Leg for life? The use of sartorius muscle flap for the treatment of an infected vascular reconstructions after VA-ECMO use. A case report

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Use of VA-ECMO systems may be encumbered by severe vascular complications.

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Infections developed after femoral arterial surgery cause significant morbidity.

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Coverage of vascular structures with a muscle flap can achieve site sterilization.

Introduction

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO1) systems are a life-saving option in the treatment of acute respiratory distress syndrome (ARDS2), but may be encumbered by severe vascular complications in the groin.

Presentation of case

A pregnant woman was admitted with respiratory failure due to H1N1 influenza. VA-ECMO was inserted percutaneously by the intensivists and then accidentally removed by the patient after 8 days. 24 h later VA-ECMO was reinstalled with surgical denudation of femoral vessels in another department. 2 h later, due to active bleeding and signs of limb ischemia, the patient was referred to our department and emergency trombectomy and patch angioplasty with PTFE were performed. Evolution was further bad with wound infection (Pseudomonas, Proteus), which imposed large debridement, replacing the PTFE patch with 2 parallel venous patches and wound reconstruction through sartorius muscle rotation. The wound underwent negative pressure therapy for 10 days and was skin grafted. The patient recovered under systemic antibiotic and virostatic therapy.

Discussion

Major complications of using VA-ECMO devices are related to vascular access, most common bleeding at the puncture site and acute limb ischemia. In the groin, sartorius muscle flap is the most used for vascular coverage and small tissue defect reconstruction because of the ease in harvesting and low donor-site complications.

Conclusion

Although ischemic complications associated with VA-ECMO are accepted by intensivists under the slogan “leg for life”, for the repair of the femoral artery in the presence of groin infection the sartorius muscle remains an efficient solution for limb salvage.