Rectus femoris flap as the preferred salvage procedure for the management of vascular graft groin complications

Author(s):
Ashley Holly; Maxim Pekarev; Therese Duane

Background:

Groin infections are a substantial risk for graft failure often resulting in the need for graft excision and/or amputation. The groin is the most common site of infection, and most are managed with local wound care and negative pressure therapy. These methods are costly and have a high rate of failure ultimately resulting in need for excision of the infected graft.

Hypothesis:

The purpose of this study was to demonstrate the role of the rectus femoris flap (RFF) as a salvage procedure for groin complications following vascular surgery.

Methods:

We performed a retrospective review of patients who underwent a RFF as a salvage procedure for groin complications following vascular surgery between 2015 to 2021.  A groin complication was defined as any groin infection, hematoma, seroma, or lymphocele following vascular surgery.

Data points for patient demographics included age, sex, comorbid conditions, original vascular procedure, date of procedure and type of groin complication were recorded.  Other data points collected were the date the RFF was performed, any additional groin complications (i.e. flap failure) complications related to the flap donor site, and time to healing.

Results:

A total of 47 patients required 50 muscle flaps to cover 50 groin reconstruction sites. The patient population consisted of 29 males (61.7%) and 18 females (38.3%), with a mean age of 65 years (range, 48 to 87 years). A six month follow up revealed an 98% groin flap success rate with a 100% vascular graft salvage rate.  The overall complication rate was 22%.  Groin flap complications occurred at a rate of 6% with one groin flap failure due to thrombosis that required removal and reconstruction with a sartorius flap.  The other two complications were due to seroma and mild flap necrosis that were managed with local wound care.

A donor site complication rate of 16% was identified: 7 seromas, 1 abscess. Of the seroma related complications 5 were able to be managed with local wound care while 2 required additional operative intervention.  One of these seroma complications required a split thickness skin graft to the area.  The other one involved a donor site seroma that extended to the groin and required reconstruction with a vastus lateralis flap and sartorius flap.

Conclusions:

Management of groin complications following vascular surgery remains a challenging problem.  Local wound care remains the standard despite the cost, length of treatment and additional complication rate.  Our study demonstrated the use of a RFF as a salvage procedure following groin complications is a safe and highly effective treatment with a 100% graft salvage rate with few overall complications.