The soft-tissue defect at knee joint is one of the complications in traumatic knee injury. Sylvestre AM, Weinstein MJ, Popovitch CA, Brockman DJ. Dumanian GA, Ondra SL, Liu J, Schafer MF, Chao JD. The sartorius muscle flap has several advantages over other muscle flaps: it is immediately adjacent to the groin, it is easy to prepare, and the harvest causes no functional morbidity. Demographic data for the patient cohort are listed in Table 1. Muscle flaps can be used to facilitate soft-tissue coverage and graft salvage. The purpose of this study is to determine the reliability of SM performed by vascular surgeons in the management of vascular groin wound complications. Please enable it to take advantage of the complete set of features! This technique improves the viability of cutaneous flap before their transfer. In 2005, the vascular surgery division at the Oregon Health and Science University began performing its own sartorius flaps for complex femoral wounds. At 1 year after surgery, his knee healed completely (Fig. The objectives of this study were to describe the sartorius muscle flap for body wall reconstruction, including description of the anatomy and surgical technique and to report its clinical application for abdominal wall . For small and deep soft-tissue defect (<4 cm) which is exposed to the patella, bone, or joint, free flap coverage is necessary. Toutes les complications taient mineures et ont t mdicalement gres avec succs. It is a superficial muscle, the longest muscle and its. Afterward, the sartorius was moved into subcutaneous tunnel and expanded to provide coverage for the wound defect. The sartorius is the longest muscle of the body, and it has been used as a reconstructive flap for many regions such as abdominal wall, groin, thigh, and knee [1, 3, 4, 5, 6, 7]. There are many operative techniques to reconstruct the defects depending on size, location, depth, and complexity of the wound. Sartorius myoplasty (SM) has been used as an adjunct for soft tissue coverage in vascular groin wound complications. Obturator bypass: a classic approach for the treatment of contemporary groin infection. The https:// ensures that you are connecting to the A retroperitoneal (transplant-type) right lower quadrant incision was made (below) and the external iliac artery and graft were exposed. The large vessels, nerves, and muscles remain intact, and the plain film shows no fracture. sharing sensitive information, make sure youre on a federal Federal government websites often end in .gov or .mil. Following the transposition, the sartorius remained viable through out its length, and the patient had full post-operativerecovery. See this image and copyright information in PMC. (Traduit par Isabelle Vallires). Clavert P, Cognet JM, Baley S, Stussi D, Prevost P, Babin SR, et al. PMC about navigating our updated article layout. 1Department of Orthopedics, Faculty of Medicine, Thammasat University, Thailand. Le rapport descriptif porte sur une srie de cas rtrospectifs pour 2 chiens et 3 chats. government site. The operation results showed a successful reconstruction without any complications. The SAFF technique includes dissection of fascia off sartorius and/or adductor muscles, rotation over femoral vasculature, and suturing into place. doi: 10.1093/jscr/rjx009. In 82 per cent of the cases, the sartorius muscle was still viable at reoperation and was used for continued muscle coverage. Skinincisionwas doneinthesartoriusalignment. Rabat du muscle sartorius pour la reconstruction de la paroi du corps: description de la technique chirurgicale et srie de cas rtrospectifs. The sartorius muscle differences over the other thigh muscle are that the sartorius is supplied by many segmental vessels from the femoral artery which could be considered an advantage [2]. Salvage of Infected Prosthetic Grafts at the Groin or Thigh Using Muscle Flap Coverage. Femoral wound complications can threaten vascular grafts. The technique using the distally based sartorius flap is one of the most useful treatments to cover a large anterior soft-tissue defect of knee joint. A 30-year-old man had a large skin defect at the knee following a motorcycle accident. They describe a technique for the harvest of the sartorius muscle transposition flap that preserves the most proximal pedicle. The new PMC design is here! Therefore, the sartorius has greater arc of rotation that easily to rotate a muscle flap to cover the knee joint. The Sartorius Muscle crosses the upper third of the thigh obliquely downwards medially and then descends vertically toward its insertion. All complications were minor and were successfully medically managed. Anatomical basis for distal sartorius muscle flap for reconstructive surgery below the knee. Fifty-five human cadaveric sartorius muscles and 30 canine cadaveric sartorius muscles underwent angiographic and dissection studies, and the location and course of the vessels and nerves