Results of Pedicled Groin Flaps for Upper Extremity Coverage
Veera Venkata Naga Manohar Devarasetty, BS1, Justin Wayde Vickery, MD2 and Jed Ian Maslow, MD2, (1)Vanderbilt University School of Medicine, Nashville, TN, (2)Vanderbilt University Medical Center, Nashville, TN
Introduction
Free flap reconstruction has become the preferred treatment over pedicled groin flaps for reconstruction of upper extremity soft tissue defects in recent decades. However, pedicled groin flaps are still used for a variety of reasons, although limited literature is available to guide surgeons and patients regarding outcomes. This study aimed to investigate the epidemiology and outcomes associated with pedicled groin flaps for upper extremity injuries.
Materials & Methods
The study was a single-institution retrospective case series of patients who underwent pedicled groin flaps for upper extremity soft tissue coverage between 1992 and 2022. The data collected included patient, injury, and surgical characteristics as well as outcomes and complications. An ordinal logistic regression, univariate and multivariate analysis was performed to assess the relationship between the total number of groin flap surgeries and complications with patient and injury characteristics.
Results
The analysis included 88 pedicled groin flaps performed for upper extremity coverage, with a median follow-up of 1.14 (IQR: 0.67 – 2.08) years after injury. Flaps were performed for high energy injuries (crush, motor vehicle collisions, ballistic, explosive), burns, sharp lacerations, and other (infection, oncologic, congenital defects). Patients had a median age of 35 (IQR: 22, 49) and underwent a median of 4 (IQR: 3, 5.25) surgeries. Stiffness (90.6%), partial flap loss (38%), and infection (32%) were the most common complications. Classification as a high-energy injury increased the risk of requiring more surgeries based on ordinal logistic regression. Univariate and bivariate analysis revealed no significant difference in wound complications based on patient and injury characteristics including number of comorbidities and smoking status.
Conclusions
Patients undergoing pedicled groin flaps for upper extremity injuries can expect to undergo an average of four surgeries. No patient factor increases the risk of complications though high energy injuries predict the need for more surgeries. This study represents the most extensive examination of pedicled groin flaps conducted to date.
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