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PubMedDate not supplied

Hemoglobin-based oxygen carrier does not improve survival of ischemic rat island groin flaps.

Reducing reperfusion injury to skin flaps is an effective means to improve the survival of the flap. By enhancing oxygen delivery to the microcirculation within the flap, ischemia-reperfusion injury should be decreased, improving the flap's survival. This study evaluated the effects of a hemoglobin-based oxygen carrier (Oxyglobin) on the development of necrosis and survival of ischemic rat island groin flaps. Sprague-Dawley rats were randomly assigned to one of three treatment groups. A groin flap was elevated on each rat and subjected to 9 h of ischemia. Rats in group I were given an intravenous infusion of 0.9% saline prior to elevation of the skin flap. Rats in group II were given an intravenous infusion of Oxyglobin prior to elevation of the skin flap. Rats in group III were given a low-dose intravenous infusion of Oxyglobin following the 9 h of ischemia, just prior to reperfusion. The flaps were monitored for 7 days postoperatively for necrosis. The percentage of flap necrosis was recorded at the end of 7 days. All rats were euthanized at the completion of the study and the flaps were harvested for histopathological analysis. No significant difference was noted in the survival of the flaps or the degree of necrosis in the rats treated with Oxyglobin compared to the control group. Thus, pre-reperfusion treatment with Oxyglobin did not improve the percentage of flap survival, or the degree of severity of necrosis in rat groin flaps subjected to 9 h of ischemia.

Animals↗
PubMed2002

Herniographic findings in athletes with unclear groin pain.

BACKGROUND: Groin pain in athletes is a common symptom and may, among many other entities, be caused by skeletal changes in the symphysis and the pubic bone or hernia. MATERIAL AND METHODS: Herniographies in 51 athletes -- mainly soccer players -- with unclear groin pain were reviewed. The prevalence of various hernias and skeletal changes at the symphysis and os pubis was registered. A questionnaire was also sent to the patients 3-20 years after the herniography. RESULTS: A hernia was found in 13 patients. Four patients had an indirect inguinal hernia. Eight patients had a direct inguinal hernia and 1 had an obturator hernia. The prevalence of direct inguinal hernia was higher than expected in young men. This may be explained by strain at physical exercise. Bone changes at the pubic symphysis were found in 32 patients, 21 of whom had advanced changes. CONCLUSION: A hernia can be found with herniography in one-fourth of athletes with long-standing unclear groin pain. Therefore herniography should be included in the diagnostic procedure. Lesions of the symphysis may be the result of strain of tendons, ligaments and fascias. This may predispose for an inguinal hernia as well.

Adolescent↗
PubMed1990

Reconstruction of the external genitals and repair of skin defects of the perineal region using three types of lateral groin flap.

Three types of lateral groin flap have been applied to reconstruct the external genitals and to repair skin defects in the perineal region. A single lateral groin flap was used to construct a vagina for 2 patients who had congenital absence of vagina. A composite flap containing iliac crest bone was applied to reconstruct the penis in 11 patients: 8 suffered traumatic amputation and 3 had congenital micropenis. A coaxial pedicle flap of the lateral groin and abdominal area was used to repair skin defects of the penis and scrotum after resection of the elephantiasis caused by recurrent erysipelas in 2 patients, and to relieve postburn scar contracture in the perineal region in another. Using this operative technique, 14 flaps survived completely with satisfactory results; 70% of one composite flap was lost as a result of hematoma. In the single-flap group, the distal portion (3 x 5 cm) of one flap necrosed and was resected and resurfaced with a free skin graft; the final result was good.

Adolescent↗
PubMed2001

One-stage facial augmentation with an intraoral groin adipose flap transfer.

