Sartorius and Gracilis Muscle Flaps as Adjuncts for the Management of Complicated Femoral Wounds in Vascular Surgery.

Aim: Groin complications following vascular surgery occur in 10-30% of cases and are associated with significant morbidity and mortality rates. While various institutions have published results on sartorius and rectus femoris muscle flaps for arterial reconstruction coverage, there are limited data on the use of gracilis muscle flaps. This study aimed to present the outcomes of sartorius and gracilis muscle flaps in managing complicated femoral wounds.

Method: A retrospective study was conducted from January 2019 to December 2023 at a tertiary centre in New Zealand. The study design followed the STrengthening the Reporting of Observation studies in Epidemiology (STROBE) checklist. Patients who underwent a muscle flap for an emergency vascular surgery indication were included. The primary outcome was wound healing, while secondary outcomes included re-intervention, limb and graft salvage.

Results: Twenty-three flaps were performed for post-operative complications during the study period, including 10 gracilis flaps and 13 sartorius flaps, with a median follow up of twenty-six months. Complete healing was achieved in 90% of patients in the gracilis group, compared with 69% in the sartorius group ( = 0.34). The median time to healing was 56 days in the gracilis group and 55 days in the sartorius group. Three patients in the sartorius group underwent planned re-intervention for groin debridement, compared with two in the gracilis group. Donor site wound complications occurred in two gracilis flap patients, both of which healed. Major complications in the sartorius group included two amputations and one graft occlusion, while no such event occurred in the gracilis group.

Conclusion: Both gracilis and sartorius muscle flaps are viable options for reconstructing femoral wounds, with reasonable post-operative outcomes. Further multicentre studies are needed to better correlate clinical outcomes with the perceived benefits of the gracilis flap.