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Soft Tissue Reconstruction of Complex Infrainguinal Wounds Following Revisionary Vascular Surgery
J-Frederick Hernekamp1, Henrik Lauer2, Ole Goertz2
1Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Martin-Luther Hospital Berlin, Berlin, Germany; Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.
Annals of Vascular Surgery
|August 27, 2022
Summary
Reconstructive surgery for large infrainguinal wounds after revision vascular procedures is complex. Pedicled anterolateral thigh (ALT) flaps and rectus abdominis flaps are effective for medium to large defects, while free flaps suit very large wounds.
Area of Science:
- Reconstructive Surgery
- Vascular Surgery
- Microsurgery
Background:
- Large, full-thickness infrainguinal wounds pose significant challenges in reconstructive surgery, particularly after revision revascularization.
- Patients often have comorbidities and prior surgical history, complicating soft tissue reconstruction.
Purpose of the Study:
- To analyze flap choice, outcomes, and complication rates for soft tissue reconstruction of complex inguinal wounds.
- To evaluate the effectiveness of different reconstructive techniques in challenging patient populations.
Main Methods:
- Retrospective analysis of 19 patients undergoing soft tissue reconstruction for large inguinal wounds.
- Assessment of flap types (pedicled vs. free), outcomes, and complication rates.
Main Results:
- Nineteen flaps (17 pedicled, 2 free) were used in 19 patients (average age 73.3 years).
- Anterolateral thigh (ALT) fasciocutaneous flaps (52.6%) and muscle flaps (47.4%) were most common; no flap losses occurred except minor necrosis in one gracilis flap.
- Sufficient soft tissue reconstruction was achieved in all cases, preserving bypasses, with an average length of stay of 27.2 days and a 10.5% mortality rate due to systemic complications.
Conclusions:
- Soft tissue reconstruction of complex inguinal wounds post-revision vascular surgery is challenging, with expectable wound healing issues.
- Pedicled ALT flaps and rectus abdominis flaps are suitable for medium to large defects; free flaps are recommended for very large defects.
- A structured interdisciplinary approach is crucial for managing complex wounds and preventing perioperative morbidity.
