Introduction: Complex groin wounds occur commonly in many surgical subspecialty patient populations including those undergoing infrainguinal bypass, femoral cannulation for transplantation, and urologic and gynecologic lymphadenectomy. No substantial single-muscle flap series has provided a consensus regarding wound management. This abstract reviews our experience with the rectus femoris muscle flap for complex groin wound reconstruction. Methods: Over the last five years, the rectus femoris has become our routine method of groin wound reconstruction. The rectus femoris is harvested through a mid-anterior incision extending over the distal two thirds of the thigh. The muscle is elevated on its pedicle and transposed into the groin wound defect either directly or through an intervening skin bridge. Hospital and outpatient records were reviewed for all patients undergoing groin wound reconstruction with this technique from 1999-2002. Results: Thirty-three rectus femoris muscle flaps were performed in twenty-nine patients. The mean age was 63.7 years (range: 25 to 88). Twenty-seven (81.8%) groin wounds occurred following infrainguinal revascularization, twenty-one (77.8%) of which contained prosthetic material. Five (23.8%) of these wounds had their prosthetic material removed at the time of reconstruction. The remaining six groin wounds (18.2%) occurred following femoral vessel cannulation for transplantation. There were no intraoperative or perioperative mortalities, and no anastomotic hemorrhages. There were no flap losses. 31 of the 33 treated groins healed (94.0%), 20 primarily (60.6%), 7 following delayed healing and contracture (21.2%), and four requiring reoperation (12.1%). The four patients (13.8%) that required reoperation included one (3.4%) for flap readvancement and three (10.3%) for prosthetic graft removal following flap reconstruction. Two patients (6.9%) died during their hospitalization with persistent open groin wounds following flap reconstruction. All muscle flap donor incisions healed with only two (6.1%) experiencing minimal delayed healing. There were no donor site wound infections and no donor sites required reoperation. Twenty-nine (87.9%) groin wounds demonstrated culture-positive microbial infection, twelve (41.4%) of which were polymicrobial. The thirty day mortality rate was 17.2% and the 6-month mortality rate rose to 31.0%, with multi-system organ failure as the most common cause. Conclusions: The rectus femoris muscle flap is an effective and reliable means for complex groin wound reconstruction. The muscle flap is dependable even in the presence of peripheral vascular disease and the donor site has not been problematic. Based upon our clinical results, we strongly consider the rectus femoris muscle flap the “flap of choice” for groin wound reconstruction.
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