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Minimal Incision Rectus Femoris Flap for the Management of Complex Groin Wounds
David Cabiling, M.D., Michael Mirzabeigi, Suhail Kanchwala, M.D.
University Of Pennsylvania, Philadelphia, PA, USA.

BACKGROUND:
Aggressive surgical management of groin wound complications from vascular surgery has lead to improved outcomes and decreased morbidity. In our institution, the rectus femoris flap is commonly utilized for groin coverage because its bulk provides durable coverage and obliteration of dead space. A major drawback of the rectus fermoris flap, however is the extensive dissection that is traditionally performed which typically requires a 25-30 cm anterior incision. The purpose of this study is to evaluate a novel technique for rectus fermoris flap harvest utilizing a limited incision. We describe the use of a lighted breast retractor to harvest the flap through a single 5-6 cm incision.
METHODS:
A retrospective review of 15 consecutive patients was performed who underwent limited incision harvest. We then compared them to a cohort of 14 flaps in 12 patients who underwent standard harvest. Demographic and outcomes data were collected and compared utilizing standard statistical methods.
RESULTS:
There was no statistical difference in donor site complications between groups. Importantly, operative times were similar (115 minutes in MIT vs 106 minutes, p=0.67) as was hospital stay following flap surgery (13.1 vs 11.2 days p=0.46). There were no flap losses in either group. Our average follow-up was 9.5 months. Additionally, there was one chronic groin seroma in each group.
CONCLUSIONS:
With the use of a commonly available lighted breast retractor, the rectus femoris flap can easily be performed through a limited incision. This technique diminishes donor site dissection and morbidity without increasing the complexity or time required for the operation. Given the decreased morbidity and equivalent patient outcomes, the limited incision rectus femoris flap should be considered one of the first line choices in the armamentarium for the management of complex groin wounds.


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