Sartorius Muscle Flap Research Articles

Sartorius Transposition in the Management of Synthetic Graft Infection

Introduction immediate placement of the upper end of the sartorius muscle over the graft. The wound is thoroughly lavUse of a sartorius muscle flap has been proposed not aged with an aqueous solution of 10% povidone iodine. The original graft is preserved. only as a means of preventing infection in reoperative vascular surgery but also in treatment of established Through a vertical incision along the medial border of sartorius the muscle is exposed and freed from its infection at the groin. The technique can also be used following inguinal lymphadenectomy, and for proximal insertion at the anterior border of the ilium immediately below the anterior superior iliac spine. It treatment of lymph fistulae. The aim of this paper is to describe a personal is not usually necessary to divide more than the upper two vascular pedicles to achieve satisfactory medial experience of debridement and immediate sartorius transposition for established synthetic graft infection. rotation. Once the muscle is in place it is sutured in position to cover the graft. The muscle mobilisation wound is then closed in layers with absorbable sutures. Any skin defect over the now transposed sartorius Clinical Details muscle can simply be left open and allowed to granulate. Drains are not used routinely. Seven patients with patent grafts underwent debridement and sartorius transposition. One patient developed metachronous infections at either end of a femorofemoral crossover graft. Thus eight sartorius Results (Table 2) transpositions were undertaken. Details are shown in Table 1. Of the five healed wounds two were in the 81-yearold woman who developed metachronous infection at either end of a crossover graft. All of these four grafts remain patent. Technique

Retrograde Sartorius Muscle Transposition in Popliteal Fossa Infection

Regional rotation muscle flaps have often been proposed with good results for the conservative in situ management of graft infections. In this report, we present a case of recurrent posttraumatic venous graft infection in the popliteal fossa, treated with retrograde sartorius muscle flap transposition. This particular surgical technique offers new scope for management of severe graft infections in this area, where, for technical and anatomic reasons, other proposed muscle flaps are not available.

Abstracts of the Literature.

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO1) systems are a life-saving option in the treatment of acute respiratory distress syndrome (ARDS2), but may be encumbered by severe vascular complications in the groin.A pregnant woman was admitted with respiratory failure due to H1N1 influenza. VA-ECMO was inserted percutaneously by the intensivists and then accidentally removed by the patient after 8 days. 24 h later VA-ECMO was reinstalled with surgical denudation of femoral vessels in another department. 2 h later, due to active bleeding and signs of limb ischemia, the patient was referred to our department and emergency trombectomy and patch angioplasty with PTFE were performed. Evolution was further bad with wound infection (Pseudomonas, Proteus), which imposed large debridement, replacing the PTFE patch with 2 parallel venous patches and wound reconstruction through sartorius muscle rotation. The wound underwent negative pressure therapy for 10 days and was skin grafted. The patient recovered under systemic antibiotic and virostatic therapy.Major complications of using VA-ECMO devices are related to vascular access, most common bleeding at the puncture site and acute limb ischemia. In the groin, sartorius muscle flap is the most used for vascular coverage and small tissue defect reconstruction because of the ease in harvesting and low donor-site complications.Although ischemic complications associated with VA-ECMO are accepted by intensivists under the slogan “leg for life”, for the repair of the femoral artery in the presence of groin infection the sartorius muscle remains an efficient solution for limb salvage.

Superficial femoral vein graft donation from the amputated limb

Vascular reconstruction in critical limb ischaemia is commonly achieved using autologous vein graft. Where there is no suitable venous tissue available synthetic grafts may be employed, but in the presence of local infection this may be ill advised. A case is described where reconstruction was under taken at the time of amputation. In this situation the amputa ted limb was used as a source of suitable venous tissue. back bleeding, with the superficial femoral artery previously occluded. Following removal of the graft, worsening ischaemia of the limb occurred and an aboveknee amputat ion was necessary. The superficial femoral vein distal to the proposed amputat ion level was harvested, as no suitable vein of this quality or length was available elsewhere. This segment of vein was reversed and used to bridge the defect be tween the CFA and PFA. A sartorius muscle flap was mobilised to cover the graft. Postoperatively the amputat ion s tump remains viable.

