Prophylactic muscle flaps in vascular surgery: the Penn Groin Assessment Scale.
BACKGROUND
High-risk patients undergoing vascular procedures through inguinal incisions experience significant benefit from undergoing prophylactic muscle flaps. The authors present a risk assessment tool, an evidence-based algorithm for using prophylactic muscle flaps, and a comprehensive cost analysis.


METHODS
Data derived from the authors' previously performed retrospective cohort study of patients undergoing open vascular groin surgery were used to construct an evidence-based risk assessment tool. A multivariate regression analysis identified significant, independent predictors of complications, which were used to construct a scoring system. An institutional cost analysis and preoperative assessment algorithm were derived based on patient risk stratification and statistical analyses.


RESULTS
Sixty-eight prophylactic flaps in 53 patients were compared with 195 open femoral access procedures without flaps in 178 patients. Multivariate regression demonstrated that obesity, smoking, reoperation, and prosthetic graft reconstruction are significant predictors of complications. A weighted risk factor score (0 to 7) was devised: obesity, for a value of 1; smoking, 2; reoperation for open groin surgery, 2; and prosthetic graft material, 2. Patients with higher scores had significantly more complications, infections, and more frequently required secondary salvage flap procedures. Using study data, the authors constructed an algorithm to guide preoperative groin assessment and use of prophylactic muscle flaps.


CONCLUSIONS
The authors provide an assessment tool, called the Penn Groin Assessment Scale, that accurately predicts groin complications. They also describe a simple algorithm to assess for prophylactic muscle coverage. Their results suggest that patients with two or more risk factors will benefit from prophylactic muscle flaps.


METHODS
Risk, II.
Philadelphia, Pa. From the Divisions of Plastic Surgery and Vascular Surgery and the Department of Finance, Hospital of the University of Pennsylvania.
John P
JP
Fischer
Jonas A
JA
Nelson
Jeff I
JI
Rohrbach
Liza C
LC
Wu
Edward Y
EY
Woo
Stephen J
SJ
Kovach
David W
DW
Low
Joseph M
JM
Serletti
Suhail
S
Kanchwala
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis; D005260:Female; D006119:Groin / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply / Q000637:transplantation*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013524:Surgical Flaps / Q000098:blood supply*; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000379:methods*; D055815:Young Adult