A free groin adipose flap using an intraoral approach was used to correct facial contour deformities instead of a groin dermis-fat flap. The major disadvantages of the latter flap are that multistage debulking procedures are required and there are wide postoperative donor scars because of the wide skin portion included in the flap. To overcome these weaknesses the authors developed a free groin, customized ("berry picked") adipose flap, which was transferred by an intraoral approach for reconstruction of congenital hemifacial (orbitozygomatic) hypoplasia. The advantages of this method include one-stage augmentation without secondary defatting, no skin grafting of the donor defect, a donor scar in a concealed area, and possible transfer through an intraoral approach that results in minimal invasive surgery with no scar at the graft site.

Adipose Tissue↗
PubMed2002

Intraoperative lymphatic mapping to treat groin lymphorrhea complicating an elective medial thigh lift.

Groin lymphoceles and lymphorrhea are a rare complication of medial thigh lift procedures. The author describes a case in which a very thin patient developed groin lymphorrhea after an uncomplicated medial thigh lift procedure. Initial treatment interventions, including edema control and the placement of a drain with surgical exploration, failed to control the lymphatic leak. Additionally, the onset of an infection and abscess formation complicated the treatment efforts. Using techniques well established in treating cutaneous malignancies, the lymphocele was treated successfully by identifying three separately damaged lymphatic channels with the use of intraoperative lymphatic mapping with blue dye. No drains were needed and the immediate cessation of lymph flow was noted. Using this novel adaptation of a well-known technique, the groin lymphocele was able to be repaired quickly and effectively with minimal morbidity and no evidence of recurrence to date.

Female↗
PubMed1987

Early coverage of deep hand burns with groin flaps.

Deep burns of the hands require skin flap coverage in order to protect the exposed vital structures. The groin flap is a safe and effective method of obtaining early closure of these defects. We have used groin flaps to cover deep hand burn defects in nine patients. In each case, groin flaps effectively covered the various defects, such as the volar aspect of the wrist, dorsum of the hand, first web space, thumb, and fingers.

Adult↗
PubMed1989

Coverage of acute vascular injuries of the axilla and groin with transposition muscle flaps: case reports.

Acute axillary or groin vascular injuries caused by farm machinery or shotgun blasts are often associated with extensive soft-tissue loss. Coverage of the repaired blood vessels with healthy tissue is necessary to avoid infection, desiccation, pseudoaneurysm, and rupture. Adjacent muscles are not always available to rotate for coverage, due to unacceptable functional loss, or injury to the principal vascular pedicle. We used proximally based trunk musculature with vascular pedicles out of the areas of injury to achieve coverage of four extensive axillary wounds and one extensive groin wound. Arterial repair only was performed in three axillary wounds. Combined arterial and venous repair were performed in one groin wound and one axillary wound. Followup ranging from 9 months to 5 years revealed no vascular failure or soft-tissue complications. We conclude that coverage of vascular repairs and soft-tissue defects with viable muscle is necessary in cases of extensive injury. Adjacent muscle is preferred for coverage, but when this is unavailable, coverage can still be achieved using more proximally pedicled muscles of the trunk.

Adolescent↗
PubMedDate not supplied

Effects of three groin compression methods on patient discomfort, distress, and vascular complications following a percutaneous coronary intervention procedure.

BACKGROUND: Incidence of vascular complications (VCs) after sheath removal following a percutaneous coronary intervention procedure (PCIP) vary widely by the compression method used to achieve femoral artery hemostasis. OBJECTIVE: To determine if one groin compression method causes the least discomfort and distress for patients and results in fewer VCs. METHODS: Patients (n = 306, mean age = 62.3 years, 77% male, 96.4% Caucasian) undergoing PCIPs at a tertiary care center in the urban Midwest participated in this three-group experimental design study. They were randomly assigned to Femostop, C-clamp, or manual compression and rated level of groin discomfort and distress on a 0-10 Numeric Rating Scale (NRS) prior to, during, and after arterial compression was released. The groin area was assessed for any VCs (oozing, ecchymosis, hematoma) prior to sheath removal, after compression released, and 12 and 24 hr after sheath removal. RESULTS: No significant differences were found by compression method for discomfort, distress, or VCs. Regardless of method, not having a VC prior to femoral sheath removal contributes to less oozing (z = -3.1, p = .0019), hematoma (z = -9.4, p < .0001), and ecchymosis(z = -10.1, p < .0001). C-clamp contributes to less oozing when hemostasis time is < 30 min (z = -2.2, p = .03), and Femostop is superior when time to hemostasis is >30 min (z = -2.3, p = .02). Not receiving eptifibatide (Integrilin) contributes to less ecchymosis (z = -2.9, p = .004). CONCLUSIONS: Nurses need to be vigilant when caring for patients who have a VC prior to femoral sheath removal and have received antiplatelet medications. Further research is needed to identify patient characteristics that may contribute to VCs.

