THE EFFECT OF SARTORIUS TRANSPOSITION ON WOUND MORBIDITY FOLLOWING INGUINAL-FEMORAL LYMPHADENECTOMY

In spite of efforts to reduce complications associated with inguinal-f emoral lymphadenectomy (IFL), morbidity continues to be substantial. W e sought to assess the efficacy of sartorius transposition (ST) in red ucing groin wound complications following IFL, in patients with vulvar malignancy. The records of 101 patients with vulvar cancer undergoing IFL through separate incisions between March 1975 and December 1994 w ere examined. Sixty-two patients undergoing ST (group 1) were compared to 38 who did not (group 2). The groups were similar with respect to age, weight, tobacco/alcohol use, prior abdominal/vulvar surgery, prev alence of diabetes, hypertension, or peripheral vascular disease, and previous exposure to irradiation or chemotherapy. Additionally, there was no significant difference with respect to extent of disease, incid ence of macro-/microscopic groin metastases, use of groin drains, and use of perioperative antibiotics or deep venous thrombosis prophylaxis . Groin wound complications were less frequent in patients undergoing ST (group 1). The incidence of groin cellulitis was 30% in group 1 com pared with an incidence of 58% in group 2 (P = 0.011). Significant gro in wound morbidity, defined as either wound breakdown or cellulitis, w as seen less frequently in group 1 (41% vs 66%; P = 0.029). Employing a multivariate analysis, only patient weight <150 lbs and performance of ST were established as independently associated with a reduction in groin morbidity following IFL (P = 0.0281 and P = 0.0075, respectivel y). In conclusion, despite waning enthusiasm for its performance, ST a ppeared to significantly reduce the incidence of wound morbidity after IFL. Our data confirmed that separate incisions, and improved periope rative antibiotics, have not eliminated the value inherent in this sur gical modification. We suggest a prospective trial to further establis h the benefit of sartorius transposition during IFL. (C) 1997 Academic Press.