Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Abdominal-based adipocutaneous advancement flap for reconstructing inguinal defects with contraindications to standard reconstructive approaches: a simple and safe salvage reconstructive option

  • Schaffer, Clara (Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV)) ;
  • Haselbach, Daniel (Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV)) ;
  • Schiraldi, Luigi (Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV)) ;
  • Sorelius, Karl (Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University) ;
  • Kalbermatten, Daniel F. (Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Basel) ;
  • Raffoul, Wassim (Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV)) ;
  • di Summa, Pietro G. (Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne (CHUV))
  • Received : 2019.11.23
  • Accepted : 2020.05.16
  • Published : 2021.07.15
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Abstract

Background Groin wounds occurring after vascular surgical site infection, oncologic resection, or occasionally orthopedic surgery and trauma may represent a surgical challenge. Reconstruction of these defects by the usual workhorse flaps may be contraindicated following previous surgery and in patients with lower limb lymphedema or extreme morbidity. Methods This study included 15 consecutive patients presenting with inguinal wounds after vascular or general surgery that required debridement and soft tissue coverage. All cases had absolute or relative contraindications to conventional reconstructive techniques, including a compromised deep femoral artery network, limb lymphedema, scarring of potential flap harvesting sites, or poor overall condition. Abdominal adipocutaneous excess enabled the performance of adipocutaneous advancement flaps in an abdominoplasty-like fashion. Immediate and long-term outcomes were analyzed. Results Soft tissue coverage was effective in all cases. Two patients required re-intervention due to flap-related complications (venous congestion and partial flap necrosis). All patients fully recovered over a mean±standard deviation follow-up of 2.4±1.5 years. Conclusions Abdominal flaps can be an effective and simple alternative technique for inguinal coverage with reproducible outcomes. In our experience, the main indications are a compromised deep femoral artery network and poor thigh tissue quality. Relative contraindications, such as previous open abdominal surgery, should be considered.

Keywords

References

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