Adult↗
PubMed1997

Paget's disease of the groin: report of seven cases.

Only 27 cases of Paget's disease of the groin have been reported to the present. Our aim was to describe the clinical behavior and treatment of this disease. A retrospective analysis of patients seen at the Mayo Clinic over a period of 25 years (January of 1970 to December of 1995) was undertaken. We included patients with lesions of the groin (isolated or associated with penile/scrotal locations) and with histologic confirmation of the diagnosis. We found seven patients, all male; three patients had isolated lesions. Their mean (SD) age was 73 (8.3) years. Special stains and immunohistochemistry confirmed the diagnosis in all patients. A wide local excision was performed in every patient. Three patients had recurrence; one of them died with multiple pulmonary metastases 4 years later. Two patients presented with history of associated malignancy (prostatic and renal cell carcinoma). Paget's disease of the groin is extremely infrequent. Its origin seems not to be a simple extension from the genital area. Most diagnoses can be made by light microscopy. Wide local excision with free margins is the treatment of choice. Local recurrence occurs in half of patients with tumor-free margins by frozen section; long-term follow-up is warranted. Distant metastases occur rarely, although they can be fatal.

Aged↗
PubMed1999

Free groin flap revisited.

Reported herein are 130 consecutive cases of free groin flap transfer performed by one surgeon over a 19-year period. Transplantation was performed for soft-tissue cover or augmentation of contour defects involving the head and neck (68 cases), trunk (4 cases), upper limb (14 cases), and lower limb (44 cases). Indications for flap coverage/augmentation were classified broadly into tumor, trauma, radiation induced, and miscellaneous. Specific reconstructive problems included augmentation for Romberg's hemifacial atrophy, external ear canal reconstruction after tumor ablation, and coverage of lower limb defects. There were nine failures (total flap loss), seven cases of partial flap loss, and two cases were abandoned intraoperatively. Of 15 cases that were urgently re-explored, 9 flaps were salvaged. The failure rate for the groin flap series (130 cases) was 8.5 percent compared with the failure rate of 4.2 percent for the other 517 cases of microvascular transfer performed over the same period by the same surgeon. Donor-site complications occurred in 24 cases and included hematoma or seroma formation, hypertrophic scars, nerve paresthesiae, infection, and dehiscence. Secondary debulking procedures were performed in 26 cases. The free groin flap, contrary to some reports, is a reliable flap that provides relatively thin pliable soft-tissue cover or augmentation, with minimal donor-site morbidity. The specific indications for its use have undergone an evolution since first described in 1973.

Adolescent↗
PubMed2004

The use of free groin flaps in children.

The free groin flap is a well-established method of skin coverage. Although its use in children has been reported, there have been no published series specifically in such cases. The authors report 33 consecutive cases of free groin flaps in children in their unit over a period of 9 years (1992 to 2001). Tissue transfer was performed to provide soft-tissue coverage during reconstruction of congenital defects and tumor resection and following trauma. Twenty-six cases (79 percent) involved the upper limb, six cases (18 percent) involved the lower limb, and one case involved the head. The complication rate compares favorably with similar series published for adults, with only two complete failures (6 percent), three (9 percent) minor donor-site complications (superficial wound infection, hypertrophic scarring, and dog-ears), and nine flaps requiring debulking. The reexploration rate was 24 percent, with seven of the eight flaps undergoing reexploration surviving. The groin flap is a reliable flap that can be used safely in children, with minimal morbidity.

