Prophylactic muscle flaps in high-risk-for-poor-healing patients with prosthetic bypasses increases deep wound complications

Authors

Samyuktha Ravikumar, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Renxi Li, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Jamie Thompson, Department of Surgery, The George Washington University Hospital, Washington, District of Columbia, USA.
Emanuela C. Peshel, Department of Surgery, The George Washington University Hospital, Washington, District of Columbia, USA.
Melina Recarey, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Richard Amdur, Department of Surgery, The George Washington University Hospital, Washington, District of Columbia, USA.
Salim Lala, Department of Surgery, The George Washington University Hospital, Washington, District of Columbia, USA.
John Ricotta, Department of Surgery, The George Washington University Hospital, Washington, District of Columbia, USA.
Anton Sidawy, Department of Surgery, The George Washington University Hospital, Washington, District of Columbia, USA.
Bao-Ngoc Nguyen, Department of Surgery, The George Washington University Hospital, Washington, District of Columbia, USA.

Document Type

Journal Article

Publication Date

7-17-2024

Journal

World journal of surgery

DOI

10.1002/wjs.12296

Keywords

aortofemoral bypass; axillofemoral bypass; femorofemoral bypass; femoropopliteal bypass; femorotibial bypass; iliofemoral bypass; infrainguinal bypass; muscle flap; prosthetic bypass

Abstract

BACKGROUND: Incisional complications of groin after inflow or infrainguinal bypasses with prosthetic conduits can result in major morbidities that require reoperation, infected graft removal, and limb loss. Muscle flaps are typically performed to treat groin wound complications, but they are also done prophylactically at the time of index procedures in certain high-risk-for-poor-healing patients to mitigate anticipated groin wound complications. We used a nationwide multi-institutional database to investigate outcomes of prophylactic muscle flaps in high-risk patients who underwent prosthetic bypasses involving femoral anastomosis. METHODS: We utilized ACS-NSQIP database 2005-2021 to identify all elective inflow and infrainguinal bypasses that involve femoral anastomoses. Only high-risk patients for poor incisional healing who underwent prosthetic conduit bypasses were selected. A 1:3 propensity-matching was performed to obtain two comparable studied groups between those with (FLAP) and without prophylactic muscle flaps (NOFLAP) based on demographics and comorbidities. 30-day postoperative outcomes were compared. RESULTS: Among 35,011 NOFLAP, 990 of them were propensity-matched to 330 FLAP. There was no significant difference in 30-day mortality, MACE, pulmonary, or renal complications. FLAP was associated with higher bleeding requiring transfusion, longer operative time, and longer hospital stay. FLAP also had higher overall wound complications (15.2% vs. 10.6%; p = 0.03), especially deep incisional infection (4.9% vs. 2.4%; p = 0.04). CONCLUSION: Prophylactic muscle flap for prosthetic bypasses involving femoral anastomosis in high-risk-for-poor-healing patients does not appear to mitigate 30-day wound complications. Caution should be exercised with this practice and more long-term data should be obtained to determine whether prophylactic flaps decrease the incidence of graft infection.

APA Citation

Ravikumar, Samyuktha; Li, Renxi; Thompson, Jamie; Peshel, Emanuela C.; Recarey, Melina; Amdur, Richard; Lala, Salim; Ricotta, John; Sidawy, Anton; and Nguyen, Bao-Ngoc, "Prophylactic muscle flaps in high-risk-for-poor-healing patients with prosthetic bypasses increases deep wound complications" (2024). GW Authored Works. Paper 5265.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5265

Department

Surgery