Use of groin flap in the closure of through and through defect of a forearm: A case report

The groin flap is a vascularized axial flap based on the superficial circumflex iliac artery arising from the femoral artery just below the inguinal ligament. It is used regularly by many reconstructive surgeons for covering soft tissue defects of the hand. Although the development of various fasciocutaneous free flaps during the 1980s decreased the attractiveness of the groin flap, these flaps can be used in reconstructing significant defects of the forearm and hand where free tissue transfer is not feasible.     

Bilateral groin VY advancement flaps for the repair of lower abdominal defects

Repair of lower abdominal defects with bilateral groin VY advancement flaps is presented. This procedure allows a reliable reconstruction to be performed easily with good aesthetic results. Correspondence to: K. Onishi     

Preputial flap as an adjunct to groin flap for the coverage of electrical burns in the hand

High voltage electrical contact to hand result in injuries at multiple levels that may require more than a single flap for effective coverage. We present here a simple technique to utilise preputial flap as an adjunct to groin flap in cases where simultaneous coverage was required at more than one site in hands. In the past two years, 15 patients with unilateral involvement of hands due to electrical contact injury underwent this procedure. In addition to a comfortable position of the hand, stable and purposeful coverage at the wrist and various areas of hands was achieved in all the patients and none had flap failure. Minor complications related to penile erection were encountered that resulted in partial wound dehiscence that was managed with resuturing, pain relief and temporary suppression of erection. In our opinion, preputial flap is a good addition in our armamentarium to be used alongside groin flap for effective coverage of more than a single site requiring flap cover in electric injuries of the hand.     

Leg for life? The use of sartorius muscle flap for the treatment of an infected vascular reconstructions after VA-ECMO use. A case report

IntroductionVeno-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.Presentation of caseA 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.DiscussionMajor 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.ConclusionAlthough 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.     

A bilobed groin flap for coverage of traumatic injury to both the volar and dorsal hand surfaces

BACKGROUND:

There are many methods available for coverage of both the volar and dorsal hand surfaces in traumatic injury. All of these surgical procedures allow for ample coverage of the defect, but have the major drawback of needing multiple donor sites. In the present report, a case of a complex crush injury to the hand in which both volar and dorsal surfaces received traumatic injury is presented. A bilobed groin flap pedicled on the superficial circumflex iliac artery was fashioned to cover the entire defect. Like many other described flaps, the bilobed groin flap resulted in a favourable functional and cosmetic result for the patient, but with the unique advantage of requiring a single donor site.

METHODS:

A bipedicled groin flap was raised from distal to proximal, and the flaps inset onto both the dorsal and volar hand defects.

RESULTS:

The patient regained adequate function of his hand, and was able to return to work full-time as a manual labourer.

CONCLUSION:

The bilobed groin flap appears to be a valuable option for covering complex hand injuries involving both the volar and dorsal surfaces of the hand.     

A microvascular peritoneal flap based on the deep circumflex iliac artery

Reconstructive surgery following tumor resection or trauma to the oromandibular areas requires one-stage, reliable, functional, and cosmetic results with a low donor site morbidity. In the past 2 decades free vascularized osteocutaneous flaps using the scapular, radial forearm, fibular, and groin flap have shown their advantages [2]. Only recently has the peritoneum been considered part of a vascularized flap to assure primary healing by mucosal defects [1, 3–5]. To show a constant vascular pattern of the deep circumflex iliac artery (DCIA), 17 dissections on fresh cadavers were performed. The visualization was obtained by blue dye coloration, contrast medium angiography, and intravascular silicone latex injections. The results confirmed that the osteocutaneous part of the composite groin flap is constantly supplied by the main branch and the internal oblique transverse muscle, including peritoneum (approximately 8×10 cm), mainly by the ascending branch of the DCIA.     

The Combined Use of a Pedicled Superficial Inferior Epigastric Artery Flap and a Groin Flap for Reconstruction of a Dorsal and Volar Hand Blast Injury

A hand blast injury case causing a large through-and-through composite tissue loss is presented. This injury resulted in a dorsal and a palmar hand defect with segmental bone loss. Soft tissue coverage of both dorsal and palmar wounds was achieved by two separate pedicle flaps with pedicles closely arising from the femoral artery: a superficial inferior epigastric artery (SIEA) flap and a groin flap. Simultaneously, a large iliac corticocancellous bone graft was harvested from the same incision to be used for the wrist fusion procedure. This approach uses two separate pedicled flaps with robust independent blood supply to cover simultaneously a dorsal and a volar hand wound. A large through-and-through hand defect can be reconstructed readily with this approach, and it is associated with much less perioperative morbidity compared to free composite tissue transfer options. The dissection of both the groin flap and the SIEA flap is straightforward and can be easily performed by a single surgeon. The combined use of these two flaps allows stable coverage of sizable dorsal and palmar wounds of the hand.     