Adolescent↗
PubMed2003

The medial circumflex femoral (gracilis) local perforator flap--a local medial groin perforator flap.

The medial circumflex femoral(GRACILIS) perforator free flap has been previously used to capture the superior medial thigh skin territory. This can also be valuable as a local flap, especially for adjacent groin wounds that are not uncommon after vascular interventions. Uncomplicated healing without vascular compromise was achieved using this as a local flap in 4 recent cases. Because the gracilis muscular branches can be independently dissected from the musculocutaneous perforators, the muscle itself can be separately included to form a combined conjoint flap, where the muscle is specifically only used to wrap around and protect any exposed vascular structures while the cutaneous component simplifies skin wound closure. The axis of rotation of the medial circumflex femoral perforator local flap extends throughout the groin region and potentially to the lateral thigh. This is an ideal local perforator flap because the source pedicle has a consistent location already well known to most plastic surgeons, the boundaries of the potential skin territory are reliable and well defined, and the scar from closure of the donor site within the medial groin can be readily concealed by clothing.

Femoral Artery↗
PubMed2004

Management of early groin vascular bypass graft infections with sartorius and rectus femoris flaps.

Groin infections adjacent to vascular bypass grafts continue to be a source of morbidity. The authors reviewed retrospectively 9 consecutive patients with early localized groin infections treated at their institution with sartorius or rectus femoris muscle flaps between 1998 and 2002. All wounds were initially opened and drained. Wounds with necrotic tissue were treated with serial surgical debridements, with a vacuum-assisted closure device, or with wet-to-dry dressing changes. Two bypass grafts were excised and replaced in the presence of marked exposure or pseudoaneurysm. Small wounds were closed with a turnover sartorius flap and larger wounds were closed with either a muscle or musculocutaneous rectus femoris flap. Groin wounds healed in all patients without subsequent graft exposure, rupture, or pseudoaneurysm. Local wound therapy with staged debridement and muscle flaps is effective for most early localized graft infections.

Aged↗
PubMed2005

Groin pain after a tension-free vaginal tape or similar suburethral sling: management strategies.

OBJECTIVE: To review different treatment strategies for women with groin pain after tension-free vaginal tape (TVT) or similar suburethral sling procedures. PATIENTS AND METHODS: The series comprised 450 women who had a TVT procedure, with a follow-up of 3-50 months. Five women (1%) reported significant groin pain and were offered further treatment. In addition, one woman was referred from another centre and received treatment. RESULTS: Women with pain were initially treated conservatively, and in most the pain resolved and required no further treatment. Persistent or severe discomfort was treated with a combined steroid (methyl prednisolone, 2 mL, 80 mg) and local anaesthetic (bupivacaine, 10 mL, 0.5%) injection in four women. There were no side-effects from the treatment. One woman was relieved of her pain and required no further treatment. In one woman the local injections failed to improve her symptoms but the pain was not severe enough to warrant further treatment. Two women developed recurrent pain after an initially successful injection, and in these women the TVT was excised. One woman referred from another centre was primarily treated with TVT excision. In the three women treated with distal tape excision, the mean pain scores decreased from 8.7 before excision to 0.7 afterward. One woman is awaiting tape excision. CONCLUSION: If conservative management fails to relieve the symptoms of groin pain it can be treated by injecting a mixture of steroid and local anaesthetic. However, local injection failed to provide long-term relief in three of four women. More severe symptoms might require TVT mesh dissection and excision, which provided significant pain relief.

Anesthetics, Local↗
PubMed1989

Proteeae species bacteriuria accompanying Proteeae species groin skin carriage in geriatric outpatients.

