Management of Venoarterial Extracorporeal Membrane Oxygenation Cannulation-Associated Groin Wound Complications With Muscle Flaps at a High-Acuity Cardiac Referral Center.

Abstract

Background: The insertion of large bore cannulas into the femoral vessels for venous-arterial extracorporeal membrane oxygenation (VA-ECMO) administration has been associated with significant acute and chronic wound complications in patients with significant medical and surgical comorbidities, including vessel exposure and lymphocele development. In this series, we report our experience using muscle flap reconstruction in the management of post-ECMO groin wounds, with particular emphasis on groin lymphocele.

Methods: VA-ECMO patients at a high-acuity cardiac referral center who developed groin cannulation site complications requiring muscle flap closure were included for retrospective review. Preoperative, perioperative, and postoperative factors were analyzed.

Results: Fifteen patients were included. The most common comorbidities were hypertension (66.7%), diabetes (46.7%), and renal failure (60.0%). Eight (53.3%) patients were immunosuppressed. The most frequent indications for surgery were groin lymphocele (n = 8, 53.3%) and exposed femoral vessels (n = 7, 46.7%). Median time from ECMO decannulation to reconstruction was 49.0 days. Most reconstructions were performed using a rectus femoris flap (n = 13, 86.7%). Two (13.3%) shallow wounds were covered with a sartorius muscle flap. Intraoperative cultures were positive in 9 (60.0%) patients. Seven (46.7%) patients experienced complications, including hematoma (n = 5), dehiscence (n = 1), recipient site infection (n = 1), and donor site infection (n = 1). In both groups, there were no cases involving lymphocele recurrence following reconstruction. There were no flap-specific complications and no cases of amputation. Four patients died within 1 year from septic shock (n = 3) and heart failure (n = 1).

Conclusions: We report successful reconstruction in the majority of patients. In particular, muscle flap reconstruction is a useful technique for addressing ECMO-associated lymphocele development and recurrence. Future studies are needed to determine ideal timing of reconstruction and if early plastic surgeon involvement can reduce morbidity and mortality of these difficult to treat infections.