ResultsA total of 96 RFFs were performed in 88 patients (mean age, 68 years; 67% male) and compared with a cohort of 30 SMFs in 28 patients (mean age, 64 years; 77% male). At a mean follow-up of 29 months and 23 months, respectively, comparable flap survival (94% vs 90%), secondary graft salvage (80% vs 92%), and limb salvage (89% vs 90%) rates were found. The 30-day mortality rates were 12% and 17%, respectively, and the 1-year amputation-free survival was comparable between treatment groups (71% vs 68%). ConclusionsThis study presents a large series of RFFs for deep groin wound complications after vascular surgery. We demonstrate that muscle flap coverage using the rectus femoris muscle by vascular surgeons is an effective way to manage complex groin wound infections in a challenging group of patients, achieving similarly good results as the SMF.

Thigh muscle flaps for postoperative inguinal wound complications in vascular surgery : Sartorius muscle versus rectus femoris muscle

Inguinal wound complications often cause postoperative morbidity and also mortality following vascular surgical interventions. The aim of this study was to report experiences and a comparison of the outcomes using rectus femoris muscle flaps (RFF) and sartorius muscle flaps (SMF). Aretrospective study was performed at two locations of a cross-border vascular center and all muscle flap interventions performed at the two centers within the vascular surgery department were reviewed. Primary outcomes were muscle flap survival, graft salvage and major amputations. Atotal of 44RFFs were performed in 39patients (mean age 67years, 73% males) and 25SMFs in 24patients (mean age 64years, 76% males). Wound infections were the most common indications for muscle flap reconstruction. At amean follow-up of 24months (±24) and 17months (±20), respectively, comparable flap survival rates (91% vs. 84%), wound healing rates (72% vs. 83%), graft salvage (65% vs. 73%) and amputation rates (9% vs. 8%) were found. Muscle flap reconstruction is an effective way to cover groin defects resulting from deep wound infections after vascular surgery, achieving good results in ahigh-risk group of patients. No differences were found between SMF and RFF regarding amputation and graft loss. Both techniques can be safely performed, depending on the preference and experience of the surgical team. The RFF technique should be preferentially used to cover large tissue defects, whereas the SMF procedure can be preferred to cover smaller defects in the groin.

LEA 23. Prosthetic Axillobifemoral or Axilloiliac Bypass Under the Muscle at the Inguinal and Abdominal Area to Avoid Infection

The basic technique is vulnerable to prosthetic infection. One important reason for infections is subcutaneous tunneling, which can be avoided by following a new technique. The treatment starts with an oblique incision and exposure of the preperitoneal space and the external iliac artery on the same side as the axillary anastomosis. Tunneling starts from the axillary level beneath the pectoralis major muscle over the ribs. After the lowest rib, the tunnel goes through the muscles and fascia of the abdominal wall to the preperitoneal space with hand support from an oblique incision or small opening to the abdominal wall muscles and fascia with a long surgical Crawford clamp. Skin incision under the rib should be avoided. Above the external iliac artery, the tunnel continues to the opened femoral area underneath the inguinal ligament. A crossover tunnel from the oblique incision is made by fingers over the bladder to the other side to the femoral area under the inguinal ligament. There is also sometimes a need for an oblique incision to both sides when there is a scar or firm tissue in the area. At the femoral area, a rotational sartorius muscle flap covering the prosthesis is recommended, or a distal anastomosis is made to the external iliac artery when possible. In our hospital, five patients have been treated since 2014. All patients had a smoking history, and they suffered from critical limb ischemia and had a history of vascular surgery at the femoral vessels. None of the patients had amputations or prosthetic infections at a mean follow-up of 3 years. Blood loss was <500 mL in all cases, and the operation time was between 3 and 4.5 hours. Additional treatments were six sartorius muscle flaps, six femoral endarterectomies, and one femoropopliteal bypass. One anastomosis was done to the external iliac artery and nine to the common femoral artery. By using this new technique in axillobifemoral or axilloiliac bypasses, it is possible to place the vascular prosthesis under the muscle and consequently decrease the risk for prosthetic infection. The early experience is promising.

Use of the transverse branch of the superficial circumflex iliac artery as a landmark facilitating identification and dissection of the deep branch of the superficial circumflex iliac artery for free flap pedicle: Anatomical study and clinical applications.

The deep branch of the superficial circumflex iliac artery (SCIA) should be included when a large superficial circumflex iliac artery perforator (SCIP) flap is necessary, or when anatomical structures perfused by the deep branch are procured. The aim of this study was first to describe the anatomical features of the "transverse branch" of the deep branch of the SCIA in cadavers, and then to assess the efficacy of its use as a landmark for identification and dissection of the deep branch of the SCIA through clinical applications. Twenty groin regions from 10 cadavers were dissected. The course and the takeoff point of the transverse branch were documented. With the transverse branch used as a landmark for pedicle dissection, 27 patients (16 males and 11 females) with an average age of 51.7 years underwent reconstructions that used vascularized structures nourished by the deep branch of the SCIA. Aside from the skin paddle, an iliac bone flap was used in 10 cases, a lateral femoral cutaneous nerve flap in four cases, and a sartorius muscle flap in three cases. The defect locations included the head (seven cases), the foot (six cases), the hand (six cases), the arm (five cases), and the leg (three cases). The causes of reconstruction were tumors in 13 patients, trauma in six patients, infection in four patients, surgical procedures in three patients, and refractory ulcer in one patient. In all specimens, the transverse branch was found underneath the deep fascia caudal to the anterior superior iliac spine (ASIS). The average distance from the ASIS to the transverse branch was 25.5 ± 13.0 mm (range, 5-50 mm). The average dimension of the flap was 13.1 × 5.9 cm2 . All the flaps survived completely after the surgery; lymphorrhea was seen in one patient at the donor site. The average follow-up period was 12.9 months (range, from 2 to 42 months), and all patients had good functional recovery with satisfactory esthetic results. The transverse branch was found in all specimens, branching from the deep branch of the SCIA. Successful results were achieved by using it as the landmark for identification and dissection of the deep branch of the SCIA. This method allows safe elevation of a large SCIP flap or a chimeric SCIP flap.

