Gracilis Muscle Flap After Superficial Inguinal Lymphadenectomy in an Irradiated Inguinal Field. Issue 4 (April 2023)
- Record Type:
- Journal Article
- Title:
- Gracilis Muscle Flap After Superficial Inguinal Lymphadenectomy in an Irradiated Inguinal Field. Issue 4 (April 2023)
- Main Title:
- Gracilis Muscle Flap After Superficial Inguinal Lymphadenectomy in an Irradiated Inguinal Field
- Authors:
- Valenzuela, Cristian D.
Finlay, David
Sabry, Zakir
Mariadason, James G.
Wallack, Marc K. - Abstract:
- The sartorius muscle transposition flap is the traditional method of femoral vessel coverage after superficial inguinal lymphadenectomy for regionally-metastatic cancers to the inguinal lymph nodes. However, if the groin has undergone radiotherapy, the sartorius muscle is contained within the irradiated field, and may be problematic for wound healing, in addition to being thin at its insertion and intimately related to several nerves. The gracilis muscle has been used for soft tissue defects and vascular graft infections, but its utility as an alternative to the sartorius muscle flap in the setting of radiation has never been reported. Here, we report the successful use of the retroflexed gracilis muscle flap for femoral vessel coverage after superficial inguinal lymphadenectomy, in a patient who previously underwent chemoradiation for locally-metastatic anal squamous cell carcinoma to the groin. An 86-year old female presented with Stage IIIB anal squamous cell carcinoma metastatic to one left inguinal lymph node. She underwent modified Nigro protocol chemoradiation treatment, which included radiation to the inguinal node basins. A left superficial inguinal lymphadenectomy was performed with a retroflexed gracilis muscle flap to cover the femoral vessels. This was chosen over a sartorius flap because the gracilis muscle was not located within the field of radiation. Despite a subsequent groin wound infection, the gracilis muscle flap remained viable and successfullyThe sartorius muscle transposition flap is the traditional method of femoral vessel coverage after superficial inguinal lymphadenectomy for regionally-metastatic cancers to the inguinal lymph nodes. However, if the groin has undergone radiotherapy, the sartorius muscle is contained within the irradiated field, and may be problematic for wound healing, in addition to being thin at its insertion and intimately related to several nerves. The gracilis muscle has been used for soft tissue defects and vascular graft infections, but its utility as an alternative to the sartorius muscle flap in the setting of radiation has never been reported. Here, we report the successful use of the retroflexed gracilis muscle flap for femoral vessel coverage after superficial inguinal lymphadenectomy, in a patient who previously underwent chemoradiation for locally-metastatic anal squamous cell carcinoma to the groin. An 86-year old female presented with Stage IIIB anal squamous cell carcinoma metastatic to one left inguinal lymph node. She underwent modified Nigro protocol chemoradiation treatment, which included radiation to the inguinal node basins. A left superficial inguinal lymphadenectomy was performed with a retroflexed gracilis muscle flap to cover the femoral vessels. This was chosen over a sartorius flap because the gracilis muscle was not located within the field of radiation. Despite a subsequent groin wound infection, the gracilis muscle flap remained viable and successfully protected the major vessels. We report the gracilis muscle flap as a viable alternative to the sartorius transposition muscle flap for femoral vessel coverage after oncologic superficial inguinal lymphadenectomy in the irradiated groin. … (more)
- Is Part Of:
- American surgeon. Volume 89:Issue 4(2023)
- Journal:
- American surgeon
- Issue:
- Volume 89:Issue 4(2023)
- Issue Display:
- Volume 89, Issue 4 (2023)
- Year:
- 2023
- Volume:
- 89
- Issue:
- 4
- Issue Sort Value:
- 2023-0089-0004-0000
- Page Start:
- 1218
- Page End:
- 1221
- Publication Date:
- 2023-04
- Subjects:
- inguinal lymphadenectomy -- cancer -- anal squamous cell carcinoma -- gracilis muscle flap -- inguinal metastasis
Surgery -- Periodicals
Surgery -- United States -- Periodicals
617.0973 - Journal URLs:
- https://journals.sagepub.com/home/asua ↗
http://www.sagepublications.com/ ↗ - DOI:
- 10.1177/0003134820982850 ↗
- Languages:
- English
- ISSNs:
- 0003-1348
- Deposit Type:
- Legaldeposit
- View Content:
- Available online (eLD content is only available in our Reading Rooms) ↗
- Physical Locations:
- British Library DSC - BLDSS-3PM
British Library HMNTS - ELD Digital store - Ingest File:
- 26788.xml