title: The limited incision harvest of the rectus femoris flap for complex groin wound management.
abstract: BACKGROUND
  Muscle flaps can be effective in the protocol of complex groin wound management, yet donor-site morbidity remains a continued concern. The purpose of this study was to present a minimally invasive approach to the harvest of the rectus femoris flap (RFF) for groin wound vascularized tissue coverage.
  
  
  METHODS
  A retrospective study examined all patients undergoing RFF coverage and reconstruction of a complex groin wound between July 1, 2010, and December 31, 2011. During the study period, the senior author (S.K.K.) performed all RFF harvests through a minimally invasive approach, whereas all other surgeons performed the RFF harvest through a standard approach. Patients who underwent a minimally invasive RFF approach were compared with those who underwent the standard incision.
  
  
  RESULTS
  Forty-three patients underwent RFF coverage procedures, 11 of which were carried out using the minimally invasive technique. The patients in the minimally invasive cohort were older (P = 0.03) but had similar rates of medical comorbidities. Minimally invasive RFF harvests were more commonly performed in the planned, salvage setting (P = 0.03). No difference was found in the vascular surgery procedure type (P = 0.13), presence of exposed prosthetic graft material (0.2), or rate of culture-positive wound (P = 0.67). Importantly, no differences in operative time (184.4 [45.5] minutes vs 169.3 [31.7] minutes, P = 0.45) or postoperative complications were observed, with no graft losses or major limb-related morbidity in either group.
  
  
  CONCLUSIONS
  The RFF continues to be a workhorse flap for complex groin wounds, most often in the salvage setting. This study demonstrates that a minimally invasive approach can be used for flap harvest with equivalent results to that of the standard longitudinal incision.
authors.affiliation: From the Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Nelson
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.forename: Duncan J D
authors.initials: DJ
authors.lastname: Mackay
authors.forename: Michael N
authors.initials: MN
authors.lastname: Mirzabeigi
authors.forename: David S
authors.initials: DS
authors.lastname: Cabiling
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kovach
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Serletti
authors.forename: Suhail
authors.initials: S
authors.lastname: Kanchwala
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006119:Groin / Q000293:injuries* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D052097:Quadriceps Muscle; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome