Surgical management of difficult wounds of the groin

Coverage of large defects of the soft tissue of the groin present a challenging problem. Exposure of the femoral vessels or prosthetic grafts requires urgent coverage with well vascularized tissue. The medial and lateral femoral circumflex arteries supply the gracilis, sartorius, vastus lateralis, rectus femoris and tensor fascia lata muscles, permitting the use of these muscles or myocutaneous flaps for coverage of groin defects when the femoral artery is intact. With extensive wounds of the groin resulting from trauma, ablation of carcinoma and vascular reconstruction for atherosclerosis involving the femoral vessels, the aforementioned flaps cannot be used. The external iliac artery supplies the rectus abdominis muscle through the deep inferior epigastric artery and the interal oblique muscle through the deep circumflex iliac artery. These muscle flaps are available when the femoral vessels are not intact. If the ipsilateral iliofemoral vessels are not intact, branches of the contralateral iliac artery through deep inferior epigastric artery and deep circumflex iliac artery provide suitable flaps for covering the groin wound. We review our experience with the management of difficult groin wounds (n = 31) and present a systematic approach to reconstruction of the groin based on these anatomic facts.