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Ryer EJ, Garvin RP, Kapadia RN, Jorgensen BD, Green JO, Fluck M, Orlova K, Cindric MC, Elmore JR. Outcome of rectus femoris muscle flaps performed by vascular surgeons for the management of complex groin wounds after femoral artery reconstructions. J Vasc Surg 2019; 71:905-911. [PMID: 31471237 DOI: 10.1016/j.jvs.2019.05.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/18/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Groin wound complications after femoral artery reconstructions are highly morbid and notoriously difficult to treat. Successful techniques include long-term antibiotic therapy, operative débridement, and muscle flap coverage. Historically, more complex muscle flap coverage, such as a rectus femoris muscle flap (RFF), has been performed by plastic and reconstructive surgeons. In this study, the experience of vascular surgeons performing RFF in the management of wound complications after femoral artery reconstructions is reported. METHODS Clinical data between 2012 and 2018 were retrospectively analyzed. Data were summarized, and standard statistical analysis was performed. RESULTS There were 23 patients who underwent 24 RFFs for coverage of complex groin wounds after femoral artery reconstructions. One of the 23 patients underwent bilateral RFFs. In this study cohort, patients had a median age of 67.5 years, and 79% (n = 19) were male. Median body mass index was 28.0 kg/m2, and 38% of patients were classified as obese on the basis of body mass index criteria. A history of tobacco use was present in 88%; however, only 29% were current smokers. Diabetes was present in 38% of patients and chronic kidney disease in 29%. Of the 24 RFFs, 14 (58%) were constructed in patients with reoperative groin surgery resulting in the need for muscle flap coverage. Femoral endarterectomy was the most common index procedure (46%), followed by infrainguinal leg bypass surgery (17%) and aortobifemoral bypass (17%). Grafts used during the original reconstruction included 12 bovine pericardial patches (50%), 6 Dacron grafts (25%), 4 PTFE grafts (17%), and 2 autogenous reconstructions (8%). Microbiology data identified 33% of patients (n = 8) to have gram-positive bacterial infections alone, 21% (n = 5) to have gram-negative infections alone, and 29% (n = 7) to have polymicrobial infections; 4 patients (13%) had negative intraoperative culture data. Median hospital stay after RFF was 8 days, and median follow-up time was 29.3 months. Major amputation was avoided in 20 of 24 limbs (83%) undergoing RFF. Eight patients underwent intentional graft or patch explantation (33%) before RFF, whereas 14 of the remaining 15 patients (93%) had successful salvage of the graft or patch after RFF. Two of the patients (13%) who underwent RFF with the intention of salvaging a prosthetic graft or patch required later graft excision. After RFF, 30-day and 1-year survival was 96% and 87%, respectively. CONCLUSIONS RFF coverage of complex groin wounds after femoral artery reconstructions may safely be performed by vascular surgeons with excellent outcomes.
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Affiliation(s)
- Evan J Ryer
- Department of Endovascular and Vascular Surgery, Geisinger Medical Center, Danville, Pa.
| | - Robert P Garvin
- Department of Endovascular and Vascular Surgery, Geisinger Medical Center, Danville, Pa
| | - Ravi N Kapadia
- Department of Endovascular and Vascular Surgery, Geisinger Medical Center, Danville, Pa
| | - Benjamin D Jorgensen
- Department of Endovascular and Vascular Surgery, Geisinger Medical Center, Danville, Pa
| | - Jessica O Green
- Department of Endovascular and Vascular Surgery, Geisinger Medical Center, Danville, Pa
| | - Marcus Fluck
- Department of Endovascular and Vascular Surgery, Geisinger Medical Center, Danville, Pa
| | - Ksenia Orlova
- Department of Endovascular and Vascular Surgery, Geisinger Medical Center, Danville, Pa
| | - Matthew C Cindric
- Department of Endovascular and Vascular Surgery, Geisinger Medical Center, Danville, Pa
| | - James R Elmore
- Department of Endovascular and Vascular Surgery, Geisinger Medical Center, Danville, Pa
