Free groin flap revisited

Reported herein are 130 consecutive cases of free groin flap transfer perfo rmed by one surgeon over a 19-year period. Transplantation was performed fo r soft-tissue cover or augmentation of contour defects involving the head a nd neck (68 cases), trunk (4 cases), upper limb (14 cases), and lower limb (44 cases). Indications for nap coverage/augmentation were classified broad ly into tumor, trauma, radiation induced, and miscellaneous. Spe cific reco nstructive problems included augmentation for Romberg's hemifacial atrophy, external car canal reconstruction after tumor ablation, and coverage of lo wer limb defects. There were nine failures (total flap loss), seven cases o f partial nap loss, and two cases were abandoned intraoperatively. Of 15 ca ses that were urgently re-explored, 9 flaps were salvaged. The failure rate for the groin flap series (130 cases) was 8.5 percent compared with the fa ilure rate of 4.2 percent for the other 517 cases of microvascular transfer performed over the same period by the same surgeon. Donor-site complicatio ns occurred in 24 cases and included hematoma or seroma formation, hypertro phic scars, nerve paresthesiae, infection, and dehiscence. Secondary debulk ing procedures were performed in 26 cases. The free groin flap, contrary to some reports, is a reliable nap that provides relatively thin pliable soft -tissue cover or augmentation, with minimal donor-site morbidity. The speci fic indications for its use have under-gone an evolution since first descri bed in 1973.