Prophylactic Sartorius Flap Reconstruction is Associated With Reduced Vascular Graft Infection

Introduction

Complications in the femoral area following vascular surgery are frequent and linked to considerable morbidity, including the risk of underlying graft infection. Sartorius muscle flaps are an important adjunct for the treatment of wound complications. In this study, we examined our experience with prophylactic sartorius muscle flap coverage and its association with prosthetic vascular graft infection.

Methods

In this single-center analysis, electronic medical records were retrospectively reviewed for all sartorius muscle flap procedures performed from 2012 to 2021. Prophylactic indication was defined as flap reconstruction during index revascularization in the absence of active inguinal infection.

Results

Over the 9-y period, a total of 54 prophylactic sartorius flaps were performed in 47 patients. The median patient age was 66 y (interquartile range [IQR] 61-77 y). Wound complications requiring reintervention occurred in 16 (29.6%) patients, including 6 (11.1%) surgical site infections, 5 (9.3%) wound dehiscence, and 5 (9.3%) infected seromata. Among patients suffering wound complications, 30-d readmission (75.0% versus 26.3%, P = 0.004) and reoperative flap creation rates (25.0% versus 2.6%, P = 0.010) were higher, whereas 30-d mortality rates (0.0% versus 5.3%, P = 0.51) were similar. Only one patient (1.9%) developed vascular graft infection over a median follow-up period of 2.4 y (IQR 0.9-4.0 y). On multivariate analysis, body mass index (adjusted odds ratio 1.23, 95% confidence interval, 1.12-1.35, P = 0.023) was associated with reoperative wound complications.

Conclusions

Wound complications were common after prophylactic sartorius flap creation in this high-risk population; however, infection of the underlying vascular graft was rare. These data suggest that sartorius flap may be effective in a prophylactic role.