title: Sartorius transposition during inguinal lymphadenectomy for melanoma.
abstract: BACKGROUND
  Inguinal lymph node dissection (ILND) for melanoma has been associated with high rates of wound complication (WC). Sartorius transposition (ST) is a technique that has been proposed to minimize morbidity. We report the frequency of utilization of ST and associated clinical outcomes in a national sample.
  
  
  METHODS
  Patients undergoing ILND for melanoma were identified in the American College of Surgeons National Surgical Quality Improvement Program Participant Use File (2005-2011). ST status was determined. Univariate logistic regression analyses were performed. Propensity score matching was used to control for operative time. Conditional logistic regression was used to determine the likelihood of a WC following ST in the matched cohort.
  
  
  RESULTS
  Of the 381 patients identified, 13% had a WC. By univariate analysis, increasing body mass index (P = 0.006), diabetes (P = 0.02), and longer operative time (P = 0.005) were associated with WC. Sixty-three patients received a prophylactic ST (16.5%). ST use was significantly associated with deep nodal dissection (P = 0.03) and increased operative time (P < 0.0001) but not with any preoperative risk factors. WC rates were similar between ST and non-ST patients (10% versus 14%, P = 0.39). In the multivariate analysis of patients matched for operative time, ST was the only factor significantly associated with lower WC rate. The WC rate was 23% in non-ST compared with 8% in ST patients (P = 0.05).
  
  
  CONCLUSIONS
  Nationally, ST is used infrequently at the time of ILND. Moreover, patients undergoing ST do not appear to be selected based on the patient factors associated with increased risk of WC. Risk factors for wound complication should be considered in the selective use of ST.
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania 19147, USA. edmund.bartlett@uphs.upenn.edu
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Bartlett
authors.forename: Chelsey
authors.initials: C
authors.lastname: Meise
authors.forename: Neha
authors.initials: N
authors.lastname: Bansal
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.forename: David W
authors.initials: DW
authors.lastname: Low
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Czerniecki
authors.forename: Robert E
authors.initials: RE
authors.lastname: Roses
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Fraker
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
authors.forename: Giorgos C
authors.initials: GC
authors.lastname: Karakousis
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006119:Groin / Q000601:surgery; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D009017:Morbidity; D018482:Muscle, Skeletal / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000453:epidemiology / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control; D013927:Thrombosis / Q000453:epidemiology / Q000517:prevention & control; D014481:United States / Q000453:epidemiology
keywords: Inguinal lymph node dissection; Melanoma; Sartorius transposition flap; Wound complication