Contralateral rectus abdominis muscle flap coverage for a radionecrotic groin defect

An inferiorly based contralateral rectus abdominis muscle flap was utilized to reconstruct an infected, radionecrotic wound in the groin. The selection criteria for this particular flap are discussed, comparing it to other reconstructive choices. It is believed that the contralateral rectus muscle flap is a good reconstructive choice, since its blood supply is distant to the site of the radiation-induced vascular insufficiency.     

髂腹股沟带蒂真皮下血管网皮瓣修复手部皮肤脱套伤

目的应用髂腹股沟带蒂真皮下血管网皮瓣修复手部皮肤脱套伤.方法将带旋髂浅血管或腹壁浅血管为蒂的髂腹股沟皮瓣的远端1/3～1/2修剪成带真皮下血管网薄皮瓣,修复除拇指以外的手部大面积皮肤缺损.结果临床应用9例,皮瓣全部成活,外形及运动功能恢复满意.结论带蒂髂腹股沟真皮下血管网皮瓣修复手部皮肤脱套伤是简单、有效的方法.     

Outcome of rectus femoris muscle flaps performed by vascular surgeons for the management of complex groin wounds after femoral artery reconstructions

ObjectiveGroin wound complications after femoral artery reconstructions are highly morbid and notoriously difficult to treat. Successful techniques include long-term antibiotic therapy, operative débridement, and muscle flap coverage. Historically, more complex muscle flap coverage, such as a rectus femoris muscle flap (RFF), has been performed by plastic and reconstructive surgeons. In this study, the experience of vascular surgeons performing RFF in the management of wound complications after femoral artery reconstructions is reported.MethodsClinical data between 2012 and 2018 were retrospectively analyzed. Data were summarized, and standard statistical analysis was performed.ResultsThere were 23 patients who underwent 24 RFFs for coverage of complex groin wounds after femoral artery reconstructions. One of the 23 patients underwent bilateral RFFs. In this study cohort, patients had a median age of 67.5 years, and 79% (n = 19) were male. Median body mass index was 28.0 kg/m², and 38% of patients were classified as obese on the basis of body mass index criteria. A history of tobacco use was present in 88%; however, only 29% were current smokers. Diabetes was present in 38% of patients and chronic kidney disease in 29%. Of the 24 RFFs, 14 (58%) were constructed in patients with reoperative groin surgery resulting in the need for muscle flap coverage. Femoral endarterectomy was the most common index procedure (46%), followed by infrainguinal leg bypass surgery (17%) and aortobifemoral bypass (17%). Grafts used during the original reconstruction included 12 bovine pericardial patches (50%), 6 Dacron grafts (25%), 4 PTFE grafts (17%), and 2 autogenous reconstructions (8%). Microbiology data identified 33% of patients (n = 8) to have gram-positive bacterial infections alone, 21% (n = 5) to have gram-negative infections alone, and 29% (n = 7) to have polymicrobial infections; 4 patients (13%) had negative intraoperative culture data. Median hospital stay after RFF was 8 days, and median follow-up time was 29.3 months. Major amputation was avoided in 20 of 24 limbs (83%) undergoing RFF. Eight patients underwent intentional graft or patch explantation (33%) before RFF, whereas 14 of the remaining 15 patients (93%) had successful salvage of the graft or patch after RFF. Two of the patients (13%) who underwent RFF with the intention of salvaging a prosthetic graft or patch required later graft excision. After RFF, 30-day and 1-year survival was 96% and 87%, respectively.ConclusionsRFF coverage of complex groin wounds after femoral artery reconstructions may safely be performed by vascular surgeons with excellent outcomes.     

Posterior Scrotal Artery Flap to Cover a Groin Defect: A New Technique

Commonly, a groin defect is reconstructed with flaps from ipsilateral thigh or lower abdomen. Here we present a case report of use of a pedicled flap from the posterior scrotum based on posterior scrotal artery to cover a groin defect exposing femoral vessels. Posterior scrotal artery, to best of our knowledge, has not been described in the literature to cover a groin defect.     

Groin flap: current applications

Summary A revue of the clinical use of the groin flap in a service of plastic surgery during a period of five years is presented. The diverse pathologies and indications for the flap are described. Finally, the functional and aesthetic results are evaluated after a minimum of two years follow-up.     

带蒂髂腹股沟皮瓣一期修复手部皮肤缺损65例

采用带蒂髂腹股沟皮瓣一期修复手部皮肤缺损６５例。断蒂时间１４～２８天（平均１６天）。断蒂后皮瓣全部成活，仅５例皮瓣边缘坏死，６例有轻度感染。随访６个月～５年，皮瓣的质地及弹性均好。讨论了带蒂髂腹股沟皮瓣一期修复手外伤的优点。     

