title: Early transposition of the sartorius muscle for exposed patent infrainguinal bypass grafts.
abstract: The traditional approach for patent and exposed and infected infrainguinal bypass grafts in the groin has included wide operative debridement and secondary or delayed primary closure. However, this has been associated with significant risk of further contamination and length of stay. The authors reviewed their experience using the wide debridement, sartorius muscle flap transposition, and primary wound closure as an alternative. During the past 5 years, they have had 50 patients with major wound necrosis or infection in the groin or thigh with the graft or native artery being exposed after debridement. This group included 28 men; 74% of the patients had hypertension, 58% had diabetes, and 20% had renal failure. The grafts were split evenly between native vein and prosthetic material. After wide debridement, closure was performed by the vascular surgeon using the sartorius muscle flap. Postoperatively, there was an 8% major amputation rate and a 12% mortality rate in the first 30 days. One patient developed a pseudoaneurysm 5 weeks after placement of the flap. This patient underwent removal of the infected polytetrafluoroethylene graft with ligation of the common femoral artery. None of the procedures have resulted in further systemic or graft sepsis. None have resulted in arterial or graft blowout. Follow-up was for an average of 18 months. Closure of groin and thigh wounds with exposed bypass graft or native artery can be safely performed with the sartorius muscle flap with excellent results. The length of stay of these patients compared to historical controls is acceptable. Furthermore, the chance of infection of the native artery or bypass may be reduced. Familiarity with this simple technique can be a valuable tool for the vascular surgeon.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA. eascher@maimonidesmed.org
authors.forename: Richard
authors.initials: R
authors.lastname: Schutzer
authors.forename: Anil
authors.initials: A
authors.lastname: Hingorani
authors.forename: Enrico
authors.initials: E
authors.lastname: Ascher
authors.forename: Natalia
authors.initials: N
authors.lastname: Markevich
authors.forename: Sreedhar
authors.initials: S
authors.lastname: Kallakuri
authors.forename: Theresa
authors.initials: T
authors.lastname: Jacob
mesh_terms: D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation; D003646:Debridement; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply / Q000601:surgery*; D008297:Male; D018482:Muscle, Skeletal / Q000637:transplantation*; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D013524:Surgical Flaps; D014654:Vascular Patency