IP215. Mature Radiocephalic Fistula as Conduit for Bypass of a Mycotic Common Femoral Artery Pseudoaneurysm: A Case Report

Mycotic common femoral artery pseudoaneurysms are a challenging entity with high morbidity. Surgical intervention has been described in intravenous drug abusers. Ligation of the infected pseudoaneurysm and revascularization often result in limb amputation or other complications. This case report describes the safety and efficacy of novel limb preservation surgery using an arteriovenous fistula as a robust conduit. A 59-year-old woman with history of end-stage renal disease, diabetes mellitus, and peripheral vascular disease presented status post cardiac catheterization with a right mycotic common femoral artery pseudoaneurysm measuring 2.3 × 1.8 × 2.3 cm. Preoperative vein mapping revealed no suitable superficial veins for graft harvesting, given the need to support a high-flow area. Blood culture specimens grew Pseudomonas aeruginosa, and antibiotics were initiated. Taking into account the need for permanent vascular access for dialysis in the future, deep veins were not harvested. The patient's radiocephalic fistula was created 6 months earlier and was functioning well as access for dialysis. A tunneled dialysis catheter was placed in preparation for ligation of the patient's fistula. During the procedure, the distal common iliac was exposed through a retroperitoneal approach with a longitudinal groin incision to expose the distal anastomosis site. The pseudoaneurysm was incised and oversewn. Proximal and distal anastomoses were made using the patient's arteriovenous fistula. The groin incision was closed with a sartorius muscle flap. On postoperative day (POD) 2, the patient developed a non-ST-segment elevation myocardial infarction, which was managed conservatively without further cardiac catheterization, and the patient was discharged on POD 6. On POD 16, the patient was readmitted for a groin abscess, which was treated with antibiotics and negative pressure wound therapy. No vascular or limb complications have been observed at the time of this report 2 months after the procedure. Infected pseudoaneurysms in drug abusers involving the common femoral artery have previously been treated with ligation and excision of the pseudoaneurysm with autogenous vascular reconstruction. No deaths were reported in this cohort, but patients who underwent ligation and excision only experienced significant claudication, and 33% resulted in amputation of the limb. We wished to avoid the likely complication of lower extremity amputation if our patient's pseudoaneurysm was treated with conventional methods. Prosthetic grafts would have been inappropriate with active Pseudomonas infection. Use of a mature, patent arteriovenous fistula graft as a conduit for bypass of a common femoral artery pseudoaneurysm appears to be a safe and effective option for revascularization.

An Unusual Case of Squamoid Eccrine Carcinoma of the Abdominal Wall with Inguinal Nodal Metastases: A Case Report and Review of the Literature

Introduction: Squamoid eccrine carcinoma is a very rare carcinoma with few reported cases in the literature. As a result, there islimited guidance on management and follow-up of these cases.Case Presentation: We describe the case of a 39 year-old male with a large painful squamoid eccrine carcinoma of the right lowerabdominal wall with inguinal nodal involvement. He underwent radical resection, superficial groin dissection, transposition of asartorius muscleflap, anda pedicled anterolateral thigh perforatorflapfor reconstruction. The postoperative coursewasuneventfulapart from a postoperative seroma which was treated with aspiration. He underwent adjuvant radiation following full recoveryfrom his procedure.Conclusions: Our case study represents a rare, large squamoid eccrine carcinoma of the abdominal wall treated with radical resection,superficial groin dissection, transposition of a sartorius muscle flap, and a pedicled anterolateral thigh perforator flap forreconstruction. Due to the limited number of reported cases, there are no guidelines for management of squamoid eccrine carcinomas.With this case report we aim to increase awareness of this rare carcinoma, and to summarize the existing literature onmanagement of squamoid eccrine carcinoma.

The role of sartorius muscle flaps in the management of complex groin wounds.

A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed was whether sartorius muscle flaps (SMF) can be effectively used in the setting of complex groin wounds with exposed prosthetic grafts for graft salvage and limb salvage. The literature review identified 33 articles reporting on the use of SMF for complex vascular wounds. Of these, 7 articles reporting on the use of 539 SMFs were considered the best evidence to answer the clinical question. Indications included surgical site infections with or without wound dehiscence, lymph leaks, graft infection and groin pseudoaneurysms, whereas in 98 of the included 539 cases, the flaps were performed prophylactically. Vacuum-assisted closure systems were used in 25 cases to promote healing. The use of an SMF is associated with low rates of muscle flap and graft complications, whereas outcomes seem to be independent of the presence of occlusive disease in the superficial femoral artery. They can be effectively combined with aggressive debridement strategies and vacuum-assisted closure devices to optimize outcomes. The published literature supports the use of SMF in the management of complex groin wounds following vascular reconstruction and is associated with encouraging flap, limb and graft salvage rates.