A variety of muscle flaps have been described to treat complex groin wounds associated with infected and/or exposed femoral vessels or vascular grafts, persistent lymphatic leaks, and for prophylaxis against wound breakdown following inguinal lymphadenectomy. The sartorius muscle flap has several advantages over other muscle flaps: it is immediately adjacent to the groin, easy to prepare, and the harvest causes no functional morbidity. Despite these advantages, the reliability of the sartorius muscle flap has been questioned because of the segmental blood supply to the muscle and its limited arc of rotation. In order to improve the reliability of the sartorius muscle flap, the authors defined the proximal vascular anatomy of the sartorius muscle in 20 human cadavers, assessed the correlation with 20 clinical cases, and described a technique for the harvest of the sartorius muscle transposition flap that preserves the most proximal pedicle.
From July 2000 to January 2004, 40 sartorius muscles were dissected in 20 human preserved cadavers. During the same time period, 21 sartorius muscle transposition flaps were performed in 19 patients for a variety of complex groin wounds, including infection (10), lymphadenectomy (4), lymphatic leak (3), exposed femoral vessels (3), high risk wounds (1). The location of the most proximal vascular pedicle with respect to the anterior superior iliac spine was measured in each cadaveric dissection as well as each clinical case. Outcomes were assessed in the clinical cases with respect to wound healing.
The distance between the anterior superior iliac spine and the proximal vessels in the cadaver specimens was 6.6 ± 1.3 cm (range: 5.0–9.5 cm). The distance between the anterior superior iliac spine and the proximal vessels in the clinical patients was 6.2 ± 0.6 cm (range: 5.5–7.5 cm). Patients were followed for an average of 30 months (range: 5–45 months). There were no incidences of partial or total flap necrosis. All wounds healed to completion.
The proximal pedicle of the sartorius muscle is consistently located at 6.5 cm from the anterior superior iliac spine. Preservation of the proximal pedicle during dissection insures the viability of the sartorius muscle transposition flap for the treatment of complex groin wounds.
