MANAGEMENT OF EXPOSED INGUINOFEMORAL ARTERIAL CONDUITS BY SKELETAL MUSCULAR ROTATIONAL FLAPS

Peripheral vascular reconstructions are common operations for the trea tment of occlusive atherosclerosis, and the vast majority are uncompli cated. However, despite all precautionary measures, a small percentage of patients will manifest wound infection and graft exposure that may evolve to loss of limb and/or life. Treatment has traditionally consi sted of systemic administration of antibiotic medication(s), graft ext irpation, and extra-anatomic arterial bypass; yet despite use of these more radical modalities, morbidity and mortality have remained high. An additional meritorious adjunct for the treatment of exposed prosthe tic or autogenous saphenous vein arterial bypass grafts is the use of local/regional autogenous skeletal muscular rotational flaps. Reported herein are the results of this technique applied to the inguinofemora l regions of eight patients. Rectus abdominis (1 patient), rectus femo ris (4), and sartorius (4) skeletal muscular rotational flaps were emp loyed. Seven of eight (88%) patients convalesced well at mean duration of follow-up measuring 24 months, although one patient subsequently r equired major amputation due to progression of occlusive atheroscleros is. One of eight (12%) patients succumbed secondary to irreversible se psis, despite radical amputation. The data suggest that use of local/r egional skeletal muscular rotational flaps is a useful adjunct for the treatment of patients with exposed arterial conduits.