Sartorius Muscle Flaps: Perioperative Outcomes Based on Surgical Specialty

Tammam Obeid, Satinderjit Locham, Isibor Arhuidese, Besma Nejim, Hanaa D. Aridi, Mahmoud Malas

Research output: Contribution to journalArticle

Abstract

Background: Complicated groin wounds often require repair by sartorius muscle flap (SMF). Operating surgical specialty differs based on SMF indication, hospital, and operating surgeon preference. We aim to assess the effect of operating surgical specialty, indication for SMF, and other patient-level factors on 30-day outcomes. Methods: We collected data on all patients undergoing SMF performed at our institution from 2005 to 2015, including age, sex, body mass index, comorbidity index (hypertension, diabetes, dyslipidemia, peripheral arterial disease, coronary artery disease), smoking status, history of malignancy, indication for SMF (infection, noninfectious complication, prophylaxis), and operating surgeon's specialty (vascular, plastic, general, other). Primary outcome was any 30-day complications (wound infection, seroma, dehiscence, or bleeding). Secondary outcome included 30-day surgical reintervention rate. Univariate analysis and multivariate logistic regression modeling were used to evaluate primary outcomes. Results: A total of 170 SMFs were performed during the study period (mean patient age 58 years; 49% male). Primary indication for SMF was prophylaxis in 116 cases (68%), followed by infection in 36 cases (21%) and noninfectious complications in 18 cases (11%). General surgeons performed the highest proportion of SMF (45%) followed by vascular surgeons (26%), "other specialties" (15%), and plastic surgeons (14%). Compared with all specialties, vascular surgeons operated on the severely ill patients (77% of vascular patients had ≥3 comorbidities, P < 0.001). Surgical reintervention within 30 days was required in 7 patients (4.1%): 3 by vascular surgeons (6.8% of total cases by vascular surgery) and 4 by plastic surgeons (17.4% of total cases by plastic surgery, P < 0.001). Any 30-day complications occurred in 47 patients (28%): 30 general surgery cases (39%), 7 plastic surgery cases (30%), 7 other specialty cases (27%), and 3 vascular surgery cases (7%) (P < 0.001). Of all vascular disease-related cases (56), plastic surgeons performed 21% of SMF, while vascular surgeons performed 79%. On logistic regression correcting for baseline differences between groups, vascular surgeon SMF outcomes were compared favorably with those done by other specialties. Conclusions: Overall, SMFs have low perioperative reintervention rates but high complication rates. Vascular surgeons perform SMF on high-risk patients with more comorbidities compared with other specialties. Although overall morbidity associated with this procedure is high, perioperative outcomes for SMF performed by vascular surgeons are favorable.

Original languageEnglish (US)
JournalAnnals of Vascular Surgery
DOIs
StateAccepted/In press - Nov 15 2016

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Surgical Specialties
Blood Vessels
Muscles
Plastic Surgery
Comorbidity
Surgeons
Logistic Models
Seroma
Groin
Peripheral Arterial Disease
Wound Infection
Dyslipidemias
Infection
Vascular Diseases
Plastics

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Obeid, T., Locham, S., Arhuidese, I., Nejim, B., Aridi, H. D., & Malas, M. (Accepted/In press). Sartorius Muscle Flaps: Perioperative Outcomes Based on Surgical Specialty. Annals of Vascular Surgery. https://doi.org/10.1016/j.avsg.2017.01.003

Sartorius Muscle Flaps : Perioperative Outcomes Based on Surgical Specialty. / Obeid, Tammam; Locham, Satinderjit; Arhuidese, Isibor; Nejim, Besma; Aridi, Hanaa D.; Malas, Mahmoud.

In: Annals of Vascular Surgery, 15.11.2016.