Surgical transfer of the sartorius muscle to the groin after lymphadenectomy or debridement: CT findings.

We describe the CT findings of medial transfer of a sartorius muscle flap, which is done to protect the femoral blood vessels after radical inguinal lymphadenectomy for cancer or surgical debridement of infected femoral vascular grafts. We reviewed the appearances and initial interpretations of 33 CT studies in 17 patients who underwent medial sartorius flap transfer after either (1) inguinal lymphadenectomy for melanoma or penile cancer or (2) debridement of infected groin wounds complicating vascular reconstruction of the femoral arteries. Muscle flap transfer was defined by the surgical record as either complete or incomplete. In complete sartorius muscle transfer, the proximal end of the muscle is dissected from the anterior superior iliac spine, rotated along its long axis, and sutured medially to the inguinal ligament. In incomplete transfer, the muscle it mobilized and stretched medially, and its medial border is fixed to the inguinal ligament and deep tissues. Clinical correlation and follow-up examinations were done for all patients, and CT reevaluation at intervals was done in nine patients. Complete sartorius flap transfer resulted in a mass anterolateral or anterior to the femoral vessels on postoperative CT scans in 20 studies; five of these masses were misinterpreted initially as possible recurrent metastatic lymphadenopathy, infection, or hematoma. Incomplete sartorius flap transfer resulted in bandlike stretching of the muscle over the femoral vessels in 13 studies. Medial transfer of the sartorius muscle causes a variable appearance of the groin on CT scans. The findings on CT scans after complete sartorius flap transfer should be distinguished from recurrent lymphadenopathy and from postoperative phlegmon or hematoma.

In situ replacement of arterial prosthesis infected by bacterial biofilms: long-term follow-up.

Bacterial biofilm infections of vascular prostheses are characterized by an absence of systemic sepsis, a fluid-filled cavity surrounding the graft, a draining sinus tract, and microorganisms that must be removed from the fabric prosthesis for bacterial culture. Since 1987 we have treated 20 infected grafts with prosthetic excision and in situ replacement in 14 men and 6 women. The time from initial graft implantation to diagnosis of graft infection ranged from 3 months to 14 years (mean 4.5 years). The original graft (Dacron-17, polytetrafluoroethylene-3) was an aortobifemoral in 14, axillofemoral femorofemoral in 3, iliofemoral in 2, and femoropopliteal in 1 patient. Presenting symptoms were groin false aneurysm with perigraft fluid in 10, inflammatory mass in 6, and sinus tract in 4. At surgery all unincorporated graft material and the perigraft capsule were excised from a point where the proximal graft was incorporated, including debridement of vessels at the distal anastomosis. Of the 14 aortobifemoral grafts, only the femoral limbs were excised at the initial presentation of biofilm infection. The conduit was replaced with an in situ polytetrafluoroethylene interposition graft, which was covered with a gracilis or sartorius muscle flap when possible. All surgical sites healed, all grafts remained patent, and there was no limb loss. After ultrasonic oscillation of the explanted graft, bacterial cultures recovered coagulase-negative Staphylococcus species in 14, coagulase-positive Staphylococcus species in one, both species in three, with no growth from two specimens. During follow-up, two patients have had clinical involvement in the proximal intraabdominal portion of the graft that had not been previously resected. In all grafts, the in situ replacement graft remained well incorporated. In situ graft replacement is effective treatment for biofilm infections of vascular prostheses. Because of the indolent nature of these infections, subsequent infection of previously uninvolved graft segments may be expected.

Treatment of Trochanteric Ulcers with Cranial Sartorius and Rectus Femoris Muscle Flaps

Five dogs with pressure ulcers over the greater trochanter were treated by debridement and transposition of the cranial part of the sartorius or the rectus femoris muscle. Both muscles had vascular anatomy that allowed transposition based on a major vascular pedicle. All wounds healed promptly by primary intention and no ulcer recurred. The cranial sartorius flap technique was easier to perform than the rectus femoris technique.

