Predicting the need for muscle flap salvage after open groin vascular procedures: A clinical assessment tool. Issue 6 (December 2014)

• Record Type: Journal Article
• Authors: Fischer, John P.; Nelson, Jonas A.; Shang, Eric K.; Wink, Jason D.; Wingate, Nicholas A.; Woo, Edward Y.; Jackson, Benjamin M.; Kovach, Stephen J.; Kanchwala, Suhail
• Is Part Of: Journal of plastic surgery and hand surgery. Volume 48:Issue 6(2014)
• Page Start: 389
• Page End: 395
• Publication Date: 2014-12
• Subjects: Surgery -- Periodicals; Hand -- Surgery -- Periodicals; Orthopedics -- Periodicals; Surgery, Plastic -- Periodicals; 617.95
• DOI: 10.3109/2000656X.2014.899242
• Languages: English
• ISSNs: 2000-656X

Abstract

<abstract> <title>Abstract</title> <p>Groin wound complications after open vascular surgery procedures are common, morbid, and costly. The purpose of this study was to generate a simple, validated, clinically usable risk assessment tool for predicting groin wound morbidity after infra-inguinal vascular surgery. A retrospective review of consecutive patients undergoing groin cutdowns for femoral access between 2005–2011 was performed. Patients necessitating salvage flaps were compared to those who did not, and a stepwise logistic regression was performed and validated using a bootstrap technique. Utilising this analysis, a simplified risk score was developed to predict the risk of developing a wound which would necessitate salvage. A total of 925 patients were included in the study. The salvage flap rate was 11.2% (<italic>n</italic> = 104). Predictors determined by logistic regression included prior groin surgery (OR = 4.0, <italic>p</italic> < 0.001), prosthetic graft (OR = 2.7, <italic>p</italic> < 0.001), coronary artery disease (OR = 1.8, <italic>p</italic> = 0.019), peripheral arterial disease (OR = 5.0, <italic>p</italic> < 0.001), and obesity (OR = 1.7, <italic>p</italic> = 0.039). Based upon the respective logistic coefficients, a simplified scoring system was developed to enable the preoperative risk stratification regarding the likelihood of a significant complication which would require a salvage muscle flap. The c-statistic for the regression demonstrated excellent discrimination at 0.89. This study presents a simple, internally validated risk assessment tool that accurately predicts wound morbidity requiring flap salvage in open groin vascular surgery patients. The preoperatively high-risk patient can be identified and selectively targeted as a candidate for a prophylactic muscle flap.</p> </abstract>