supplying sartorius are . Before In Mathes and Nahai classification of the vascular anatomy of muscle, sartorius is a Type IV classification [7]. HHS Vulnerability Disclosure, Help From July of 2000 to January of 2004, 40 sartorius muscles were . Careers. The objectives of this study were to describe the sartorius muscle flap for body wall reconstruction, including description of the anatomy and surgical technique and to report its clinical application for abdominal wall reconstruction in dogs and cats. Thesartorius was move dintosubcutaneoustunnelandused to providecoverageforthewounddefect. The flap and graft were survived. eCollection 2018. On examination, he has a large 8 cm wound at the anterior aspect of his left knee on the patellar tendon level. Consent: The authors confirm that Informed consent of the patient is taken for publication of this case report, National Library of Medicine Thomas WO 3rd, Parry SW, Powell RW, McGee GS, Rodning CB. Patel A, Taylor SM, Langan EM 3rd, Snyder BA, Cull DL, Sullivan TM, Youkey JR, Gray BH, Carsten CG 3rd. We reviewed a prospective database to determine the outcomes of sartorius flaps on facilitating wound healing and graft salvage and patency. and transmitted securely. The difference between this algorithm and our case is the size of wound. The groin wound was then revealed and the graft pulled out (below). In some study, the technique of prefabricated, distally based sartorius muscle flap was used for coverage the wound around knee joint [4, 6]. will also be available for a limited time. Epub 2019 May 2. The sartorius muscle was mobilized and applied as a flap over this. In cases of SM failure, the vascular surgeon should consider other more extensive muscle flap options. First, a skin incision was done on the muscle alignment. We have used this method routinely during the past 6 years in patients with groin sepsis and did not . Epub 2017 Mar 1. reported two cases with a complex wound at the knee [4]. An official website of the United States government. Management of exposed inguinofemoral arterial conduits by skeletal muscular rotational flaps. The descriptive report involves a retrospective case series for 2 dogs and 3 cats. Background: Inguinal lymph node dissection (ILND) for melanoma has been associated with high rates of wound complication (WC). Perfusion decellularization of a human limb: A novel platform for composite tissue engineering and reconstructive surgery. A local flap is simple and has a low risk of flap necrosis [3]. MeSH Results. First, a skin incision was done on the muscle alignment. This site needs JavaScript to work properly. 4). We report a series of sartorius flaps performed by vascular surgeons in the treatment of complicated femoral wounds. Clipboard, Search History, and several other advanced features are temporarily unavailable. Request PDF | Sartorius muscle flap for body wall reconstruction: Surgical technique description and retrospective case series | The objectives of this study were to describe the sartorius muscle . PMC legacy view They suggest to use the sartorius or other distally based thigh muscle flap such as gracilis to cover a suprapatellar infected wound. As predicted on CT, the graft was well incorporated. An official website of the United States government. The cranial sartorius flap technique was easier to perform than the rectus femoris technique. Bookshelf In the case with soft-tissue defects around knee joint, there are many operative techniques. The graft did not have a telltale haze around it nor a dark halo of fluid which signaled to me that it was likely well incorporated and only sick in the exposed part. The technique of sartorius flap creation has. This site needs JavaScript to work properly. doi: 10.1097/GOX.0000000000001274. 2007 May;22(2):82-8. doi: 10.1053/j.ctsap.2007.03.009. The most common reason for SM failure was hemorrhage (45%). 2021 May 11;13(5):e14954. Am Surg. Fischer JP, Mirzabeigi MN, Sieber BA, Nelson JA, Wu LC, Kovach SJ, Low DW, Serletti JM, Kanchwala S. J Plast Reconstr Aesthet Surg. Clin Tech Small Anim Pract. Federal government websites often end in .gov or .mil. The .gov means its official. Petty CT, Hogue RJ Jr. Closure of an exposed knee joint by use of a sartorius muscle flap:Case report. Clipboard, Search History, and several other advanced features are temporarily unavailable. Outcome analysis of 244 consecutive flaps for managing complex groin wounds. The wound developed from a contusion to a necrotic tissue. The remote endarterectomy of the external iliac artery remains patent. The blood supply to sartorius muscle is mostly comprised of muscular branches . The sartorius muscle flap is a versatile surgical technique, which has proven successful for repairing ipsilateral and contralateral abdominal wall defects after hemipelvectomy and en bloc tumor removal as shown by this case series. Physiotherapy helps to decrease the inflammation of the