Relative outcomes of flap-based reconstruction and incisional negative-pressure wound therapy for groin closure in the setting of open vascular procedures in the groin.

Abstract

We analyzed outcomes of pedicled sartorius muscle flap, pedicled rectus femoris muscle flap, and incisional negative-pressure wound therapy (iNPWT) alone for prophylactic groin closure following vascular operations with open groins. We also compared outcomes of both flap options for complication-related groin closure. This single-institution retrospective cohort study included patients receiving prophylactic or complication-related groin closure during vascular operations involving groin exposure between 2018 and 2022. We examined comorbidities, interventions, complications, and outcomes and used Fisher's logistic regression to examine whether intervention type predicted outcomes that differed on bivariate analysis. Among 115 prophylactic groin closure cases in 94 patients, management included iNPWT alone (38%), sartorius flap (30%), and rectus femoris flap (31%). The treatment group was a significant predictor of infection risk when controlling for baseline intergroup differences, with rectus femoris flaps associated with significantly lower infection risk than iNPWT alone (odds ratio [OR] 0.30, 95% confidence interval [CI] [0.09-0.93], p = 0.04). Rates of other complications and outcomes, including vascular intervention patency, were comparable (p ≥ 0.16). Among 63 complication-related groin closure cases in 56 patients, management included sartorius flap (43%) and rectus femoris flap (57%). Rectus femoris flap use was a significant predictor of incisional breakdown/dehiscence (OR 4.92, 95% CI [1.26-27.66], p = 0.02). Rates of other complications and outcomes, including vascular graft/bypass salvage, were comparable (p ≥ 0.08). In prophylactic groin closure following vascular operations involving groin exposure, rectus femoris flap use is associated with lower infection rates than iNPWT alone. In complication-related groin closure, rectus femoris flaps are associated with increased rates of incisional breakdown compared with sartorius flaps.