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Hinterseher I, Erdman R, Elmore JR, Stahl E, Pahl MC, Derr K, Golden A, Lillvis JH, Cindric MC, Jackson K, Bowen WD, Schworer CM, Chernousov MA, Franklin DP, Gray JL, Garvin RP, Gatalica Z, Carey DJ, Tromp G, Kuivaniemi H. Novel pathways in the pathobiology of human abdominal aortic aneurysms. Pathobiology 2012; 80:1-10. [PMID: 22797469 PMCID: PMC3782105 DOI: 10.1159/000339303] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 04/23/2012] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Abdominal aortic aneurysm (AAA), a dilatation of the infrarenal aorta, typically affects males >65 years. The pathobiological mechanisms of human AAA are poorly understood. The goal of this study was to identify novel pathways involved in the development of AAAs. METHODS A custom-designed 'AAA-chip' was used to assay 43 of the differentially expressed genes identified in a previously published microarray study between AAA (n = 15) and control (n = 15) infrarenal abdominal aorta. Protein analyses were performed on selected genes. RESULTS Altogether 38 of the 43 genes on the 'AAA-chip' showed significantly different expression. Novel validated genes in AAA pathobiology included ADCY7, ARL4C, BLNK, FOSB, GATM, LYZ, MFGE8, PRUNE2, PTPRC, SMTN, TMODI and TPM2. These genes represent a wide range of biological functions, such as calcium signaling, development and differentiation, as well as cell adhesion not previously implicated in AAA pathobiology. Protein analyses for GATM, CD4, CXCR4, BLNK, PLEK, LYZ, FOSB, DUSP6, ITGA5 and PTPRC confirmed the mRNA findings. CONCLUSION The results provide new directions for future research into AAA pathogenesis to study the role of novel genes confirmed here. New treatments and diagnostic tools for AAA could potentially be identified by studying these novel pathways.
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Affiliation(s)
- Irene Hinterseher
- Sigfried and Janet Weis Center for Research, Geisinger Clinic, Danville, Pennsylvania, USA
- Department of Visceral, Thoracic and Vascular Surgery, Technical University of Dresden, Dresden, Germany
| | - Robert Erdman
- Sigfried and Janet Weis Center for Research, Geisinger Clinic, Danville, Pennsylvania, USA
| | - James R Elmore
- Department of Vascular and Endovascular Surgery, Geisinger Clinic, Danville, Pennsylvania, USA
| | - Elizabeth Stahl
- Sigfried and Janet Weis Center for Research, Geisinger Clinic, Danville, Pennsylvania, USA
| | - Matthew C Pahl
- Sigfried and Janet Weis Center for Research, Geisinger Clinic, Danville, Pennsylvania, USA
| | - Kimberly Derr
- Sigfried and Janet Weis Center for Research, Geisinger Clinic, Danville, Pennsylvania, USA
| | - Alicia Golden
- Sigfried and Janet Weis Center for Research, Geisinger Clinic, Danville, Pennsylvania, USA
| | - John H Lillvis
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Matthew C Cindric
- Department of Vascular and Endovascular Surgery, Geisinger Clinic, Danville, Pennsylvania, USA
| | - Kathryn Jackson
- Sigfried and Janet Weis Center for Research, Geisinger Clinic, Danville, Pennsylvania, USA
| | - William D Bowen
- Department of Vascular and Endovascular Surgery, Geisinger Clinic, Danville, Pennsylvania, USA
| | - Charles M Schworer
- Sigfried and Janet Weis Center for Research, Geisinger Clinic, Danville, Pennsylvania, USA
| | - Michael A Chernousov
- Sigfried and Janet Weis Center for Research, Geisinger Clinic, Danville, Pennsylvania, USA
| | - David P Franklin
- Department of Vascular and Endovascular Surgery, Geisinger Clinic, Danville, Pennsylvania, USA
| | - John L Gray
- Department of Vascular and Endovascular Surgery, Geisinger Clinic, Danville, Pennsylvania, USA
| | - Robert P Garvin
- Department of Vascular and Endovascular Surgery, Geisinger Clinic, Danville, Pennsylvania, USA
| | | | - David J Carey
- Sigfried and Janet Weis Center for Research, Geisinger Clinic, Danville, Pennsylvania, USA
| | - Gerard Tromp
- Sigfried and Janet Weis Center for Research, Geisinger Clinic, Danville, Pennsylvania, USA
| | - Helena Kuivaniemi
- Sigfried and Janet Weis Center for Research, Geisinger Clinic, Danville, Pennsylvania, USA
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