足底内侧岛状皮瓣联合腹股沟游离皮瓣修复足跟部软组织缺损

目的探讨足底内侧岛状皮瓣联合腹股沟游离皮瓣修复足跟部皮肤软组织缺损的临床效果。方法回顾性分析2015年10月至2020年12月榆林市第二医院烧伤整形手足外科收治的足跟部皮肤软组织缺损患者的临床资料。患者经急诊清创或扩创后,应用足底内侧岛状皮瓣修复足跟部创面,腹股沟游离皮瓣修复足底内侧供区创面,腹股沟供区直接缝合。术后观察皮瓣血运及存活、皮瓣供区愈合情况,并对足跟外形与功能恢复情况进行随访。结果共纳入8例患者,男7例,女1例,年龄20~71岁,平均32.2岁。其中5例为足跟外伤,1例足跟鳞状细胞癌,1例足跟冻伤,1例足跟溃疡。足跟部创面面积4 cm×3 cm~7 cm×6 cm。手术过程顺利,足跟岛状皮瓣及腹股沟皮瓣切取范围较足跟创面扩大0.5~1.0 cm。8例患者术后皮瓣血运良好,创面均一期愈合。术后随访3~12个月,所有患者足跟弹性佳,外形无臃肿,耐磨、耐压,感觉及行走功能满意;足底内侧供区无凹陷,无瘢痕增生及挛缩,无局部皮肤溃疡;腹股沟供区仅见线性瘢痕。结论足底内侧岛状皮瓣联合腹股沟游离皮瓣修复足跟部缺损,足部外观及功能恢复良好,效果满意。     

A systematic review on the use of muscle flaps for deep groin infection following vascular surgery

ObjectiveThe aim of this systematic review is to assess potential differences in effectiveness (graft loss and limb loss) between the sartorius muscle flap (SMF) and the rectus femoris muscle flap (RFF) coverage technique for deep groin wound infection following vascular surgery. Our hypothesis was that RFF reconstruction is more effective in groin coverage.MethodsThe PubMed, Embase, and Medline databases were systematically searched by two independent researchers for articles reporting effectiveness of both muscle flaps in the treatment of groin infections following vascular surgery. After quality assessment using the Newcastle-Ottawa Scale and Methodological Index for NOn-Randomized studies (MINOR) scores and data extraction, individual results of the included studies were reviewed. Weighted pooled outcome estimates were calculated.ResultsA total of 17 studies comprising 544 SMF reconstructions and 238 RFF reconstructions were included. The pooled flap survival rate was 100% in both groups, with a pooled amputation rate of 0% and 2%, respectively. In the RFF group, a pooled 30-day mortality rate of 0% was found, compared with 1% in the SMF group. Pooled graft loss rates were 2% in the RFF group and 21% in the SMF group. Only one head-to-head comparison between both muscle flaps was performed, finding no significant differences.ConclusionsDeep groin infection after vascular surgery can be treated with debridement and local muscle flap coverage. In this systematic review, superiority of either muscle flap on amputation or mortality rates was not demonstrated; however, there was a lower rate of vascular graft loss after RFF reconstruction. These conclusions are based on low-quality evidence because of limited data. Local muscle flap reconstruction using both techniques is effective in the treatment of infected groin wounds, achieving good results in a fragile group of patients. Therefore, anatomical and patient characteristics, which were not assessed in this analysis, are critical in the decision-making process on which muscle flap reconstruction is the best treatment option for an individual patient.     

显微外科治疗重度虎口挛缩的疗效分析

目的 探讨髂腹股沟皮瓣与桡动脉鼻烟窝上行穿支逆行皮瓣治疗重度虎口挛缩的手术疗效.方法 2007年3月至2009年6月,采用髂腹股沟皮瓣和桡动脉鼻烟窝上行穿支逆行皮瓣治疗虎口重度挛缩45例,其中采用髂腹股沟皮瓣治疗33例,采用桡动脉鼻烟窝上行穿支逆行皮瓣治疗12例,开大虎口同时行拇外展功能重建21例,术后进行6～12个月随访.结果 除3例选择桡动脉鼻烟窝上行穿支逆行皮瓣患者和1例选择髂腹股沟皮瓣患者皮瓣远端出现远端浅表坏死,其余患者皮瓣均一期愈合,虎口开大距离均可达健侧虎口90%以上.术后随访患者对掌功能恢复良好,髂腹股沟皮瓣稍臃肿,部分出现轻度色素沉着,其余皮瓣颜色均与手部皮肤相近.结论 对儿童、青少年及50岁以下成人病例开大虎口宜首选髂腹股沟皮瓣修复,对50岁以上成人及老年病例宜首选桡动脉鼻烟窝上行穿支逆行皮瓣修复.     

Groin hernias in women

A consecutive series of 255 women with primary groin hernias repaired electively over a five-year period, was reviewed. There were 271 hernias; the majority, 182 (67%) were indirect inguinal hernias, 35 (14%) were direct, and 54 (20%) were femoral. There were no major post-op complications and no recurrences. Most patients presented with a swelling but in 13 cases there was pre-operative discomfort only. Groin pain in women should arouse suspicion of an occult hernia. Lichtenstein repair for inguinal hernia is easier than in men, and as effective.