Outcome of Rectus Femoris Muscle Flaps Performed by Vascular Surgeons for the Management of Femoral Arterial Graft Complications
Benjamin Chandler, MD, Robert Garvin, MD, Evan Ryer, MD, Matthew Cindric, MD, James Elmore, MD.
Geisinger Medical Center, Danville, PA, USA.
Objective(s): Wound complications following femoral arterial reconstruction with prosthetic grafts are highly morbid and notoriously difficult to treat in the vascular surgery patient population plagued with obesity, diabetes, and tobacco use. Successful management requires long term intravenous antibiotic therapy, operative debridement, and wound coverage, historically performed by Plastic Surgeons. In this study, we report our experience of Vascular Surgeons performing rectus femoris flap (RFF) in the management of wound complications following common femoral arterial reconstructions.
Methods: All patients who underwent RFF for the management of wound complications following femoral artery reconstruction between 2012 and 2016 at Geisinger Medical Center were retrospectively reviewed. We performed a detailed analysis of patient and operative characteristics, as well as their outcomes.
Results: Over the past five years, Vascular Surgeons performed fourteen RFFs with a mean age of 72. Eleven of those 14 patients undergoing RFF were male. Mean body mass index (BMI) was 27.5 with 50% of patient having a BMI > 30. Diabetes was present in 26%. Chronic kidney disease was present in 43%. A history of tobacco use was present in 93%, however, only 43% were current smokers. Two of the index cases (14%) were performed for emergencies, and six patients (43%) had prior groin surgery. Femoral endarterectomy was the most common index procedure (64%) followed by infra-inguinal leg bypass surgery (21%) and axillary-bifemoral bypass (7%) and EVAR (7% ). Grafts used during the original reconstruction included 9 bovine pericardial patches (64%), 3 PTFE grafts (21%), and 2 dacron grafts (14%). Culture data identified 57% of RFF to have gram positive bacterial infections, 29% to have gram negative bacterial infections, and 36% to have polymicrobial infections. Eleven patients survived with a mean follow up time of 24 months. Major amputation was avoided in 13 patients, and one patient required bilateral above the knee amputations. After RFF, all patients underwent serial VAC negative pressure dressing changes, either in the OR or at the bedside until the wounds were completely granulated in and thus "closed". None of the patients who underwent RFF required wound reintervention, reoperation, or graft excision.
Conclusions: Rectus femoris flap closure of groin wounds is a safe, effective, and definitive technique of common femoral arterial reconstruction salvage that may performed by Vascular Surgeons with excellent outcomes.
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