Research output: Contribution to journalArticle

Obeid, Tammam ; Locham, Satinderjit ; Arhuidese, Isibor ; Nejim, Besma ; Aridi, Hanaa D. ; Malas, Mahmoud. / Sartorius Muscle Flaps : Perioperative Outcomes Based on Surgical Specialty. In: Annals of Vascular Surgery. 2016.
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abstract = "Background: Complicated groin wounds often require repair by sartorius muscle flap (SMF). Operating surgical specialty differs based on SMF indication, hospital, and operating surgeon preference. We aim to assess the effect of operating surgical specialty, indication for SMF, and other patient-level factors on 30-day outcomes. Methods: We collected data on all patients undergoing SMF performed at our institution from 2005 to 2015, including age, sex, body mass index, comorbidity index (hypertension, diabetes, dyslipidemia, peripheral arterial disease, coronary artery disease), smoking status, history of malignancy, indication for SMF (infection, noninfectious complication, prophylaxis), and operating surgeon's specialty (vascular, plastic, general, other). Primary outcome was any 30-day complications (wound infection, seroma, dehiscence, or bleeding). Secondary outcome included 30-day surgical reintervention rate. Univariate analysis and multivariate logistic regression modeling were used to evaluate primary outcomes. Results: A total of 170 SMFs were performed during the study period (mean patient age 58 years; 49{\%} male). Primary indication for SMF was prophylaxis in 116 cases (68{\%}), followed by infection in 36 cases (21{\%}) and noninfectious complications in 18 cases (11{\%}). General surgeons performed the highest proportion of SMF (45{\%}) followed by vascular surgeons (26{\%}), {"}other specialties{"} (15{\%}), and plastic surgeons (14{\%}). Compared with all specialties, vascular surgeons operated on the severely ill patients (77{\%} of vascular patients had ≥3 comorbidities, P < 0.001). Surgical reintervention within 30 days was required in 7 patients (4.1{\%}): 3 by vascular surgeons (6.8{\%} of total cases by vascular surgery) and 4 by plastic surgeons (17.4{\%} of total cases by plastic surgery, P < 0.001). Any 30-day complications occurred in 47 patients (28{\%}): 30 general surgery cases (39{\%}), 7 plastic surgery cases (30{\%}), 7 other specialty cases (27{\%}), and 3 vascular surgery cases (7{\%}) (P < 0.001). Of all vascular disease-related cases (56), plastic surgeons performed 21{\%} of SMF, while vascular surgeons performed 79{\%}. On logistic regression correcting for baseline differences between groups, vascular surgeon SMF outcomes were compared favorably with those done by other specialties. Conclusions: Overall, SMFs have low perioperative reintervention rates but high complication rates. Vascular surgeons perform SMF on high-risk patients with more comorbidities compared with other specialties. Although overall morbidity associated with this procedure is high, perioperative outcomes for SMF performed by vascular surgeons are favorable.",
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AU - Arhuidese, Isibor

AU - Nejim, Besma

AU - Aridi, Hanaa D.

AU - Malas, Mahmoud

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N2 - Background: Complicated groin wounds often require repair by sartorius muscle flap (SMF). Operating surgical specialty differs based on SMF indication, hospital, and operating surgeon preference. We aim to assess the effect of operating surgical specialty, indication for SMF, and other patient-level factors on 30-day outcomes. Methods: We collected data on all patients undergoing SMF performed at our institution from 2005 to 2015, including age, sex, body mass index, comorbidity index (hypertension, diabetes, dyslipidemia, peripheral arterial disease, coronary artery disease), smoking status, history of malignancy, indication for SMF (infection, noninfectious complication, prophylaxis), and operating surgeon's specialty (vascular, plastic, general, other). Primary outcome was any 30-day complications (wound infection, seroma, dehiscence, or bleeding). Secondary outcome included 30-day surgical reintervention rate. Univariate analysis and multivariate logistic regression modeling were used to evaluate primary outcomes. Results: A total of 170 SMFs were performed during the study period (mean patient age 58 years; 49% male). Primary indication for SMF was prophylaxis in 116 cases (68%), followed by infection in 36 cases (21%) and noninfectious complications in 18 cases (11%). General surgeons performed the highest proportion of SMF (45%) followed by vascular surgeons (26%), "other specialties" (15%), and plastic surgeons (14%). Compared with all specialties, vascular surgeons operated on the severely ill patients (77% of vascular patients had ≥3 comorbidities, P < 0.001). Surgical reintervention within 30 days was required in 7 patients (4.1%): 3 by vascular surgeons (6.8% of total cases by vascular surgery) and 4 by plastic surgeons (17.4% of total cases by plastic surgery, P < 0.001). Any 30-day complications occurred in 47 patients (28%): 30 general surgery cases (39%), 7 plastic surgery cases (30%), 7 other specialty cases (27%), and 3 vascular surgery cases (7%) (P < 0.001). Of all vascular disease-related cases (56), plastic surgeons performed 21% of SMF, while vascular surgeons performed 79%. On logistic regression correcting for baseline differences between groups, vascular surgeon SMF outcomes were compared favorably with those done by other specialties. Conclusions: Overall, SMFs have low perioperative reintervention rates but high complication rates. Vascular surgeons perform SMF on high-risk patients with more comorbidities compared with other specialties. Although overall morbidity associated with this procedure is high, perioperative outcomes for SMF performed by vascular surgeons are favorable.

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