Cranial Sartorius Muscle Flap in the Dog

An anatomic study was performed on canine cadavers to define the blood supply to the cranial sartorius muscle. The vascular supply to this muscle was found to be a single dominant pedicle branching from the femoral artery at the proximal portion of the muscle. This anatomic information was applied in designing a study to determine the feasibility of performing a cranial sartorius muscle flap in the dog. The cranial sartorius muscle was transposed to the caudal abdominal region in four dogs. The muscle flap was based on the singular vascular pedicle defined in the anatomic study. All muscle transpositions were successful on day 19 as evidenced by gross appearance and histologic examination. Grossly, the muscles were well adhered to the recipient sites and were covered by connective tissue. Histologically, the specimens were characterized by viable skeletal muscle fibers, proliferative and maturing granulation and fibrous connective tissue, and mild to moderate mononuclear inflammation. Seroma formation and infection were the two postoperative complications noted. The cranial sartorius muscle flap has potential clinical application for repair of traumatic caudal abdominal hernias and large inguinal hernias in the dog.

Muscle flaps in the management of vascular grafts in contaminated wounds: an experimental study in dogs.

This study evaluates in an animal model the efficacy of muscle flaps in protecting the fabric vascular prosthesis when placed in contaminated wounds. A total of 20 adult mongrel dogs received a 2-cm interpositional polytetrafluoroethylene (PTFE) graft to each femoral artery at the groin level. During the surgical procedure, the wounds were inoculated with a Staphylococcus aureus suspension containing either 1 x 10(4) or 1 x 10(5) organisms per milliliter. In half the animals, the grafts were wrapped with a distally based sartorius muscle flap before a standard two-layer closure was completed. One month after the surgery, all the animals were sacrificed and quantitative cultures were performed of the grafts and wounds. The muscle flaps were capable of protecting the vascular prosthesis with inoculums up to 1 x 10(4) organisms (p less than 0.05), but at greater bacterial contamination their efficacy was no longer significant.

Caudal sartorius muscle flap in the dog.

An anatomic study was performed on canine cadavers to define the blood supply to the caudal sartorius muscle. The vascular supply to this muscle was segmental with the saphenous artery and vein providing a distal vascular pedicle. Anastomotic channels existed between distal and proximal capillary beds within the muscle belly. This anatomic information was used to determine the feasibility of performing caudal sartorius muscle flaps in dogs. The caudal sartorius muscle was transposed to the medial tibial region in four dogs. The muscle flap was based on a singular vascular pedicle of the saphenous artery and vein. The muscle transpositions were all successful on day 14 as evidenced by gross appearance and results of histologic examination. Grossly, the muscles were well adhered to the recipient sites and were covered by connective tissue. Histologically, the specimens were characterized by viable skeletal muscle fibers, large amounts of granulation tissue, varying degrees of inflammatory response, and small foci of myocyte necrosis (2 cases). Seroma formation was a consistent postoperative complication.

人工血管移植後の大腿部開放創に対するＳａｒｔｏｒｉｕｓ ｍｕｓｃｌｅ ｆｌａｐ法による一次的閉鎖術について

人工血管移植後の大腿部開放創に対するＳａｒｔｏｒｉｕｓ ｍｕｓｃｌｅ ｆｌａｐ法による一次的閉鎖術について

The Differing Effects of Isoxsuprine on Muscle Flap and Skin Flap Survival in the Pig

The pretreatment of pigs with isoxsuprine for two weeks resulted in a significant increase in the surviving length of sartorius muscle flaps when compared with untreated flaps on the same animal. However, there was no improvement in the surviving length of neurovascular island skin flaps when these animals were treated with isoxsuprine. The difference in these results is thought to be due to the action of isoxsuprine on the blood supply of skeletal muscle.