title: Predicting the need for muscle flap salvage after open groin vascular procedures: a clinical assessment tool.
abstract: Groin wound complications after open vascular surgery procedures are common, morbid, and costly. The purpose of this study was to generate a simple, validated, clinically usable risk assessment tool for predicting groin wound morbidity after infra-inguinal vascular surgery. A retrospective review of consecutive patients undergoing groin cutdowns for femoral access between 2005-2011 was performed. Patients necessitating salvage flaps were compared to those who did not, and a stepwise logistic regression was performed and validated using a bootstrap technique. Utilising this analysis, a simplified risk score was developed to predict the risk of developing a wound which would necessitate salvage. A total of 925 patients were included in the study. The salvage flap rate was 11.2% (n = 104). Predictors determined by logistic regression included prior groin surgery (OR = 4.0, p < 0.001), prosthetic graft (OR = 2.7, p < 0.001), coronary artery disease (OR = 1.8, p = 0.019), peripheral arterial disease (OR = 5.0, p < 0.001), and obesity (OR = 1.7, p = 0.039). Based upon the respective logistic coefficients, a simplified scoring system was developed to enable the preoperative risk stratification regarding the likelihood of a significant complication which would require a salvage muscle flap. The c-statistic for the regression demonstrated excellent discrimination at 0.89. This study presents a simple, internally validated risk assessment tool that accurately predicts wound morbidity requiring flap salvage in open groin vascular surgery patients. The preoperatively high-risk patient can be identified and selectively targeted as a candidate for a prophylactic muscle flap.
authors.affiliation: Division of Plastic Surgery.
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Nelson
authors.forename: Eric K
authors.initials: EK
authors.lastname: Shang
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wink
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Wingate
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Woo
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Jackson
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kovach
authors.forename: Suhail
authors.initials: S
authors.lastname: Kanchwala
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000601:surgery; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006119:Groin; D006801:Humans; D007264:Inguinal Canal / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000601:surgery; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: Muscle flaps; groin wounds; infection; risk assessment; salvage; seroma; vascular