muscle & improve mobility. From 2005 to 2008, 21 sartorius flaps were performed in infected or threatened femoral wounds. Methods: The SAFF technique includes dissection of fascia off sartorius and/or adductor muscles, rotation over femoral vasculature, and suturing into place. We use the sartorius muscle flap to cover the wound defect. The arterial inflow to the groin flap is provided by the superficial circumflex iliac artery (SCIA), a branch off the external iliac/superficial femoral artery at the level of the inguinal ligament. The sartorius muscle is innervated by the femoral nerve. Prophylactic Muscle Flaps in Primary Vascular Procedures of the Groin. The patient could return to work after 1 month after the operation. A small incision was made on the sartorius muscle. 5). Revascularisation through the obturator foramen of lower limbs with a compromised ipsilateral groin due to infection. A muscle flaps such as sartorius are useful for deep infection because they obliterate the dead space arising from debridement and bring stability to the wound. Taylor ME, Ngaage LM, Wasicek P, Ha M, Nagarsheth K, Toursavadkohi SA, Karwowski J, Rasko YM. Please enable it to take advantage of the complete set of features! The artery of the . MeSH Because of the location of wound is in the anterior aspect of the knee, we cannot use the gastrocnemius myocutaneous flap. When salvage bypass was required, extra-anatomic obturator bypass was performed in 80 per cent of cases. The range of motion of the knee is also normal (Fig. Epub 2021 Jul 8. The https:// ensures that you are connecting to the A large contusion was presented. A Sartorius muscle elevation; B Sartorius muscle flap for closure after hemipelvectomy. One of which was the sartorius muscle flap which was first used in 1978 to close an exposed knee joint [1]. 2011 Apr;53(4):1014-9. doi: 10.1016/j.jvs.2010.11.047. CTA shows along with his short segment SFA occlusion which we will treat, a widely patent R. EIA (below). The site is secure. Les objectifs de cette tude taient de dcrire le rabat du muscle sartorius pour la reconstruction de la paroi du corps, y compris la description de lanatomie et de la technique chirurgicale et de faire rapport sur son application clinique pour la reconstruction de la paroi abdominale des chiens et des chats. Compare this to the preop CTA which I found and wasnt available when I posted this case originally: The chronically occluded EIA can be readily seen. Cette srie de cas dmontre que le rabat du muscle sartorius reprsente une option possible pour la fermeture de larges dfauts de la paroi abdominale caudale. The wound was large, and hence, a primary suture cannot be done. One patient developed bilateral inguinal seromas for which bilateral muscle flaps were performed. Signalment, pre-operative clinical signs, location and tumor extent, diagnostic imaging and clinical pathology findings, surgical methods, and complications were recorded. SM performed by the vascular surgeon provides reliable soft tissue coverage for vascular groin wound complications and should be used as the primary muscle flap in the majority of patients. Accessibility It also abducts the thigh and rotates it laterally, as when resting the foot on the opposite knee when sitting. The graft was mobilized and transected and anastomosed end to side to this segment of artery (below). Dissecting was made difficult by how well incorporated it was. Colwell AS, Donaldson MC, Belkin M, Orgill DP. The sartorius muscle assists in flexing the thigh at the hip joint and the leg at the knee joint. According to previous study, a distal third of the sartorius has a mean mobile length of 5.6 cm. Le signalement, les signes cliniques avant lopration, lemplacement et ltendue de la tumeur, les rsultats de limagerie diagnostique et de la pathologie clinique, les mthodes chirurgicales et les complications ont t consigns. We use the distally based sartorius flap to cover the wound defect around the knee. Zenunaj G, Traina L, Acciarri P, Spataro C, Gasbarro V. Ann R Coll Surg Engl. Chatterjee A, Kosowski T, Pyfer B, Fisher CS, Tchou JC, Maddali S. Plast Reconstr Surg. and transmitted securely. Well-healed flap at 1 year postoperatively in the anterior and medial view. Covering of an exposed vascular graft in the groin with an external oblique muscle rotational flap. The .gov means its official. The patient was then followed up at out patient department after surgery. Before 8600 Rockville Pike 2002 Aug;68(8):653-8; discussion 658-9. The patella tendon and patella were exposed. Conclusions: The These flaps are useful in large, deep, and infected wound, but they are associated with variable donor site morbidity and need the pre-operative vascular imaging to select the recipient vessel. 2020 Dec 25;13(4):404-409. doi: 10.3400/avd.oa.20-00123. From a study of Clavert et al. On revealing his groin, this is what I saw: A CT scan was sent with the patient but has been lost to time, and it showed a patent aorto-bifemoral bypass send flow around an occluded distal aorta and iliac arteries. 