背景:经人工导管流入或腹股沟下分流术后腹股沟切口并发症可导致需要再次手术的重大并发症,感染的移植物切除,和断肢。肌肉皮瓣通常用于治疗腹股沟伤口并发症,但在某些愈合不良的高风险患者中,也可以在索引手术时进行预防性治疗,以减轻预期的腹股沟伤口并发症.我们使用了全国性的多机构数据库,以调查高风险患者的预防性肌皮瓣的结果,这些患者接受了涉及股骨吻合术的假体搭桥术。
方法:我们利用ACS-NSQIP数据库2005-2021来识别所有涉及股骨吻合术的选择性流入和腹股沟下旁路。仅选择切口愈合不良且接受人工导管旁路的高风险患者。根据人口统计学和合并症,进行了1:3的倾向匹配,以在有(FLAP)和没有预防性肌瓣(NOFLAP)的人之间获得两个可比的研究组。比较术后30天的结果。
结果:在35,011个NOFLAP中,其中990与330个FLAP倾向匹配。30天死亡率没有显着差异,MACE,肺,或肾脏并发症。FLAP与需要输血的出血增加有关,更长的手术时间,住院时间更长。FLAP的整体伤口并发症也较高(15.2%vs.10.6%;p=0.03),尤其是深切口感染(4.9%vs.2.4%;p=0.04)。
结论:在愈合不良的高风险患者中,预防性肌瓣用于涉及股骨吻合术的假体旁路手术似乎不能减轻30天的伤口并发症。这种做法应谨慎行事,并应获得更多长期数据以确定预防性皮瓣是否降低移植物感染的发生率。
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).
CONCLUSIONS: 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.