Outcome analysis of 244 consecutive flaps for managing complex groin wounds

Abstract

Background: Complex groin wounds present a significant challenge to the reconstructive surgeon. We present a large experience of flaps for managing complex groin wounds. The purpose of our study was to assess outcomes with respect to flap selection and indication (prophylactic versus salvage).

Patients and methods: A retrospective review of all patients receiving flaps for complex groin wounds between 2005 and 2011 was performed. Two types of procedures were evaluated: prophylactic muscle flaps (PMFs) and salvage flaps. We performed an outcome analysis of complications based on flap timing and selection.

Results: A total of 244 flaps were performed during the study period: 146 flaps for salvage and 98 for prophylaxis. Flaps included: sartorius muscle flap (SMF) (N=132), rectus femoris flap (RFF) (N=99), and antero-lateral thigh (ALT) (N=13). Salvaged wounds had higher rates of major wound dehiscence compared to prophylactic wounds (P=0.002). The SMF (N=132) and RFF (N=99) cohorts were similar with respect to patient and operative characteristics, however, the RFF cohort tended to be obese (P=0.002), used for salvage (P=0.0005), endarterectomy procedures (P=0.018), and culture positive wounds (P=0.09). Major limb related complications (graft loss, limb loss, and reoperation) were significantly lower in the RFF group (P=0.03).

Conclusions: Muscle flaps for complex groin wounds can be safely performed with excellent outcomes. We suggest use of the SMF in the prophylactic setting and for smaller salvage wounds. The RFF may be better suited to address larger, more complex wounds. PMFs in select, high-risk patients optimize wound healing relative to patients undergoing groin wound salvage.

Level of evidence: Prognostic/risk category, level III.

Keywords: Complex groin wound; Muscle flap salvage; Outcome; Prophylactic flap.