2015 Jun;135(6):1707-1714. doi: 10.1097/PRS.0000000000001267. 1997 Jan-Feb;33(1):91-6. doi: 10.5326/15473317-33-1-91. In 2014, Gravvanis et al. All vascular reconstructions remained patent at the 9.5-month follow-up. About the half of the sartorius muscle as able to be sung down over the femoral artery. Obeid T, Locham S, Arhuidese I, Nejim B, Aridi HD, Malas M. Ann Vasc Surg. It lies superficially in the anterior compartment of thigh and runs from anterior superior iliac spine of the pelvic bone to the anteromedial surface of the uppertibia. It avoids having to remove the whole graft which then damages the left side -I have seen other surgeons take this approach elsewhere taking a all-or-nothing approach to graft infection to considerable morbidity to the patient. Would you like email updates of new search results? and transmitted securely. HHS Vulnerability Disclosure, Help Finally, we used the skin graft to cover over the muscle flap (Fig. PMC Search life-sciences literature (Over 39 million articles, preprints and more) show knee reconstructive algorithm [3]. A Hyperpigmentation and moist desquamation secondary to, MeSH One of which includes the local fasciocutaneous flap, a regional muscle flap, and free flap transfer. Hong et al. 2013 Oct;66(10):1396-404. doi: 10.1016/j.bjps.2013.06.014. HHS Vulnerability Disclosure, Help show knee reconstructive algorithm [ 3 ]. The patient healed very rapidly and remains infection free. A segment of saphenous vein was harvested from the patient medially and the arteriotomy was patched. HHS Vulnerability Disclosure, Help Accessibility Despite these advantages, the flap's reliability has been questioned because of the segmental blood supply to the muscle and the flap's limited arc of rotation. Secondary wound closure was achieved in 11 patients with mean healing time of 2.3 months. Disclaimer, National Library of Medicine Tanaka K, Mii S, Ishida M, Guntani A, Kawakubo E, Tanaka S, Yoshiga R, Okazaki J. Ann Vasc Dis. FOIA A primary suture cannot be done to close the wound due to the nature of the large wound (Fig. We report the frequency of utilization of ST and associated clinical outcomes in a national sample. The objectives of this study were to describe the sartorius muscle flap for body wall reconstruction, including description of the anatomy and surgical technique and to report its clinical application for abdominal wall reconstruction in dogs and cats. Autologous tunica vaginalis communis flap for repairing an abdominal wall hernia in a dog. Sartorius Muscle Flaps: Perioperative Outcomes Based on Surgical Specialty. Reconstruction with latissimus dorsi, external abdominal oblique and cranial sartorius muscle flaps for a large defect of abdominal wall in a dog after surgical removal of infiltrative lipoma. A total of 99 patients underwent 103 SM procedures. Following the debridement, he lost skin and subcutaneous tissue cover of the knee. 2004 Jan;52(1):49-53. doi: 10.1097/01.sap.0000099960.68038.53. Before Ann Plast Surg. It is not a true musculocutaneous flap because the cutaneous portion of the flap is not supplied by direct musculocutaneous perfo- rating vessels. The purpose of this study is to determine the reliability of SM performed by vascular surgeons in the management of vascular groin wound complications. Intra-operative images from Cat 3. The artery shown in the current CTA is that recanalized artery. However, the reliability of SM as a primary muscle flap has been questioned. The principles of salvage are in rescuing valuable undamaged goods in the setting of catastrophe. Necrosis of the muscle flap as a result of interruption of its vascular pedicle can lead to complications that jeopardize the patient's life and limb. Abdominal wall defect reconstructions using the sartorius muscle flap were successfully performed in all 5 patients with good return to function. 2003 Jun 1;28(11):1203-11. doi: 10.1097/01.BRS.0000067260.22943.48. A Hyperpigmentation and moist desquamation secondary to radiotherapy at Day 54 post-surgery; B Surgical site healed. An alternative surgical treatment for patient with soft tissue defect at anterior aspect of knee joint by using the distally based sartorius flap. Bethesda, MD 20894, Web Policies Half of the patients were men and half were . Infrainguinal open reconstruction: a review of surgical considerations and expected outcomes. The patient was not septic, but had grown MRSA from the wound which was granulating from the extensive wound care that had been delivered. The musclef lapwas coveredwithfull-thickness skingraft. Afterward, the sartorius was moved into subcutaneous tunnel and used to provide coverage for the wound defect (Fig. Hence, the two-stage procedure is not necessary. We report our initial experience with the use of sartorius flaps performed