Assessment of Donor-Site Morbidity following Rectus Femoris Harvest for Infrainguinal Reconstruction
ABSTRACT Advantages of the pedicled rectus femoris myofascial flap for groin wound coverage include a sufficient arc of rotation to reach the groin and inguinal region, a dependable vascular pedicle, and low donor-site morbidity. The authors aim to demonstrate the functional deficit resulting from use of the rectus femoris flap in groin wound reconstruction.
One hundred six rectus femoris flaps were performed for groin wound reconstruction over a 10-year period. From this cohort, consent was successfully obtained from 20 patients for testing of thigh function. Testing included both a subjective questionnaire eliciting patient assessment of postoperative thigh strength, and objective muscle strength testing using isometric dynamometer analysis. An age- and sex-matched control group of 20 subjects with no operative history or known discrepancy of thigh strength underwent identical testing.
: Subjects were tested an average of 33 months postoperatively. Dynamometer studies demonstrated a mean nonoperative and operative thigh peak torque of 135 ft-lb and 104 ft-lb, respectively, or a 21 percent difference in isometric knee extensor strength favoring the dominant leg (p = 0.02). Similarly, the control group exhibited a 17 percent strength difference between both thighs (p = 0.04).
Operative subjects exhibited a lower peak torque generated by the operative leg relative to the nonoperative leg. However, a similar difference was observed in the matched control cohort. Thus, there is little isolated deficit in quadriceps strength as a result of rectus femoris harvest.
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ABSTRACT: Two cadavers, one male and one female, with short short left-sided rectus femoris muscle belly are described. The variant muscle belly was foreshortened by approximately 30-40% compared to the contralateral normal muscle, with no evidence of scarring. Numerous anatomical variants of rectus femoris have been described but are rare. This particular variant has not been documented previously. Considering the widespread use of the pedicled rectus femoris muscle flap in reconstruction of complex groin wounds, this rare variant is of surgical significance.
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ABSTRACT: Vascular surgery-related groin complications can lead to catastrophic outcomes and pose a significant healthcare burden. We have taken steps to reduce potential complications at the time of initial surgery by performing prophylactic muscle flaps. The purpose of this study is to evaluate the efficacy and benefit of prophylactic flaps in high-risk patients. A retrospective cohort study was performed on patients undergoing open vascular surgery involving the femoral vessels through a groin incision between 2005 and 2010. Patients receiving prophylactic muscle flaps at their initial surgery were compared with those patients not receiving a flap (control). Sixty-eight prophylactic flaps in 53 patients were compared with 195 open vascular procedures without flaps in 178 patients. The most frequent indication was reoperative bypass surgery with prosthetic reconstruction (63%). The prophylactic patient group exhibited significantly higher rates of comorbidities, including chronic obstructive pulmonary disease (25.0% vs 12.6%; P = .018) and hyperlipidemia (80.9% vs 59.1%; P = .002). Patients receiving prophylactic flaps had lower rates of overall complications (16.2% vs 50.3%; P < .001), infections (1.5% vs 38.5%; P < .001), seroma (0% vs 7.2%; P = .023), and lymphocele (1.5% vs 15.4%; P = .002). Multivariate regression demonstrated that obesity (odds ratio [OR], 2.1 [1.001-4.49]; P = .05), smoking (OR, 2.7 [1.37-5.16]; P = .004), reoperation (OR, 3.5 [1.41-8.63]; P = .007), and prosthetic graft reconstruction (OR, 2.0 [1.03-3.78]; P = .04) were associated with postoperative complications. Additionally, in analyzing all groin complications in all patients, we found that patients who received a prophylactic flap experienced significantly less groin wound complications (OR, 0.17; P < .001). Complications following open groin surgery are common, lead to significant morbidity, and are very costly. Performing prophylactic muscle flaps at the initial surgery to cover the femoral vessels and reduce dead space can significantly reduce complications in select high-risk patients. Prophylactic flaps are safe, effective, and should be considered in patients with multiple comorbidities undergoing high-risk groin surgery, such as reoperative prosthetic bypass surgery.Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 12/2011; 55(4):1081-6. DOI:10.1016/j.jvs.2011.10.110 · 2.98 Impact Factor
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ABSTRACT: High-risk patients undergoing vascular procedures through inguinal incisions experience significant benefit from undergoing prophylactic muscle flaps. The authors present a risk assessment tool, an evidence-based algorithm for using prophylactic muscle flaps, and a comprehensive cost analysis. Data derived from the authors' previously performed retrospective cohort study of patients undergoing open vascular groin surgery were used to construct an evidence-based risk assessment tool. A multivariate regression analysis identified significant, independent predictors of complications, which were used to construct a scoring system. An institutional cost analysis and preoperative assessment algorithm were derived based on patient risk stratification and statistical analyses. Sixty-eight prophylactic flaps in 53 patients were compared with 195 open femoral access procedures without flaps in 178 patients. Multivariate regression demonstrated that obesity, smoking, reoperation, and prosthetic graft reconstruction are significant predictors of complications. A weighted risk factor score (0 to 7) was devised: obesity, for a value of 1; smoking, 2; reoperation for open groin surgery, 2; and prosthetic graft material, 2. Patients with higher scores had significantly more complications, infections, and more frequently required secondary salvage flap procedures. Using study data, the authors constructed an algorithm to guide preoperative groin assessment and use of prophylactic muscle flaps. The authors provide an assessment tool, called the Penn Groin Assessment Scale, that accurately predicts groin complications. They also describe a simple algorithm to assess for prophylactic muscle coverage. Their results suggest that patients with two or more risk factors will benefit from prophylactic muscle flaps. Risk, II.Plastic and Reconstructive Surgery 02/2012; 129(6):940e-949e. DOI:10.1097/PRS.0b013e31824ecb17 · 3.33 Impact Factor