The North Pacific Surgical Association The sartorius muscle flap: an important adjunct for complicated femoral wounds involving vascular grafts Gregory J. Landry, M.D.*, Jessica R. Carlson, M.S., Timothy K. Liem, M.D., Erica L. Mitchell, M.D., James M. Edwards, M.D., Gregory L. Moneta, M.D. Department of Surgery, Division of Vascular Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, OP11, Portland, OR 97239-3098, USA Abstract INTRODUCTION: Femoral wound complications can threaten vascular grafts. Muscle flaps can be used to facilitate soft-tissue coverage and graft salvage. We report a series of sartorius flaps performed by vascular surgeons in the treatment of complicated femoral wounds. METHODS: Rotational sartorius flaps were performed to attempt salvage of underlying vascular grafts. We reviewed a prospective database to determine the outcomes of sartorius flaps on facilitating wound healing and graft salvage and patency. RESULTS: From 2005 to 2008, 21 sartorius flaps were performed in infected or threatened femoral wounds. Original operations included femoral endarterectomy with patch repair in 8, aortofemoral graft in 6, axillofemoral graft in 4, and femoral-distal bypass in 3 patients. Complete wound healing occurred in 18 patients (86%). Primary wound closure was achieved in 7 patients. Secondary wound closure was achieved in 11 patients with mean healing time of 2.3 months. All vascular reconstructions remained patent at the 9.5-month follow-up. CONCLUSIONS: Sartorius muscle flaps are effective at facilitating complicated femoral wound healing while maintaining graft salvage and patency. © 2009 Elsevier Inc. All rights reserved. KEYWORDS: Muscle flaps; Femoral; Wound infection; Vascular grafts Femoral artery exposure is essential for a variety of vascular grafts, including aortofemoral, extra-anatomic, and infrainguinal bypasses, as well as femoral endarterectomies. Femoral wound complications are an unfortunately com- mon occurrence after femoral arterial reconstructions. Fem- oral wound complications vary in severity from superficial wound infections, to noninfected hematomas and seromas that result in graft exposure, to deep wound infections that can threaten vascular grafts. The involvement of the grafts in an infectious process frequently mandates graft removal. This is particularly true when prosthetic grafts are involved but can also occur in the presence of autogenous grafts. Graft removal with extra-anatomic bypass is a poten- tially morbid procedure. Numerous series have reported mortality rates ranging from 10% to 60% with limb loss rates as high as 80%. 1–3 Given the high risk involved in these procedures, it is attractive to consider methods of graft preservation. An operative strategy of wide local debridement and either primary or secondary closure has a high failure rate because of the lack of viable tissue covering the graft. Muscle flaps have been used in complex femoral wound complications to facili- tate wound healing and to attempt to salvage vascular grafts at risk. A variety of muscle flaps have been used, including sartorius, gracilis, rectus femoris, and rectus abdominus flaps. These flaps have been primarily described and perfected by * Corresponding author. Tel.: +1-503-494-7593; fax: +1-503-494-4324. E-mail address: landryg@ohsu.edu Manuscript received November 10, 2008; revised manuscript Decem- ber 29, 2008 0002-9610/$ - see front matter © 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.amjsurg.2008.12.020 The American Journal of Surgery (2009) 197, 655– 659