by vascular surgeons for the treatment of complex femoral wounds. I felt that it would be possible to move his anastomosis point more proximally on the external iliac in a sterile field (figure above), and then close, then endarterectomize the occluded external iliac artery after removing the distal graft, then after vein patching, cover the repair with a sartorius muscle flap. Epub 2021 Aug 22. In 2014, Gravvanis et al. However, for our case, the wound is simple. The site is secure. Unable to load your collection due to an error, Unable to load your delegates due to an error. It is demonstrated that the sartorius muscle flap is a feasible option for the closure of large caudal abdominal wall defects with good return to function in dogs and cats. The descriptive report involves a retrospective case series for 2 dogs and 3 cats. 6). 2016 Dec 1;78(11):1717-1721. doi: 10.1292/jvms.16-0275. According to previous study, a distal third of the sartorius has a mean mobile length of 5.6 cm. doi: 10.1371/journal.pone.0191497. Complete wound healing occurred in 18 patients (86%). The woundwas irrigated with brown bubbly and packed open with the intention of VAC application. Salvage wound coverage included rectus abdominus flap (60%), rotational flap (20%), and skin grafting (20%).Seventy-three per cent of failures came from the infectious wound group. Interrupted sutures were used to close the muscle over to the gracilis muscle flap. It assists iliacus and psoas major to flex the hip joint. Federal government websites often end in .gov or .mil. For small and deep soft-tissue defect (<4 cm) which is exposed to . To protect femoral vessels while preserving the sartorius muscle, we developed a novel sartorius and adductor fascial flap (SAFF) technique for coverage. Accessibility Spine (Phila Pa 1976). The vascular supply to the distal part of the sartorius muscle was studied in 15 limbs by dissection and after red ink and latex injections. The site is secure. Mathes SJ, Nahai F. Classification of the vascular anatomy of muscles:Experimental and clinical correlation. Khalil IM, Sudarsky L. Sartorius muscle twistrotation flap:An answer to flap necrosis. Methods: Rotational sartorius flaps were performed to attempt salvage of underlying vascular grafts. A 30-year-old Thai male presented to Thammas at University Hospital with a motorcycle accident. The patient is feeling pain in the front of the hip joint while flexing & rotating the joint during walking. It avoids having to harvest deep femoral vein -another large operation to which the body responds truculently. Hong JP, Lee HB, Chung YK, Kim SW, Tark KC. Remote endarterectomy using a Vollmer ring was used -in this case I didnt use fluoroscopy given the short distance to the terminus of the plaque which i had mobilized in the pelvis. 2017 Apr 20;5(4):e1274. 7). government site. Vasc Health Risk Manag. Coverage of difficult wounds around the knee joint with prefabricated, distally based sartorius muscle flaps. to cut is to cure - a vascular surgery blog, on Salvage: A different approach to graft infections in the groin, Salvage: A different approach to graft infections in the groin. doi: 10.7759/cureus.14954. The wound was irrigated (with brown bubbly) and closed, dressed, and sealed over with the adhesive drape. The https:// ensures that you are connecting to the This case series demonstrates that the sartorius muscle flap is a feasible option for the closure of large caudal abdominal wall defects. Disclaimer, National Library of Medicine We report a case of a woman presenting with a long-term non-healing wound below the tibial tubercle that underwent a successful sartorius muscle flap. The adventitia had good quality despite the longstanding occlusion. Wallace AB, Piper ML, Holland M, Lee S, Orringer M, Eichler C, Kim EA, Hansen SL. (Figs.22 and and3),3), and the proximal set of segmental vessels was identified and ligated. Unable to load your collection due to an error, Unable to load your delegates due to an error. A Sartorius muscle harvesting from donor site; B Harvested sartorius muscle and planned resection tumor site; C Abdominal wall defect after, Intra-operative and post-operative images from Dog 2. The sartorius muscle flap is a versatile surgical technique, which has proven successful for repairing ipsilateral and contralateral abdominal wall defects after hemipelvectomy and en bloc tumor removal as shown by this case series. The rest of the abdomen was then draped with a second large adhesive drape. Therefore, the sartorius has greater arc of rotation that easily to rotate a muscle flap to cover the knee joint. A flap positively about the medial third of the sartorius was swung down over the femoral artery. Methods: Both human and canine studies were undertaken to delineate the neurovascular anatomy of the sartorius and to determine the role for surgical delay clinically. 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