Management of inguinal lymphadenopathy: immediate sartorius transposition and reconstruction of recurrence with pedicled ALT flap.
Inguinal lymphadenectomy is associated with considerable morbidity, and several attempts have been made to minimize the morbidity by well-vascularized flaps of adequate bulk to obliterate the dead space and promote wound healing. In the case of recurrence, the overlying skin is usually involved and the reconstructive surgeon is confronted with exposed femoral vessels and complex groin defects. We report a series of 40 patients that underwent inguinal lymphadenectomy and immediate sartorius transposition for skin malignancies, and 4 patients with recurrence that was treated with radical surgical excision and pedicled anterolateral thigh flap (ATL). We examined complications such as infection, skin necrosis, lymphorea, lymphoedema, and wound healing time. The immediate sartorius transposition was associated with 7.5% infection rate, 5% superficial skin edge necrosis, 0% of persistent lymph, and 27.5% of mild lymphoedema. All ALT flaps survived completely and wounds healed uneventfully within 2 weeks without any signs of infection, seroma, or wound dehiscence.Sartorius and ALT flap are reliable methods to reconstruct the groin following inguinal lymphadenectomy. They ensure low complication rate with no donor site morbidity, and should be the first line treatment of immediate and secondary groin reconstruction, respectively.
Gravvanis
Andreas
A
St. Andrews Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, UK. gravvani@yahoo.com
Caulfield
Robert H
RH
Mathur
Bhagwat
B
Ramakrishnan
Venkat
V
D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006119:Groin / Q000601:surgery*; D006801:Humans; D007264:Inguinal Canal / Q000601:surgery; D008197:Lymph Node Excision / Q000379:methods; D008206:Lymphatic Diseases / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps; D013536:Suture Techniques; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology