P-042 - PROPHYLACTIC SARTORIUS MUSCLE FLAP FOR COVERAGE OF PROSTHETIC VASCULAR GRAFTS IN THE GROIN: A PROSPECTIVE RANDOMIZED CONTROLLED STUDY

TOPIC:
Peripheral Occlusive Arterial Disease
AUTHORS:
Rizk M. (faculty of medicine, Ain shams university ~ cairo ~ Egypt) , Mahmoud A. (faculty of medicine, Ain shams university ~ cairo ~ Egypt) , Abd Elazeem T. (faculty of medicine, Ain shams university ~ cairo ~ Egypt) , Adly M. (faculty of medicine, Ain shams university ~ cairo ~ Egypt)
Introduction:
Groin wound infection represents an extremely morbid complication that may result in increased hospital stay, bleeding, and limb loss. It is more prevalent in patients undergoing vascular reconstructive surgery due to preexisting risk factors of obesity, smoking, diabetes mellitus, previous groin wound, and long operative time. Antimicrobials, wound debridement, and muscle flaps are methods used to treat groin wound infections.
Methods:
: Between June 2019 and January 2021, 40 patients undergoing vascular reconstructive surgery involving the common femoral artery as an inflow or outflow vessel, have been randomized into two groups. Group (A): the anastomotic site has been covered with a sartorius muscle flap, while group (B) (control group): classic wound closure was done. Postoperatively, patients were followed up daily for signs of wound infection. We classified wound infection according to Samson classification for vascular graft and wound infection.
Results:
Forty patients with vascular reconstructive surgical procedures with PTFE grafts involving the common femoral artery were randomized into two groups. There was no statistical difference between both groups as regard the demographic data of patients, also no statistical difference as regard the vascular reconstructive procedure done. The mean operative time in group (A) was 142.38 ± 20.30 minutes, while it was 129.5 ± 16.35 in group (B), with a P value of 0.0332. The overall groin wound complications were 20%, 60% in both groups respectively, with a P value of 0.0225. The length of hospital stay was not affected with flap versus no flap, but it was affected with groin complications. Groin complications led to increased hospital stay, the mean hospital stay for patients with non-complicated groin wounds was 3.69 ± 0.85, 3.75 ± 0.97 days for groups (A), (B) respectively, with a P value of 0.8777. The mean hospital stays for patients having complicated groin wound was 16.5 ± 2.06, 17 ± 2.12 days for groups (A), (B) respectively, with a P value of 0.6873. The hospital stay increased due to groin wound complications, in both groups comparing non-complicated to complicated cases results in a P value of 0.0001 as regard hospital stay. Complications related the vascular reconstructive procedure leading to amputation was 0% in group (A) versus 5% in group (B)(P = 1.0000)
Conclusion:
Prophylactic use of sartorius muscle flap in the groin is a useful adjunctive method to decrease the rate of occurrence of groin wound complications which will be reflected upon hospital stay. In addition, it helps in protecting the vascular anastomotic site reducing the complications that may lead to amputation.
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