Vertical or transverse incisions for access to the femoral artery: a randomized control study.
BACKGROUND
To look at wound complications with either a transverse or vertical groin incision in vascular surgery.


METHODS
All patients undergoing vascular procedure requiring access to femoral vessels were randomized to either a vertical or transverse incision. Patients were followed up for 28 days after the procedure and examined for wound infection, wound breakdown, development of lymphatic leak and lymphatic collection.


RESULTS
88 patients (116 groins) were randomised to either incision. Of these, 55 groins had transverse incisions and the remaining had vertical incisions. There was no significant difference in the patient's age, sex, smoking, diabetes, operative times and use of prosthetic material. 29/61 (47.5%) of vertical incisions and 7/55 (12.7%) of transverse incisions had wound complications (p<0.001). There were 13(11%) wound infections in the 116 groins by day 28. There were 3 wound infections in the transverse group and 10 infections in the vertical group (p=0.062). There were 17 (27.9%) lymphatic leaks in the vertical incisions compared to 7(12.7%) in the transverse incisions (p=0.044). The majority of infections were diagnosed after patient discharge from hospital.


CONCLUSIONS
Wound complications are higher with vertical incision. Many infections are diagnosed after patient discharge. We recommend transverse incisions for access to the femoral vessels in the groin.
Swinnen
Jan
J
Departmnet of Surgery, Westmead Hospital, Westmead, NSW, Australia. john_swinnen@bluebottle.com
Chao
Alex
A
Tiwari
Alok
A
Crozier
John
J
Vicaretti
Mauro
M
Fletcher
John
J
D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006119:Groin / Q000098:blood supply*; D006801:Humans; D008206:Lymphatic Diseases / Q000209:etiology; D008210:Lymphocele / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012501:Saphenous Vein / Q000637:transplantation*; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*