Repairs of complex groin wounds with contralateral rectus abdominis myocutaneous flaps

Abstract

Management of complex groin wounds posterior to complications of vascular prosthetic surgery, malignant tumor excision, and irradiation therapy for recurrent cancers continued to pose a difficult task in reconstructive surgery. Pedicled and microsurgical myocutaneous flaps are valuable tools for wound repairs, but applications of these flaps are limited when the healthy vascular vessels are not available around the wound. In this report, we present our experience on the use of the contralateral rectus abdominis myocutaneous flaps for the coverage of the groin complex wounds in 13 patients. All the flaps were completely survived and the wounds healed uneventfully. The results suggest that the contralateral myocutaneous flap can be used for the repair of the groin wound with presence of significant comorbidities in the area, in which the ipsilateral local flaps and microsurgical flaps are not available.

Reconstruction of complex groin defects with inferior epigastric artery-based rectus abdominis muscle flaps: report of two cases

“…[3,5,6] Therefore, complex inguinal defects with an underlying vascular surgery should be addressed promptly and radically by flaps with adequate vascularity and volume. [3] In order to obtain vascularity and volume, a pedicled or a free muscle flap can be chosen. With regards to complications, these options were found to be comparable.…”

“…[1,7] However, because of the scarcity of recipient vessels, free flaps are generally not preferred for this region. [3] Other viable alternative flaps for the inguinal region include TFL, [3,8] gracilis, [3,5] sartorius, [3,9] rectus femoris, [3,10] gluteus medius, and vastus lateralis [2] regional muscle flaps. [3] However, adequate tissue volume needed for a viable reconstruction in this region may not be obtained with these options.…”

“…[3] However, adequate tissue volume needed for a viable reconstruction in this region may not be obtained with these options. [3] Another shortcoming of these flaps is their relatively short arc of rotation. [2] One of the most viable alternatives for the region is, therefore, a RAM flap with its abundant vascularity, more than adequate volume, and an arc of rotation long enough to ensure a tension-free closure.…”

“…[2] Moreover, complications like wound infection and wound dehiscence are often encountered following primary closure of defects in this region. [1,3] When all these factors are taken into account, reconstruction confined to these regions may need pedicled or free muscle flaps, which provide adequate blood supply. [1] Inferiorly based rectus abdominis muscle/muscleskin (RAMs) flaps are among the valid emerging alternatives in reconstruction of inguinal region soft tissue defects.…”

“…Adequate soft tissue volume, wide arc rotation, no repositioning required during surgery, and relatively rapid and straightforward flap harvesting render these flaps advantageous. [1][2][3] Two cases that underwent vascular repair in the femoral region followed by our inferiorly based pedicled RAM flap coverage procedure are presented herein.…”