There have been numerous reports of Proteeae species urinary tract infections among elderly individuals. To explore a possible urinary carrier source of Proteeae species in this population, the frequency of aerobic gram-negative bacillus (AGNB) bacteriuria at the greater than or equal to 10(2)/ml level was determined in 67 ambulatory elderly outpatients classified as to Proteeae group (Morganella, Proteus, Providencia) groin carriage by a set of two skin cultures obtained at least 1 week apart. None had urethral catheters, symptomatic infections, skin ulcers, or recent antibiotic therapy. We found AGNB bacteriuria in 12 of 15 carriers (80%) and in 21 of 52 noncarriers (40%) (P = 0.009). Proteeae species bacteriuria occurred in eight carriers (53.3%) and six noncarriers (11.5%) (P = 0.001). At the 10(2) to 10(4)/ml level, Proteeae species were isolated in urine specimens from seven carriers (46.7%) and four noncarriers (7.7%) (P = 0.001). There was concordance of species of skin and urine Proteeae isolates in six carriers. By contrast, non-Proteeae AGNB bacteriuria at any level was present in four Proteeae species carriers (26%) and 15 noncarriers (28.8%) (P greater than 0.05). There was a 36.7% frequency of Proteeae species bacteriuria in nursing home residents, in contrast to 8.1% among those living in private homes; this parallels the greater frequency of Proteeae species groin carriage among nursing home residents in the study population. Low-level urinary colonization with Proteeae species accompanying Proteeae species groin skin colonization in elderly individuals is a hitherto unrecognized finding. This may account for the greater frequency of Proteeae species urinary infections in this population.

Aged↗
PubMed1995

'Gilmore's groin'--or is it?

Groin injuries are a common and often difficult diagnostic problem. This paper reviews six patients presenting with symptoms highly suggestive of the syndrome 'Gilmore's groin', but in whom the pathophysiology of the groin disruption and its surgical management differed from Gilmore's description.

Adult↗
PubMed2000

High prevalence of iliofemoral venous thrombosis with severe groin infection among injecting drug users in North East Scotland: successful use of low molecular weight heparin with antibiotics.

Injecting drug use, mainly of heroin, currently represents a major public health issue in the North East of Scotland. The recent tendency of the committed injecting drug user to inject into the groin has created novel problems for the Infection Unit. Data are presented on 20 consecutive patients admitted between 1994 and 1999 with iliofemoral venous thromboses, often complicated by severe soft tissue infections and bacteraemia as a result of heroin injection into the femoral vein. Nine had coexistent groin abscesses, four had severe streptococcal soft tissue infection of the right thigh, groin and lower abdomen, and two had coincidental soft tissue infections of the upper limb. Nine were bacteraemic on admission. All of the patients were chronic injecting drug users with a median injection duration of 6.5 years. The 18 patients tested for hepatitis C virus were all seropositive. None of the 14 patients tested was positive for HIV. Seventeen patients were treated with subcutaneous low molecular weight heparin (tinzaparin), three having received intravenous unfractionated heparin initially. The tinzaparin was self administered and given for a median duration of seven weeks. One patient declined to have any treatment. Three months after presentation eight patients were asymptomatic, seven had a persistently swollen leg, and five were lost to follow up. None developed clinically apparent pulmonary embolism after institution of anticoagulant therapy. The management of iliofemoral venous thrombosis in injection drug users is problematic because of poor venous access, non-compliance with prescribed treatment, ongoing injecting behaviour, and coexistent sepsis. It is unlikely that a randomised trial of standard treatment with heparin and warfarin versus low molecular weight heparin alone would be practical in this patient group. These retrospective data indicate that the use of tinzaparin in injecting drug users is feasible and appears to result in satisfactory clinical responses. The possibility of concomitant infection in injecting drug users with venous thrombosis should always be addressed, as it appears to be a common phenomenon. Early drainage of abscesses and antimicrobial chemotherapy, often administered intramuscularly or orally because of lack of peripheral venous access, is central to the appropriate care of these patients.

Abscess↗
PubMed1989

The groin hit: complications of intravenous drug abuse.

We are seeing an increased number of complications in intravenous drug abusers who resort to injecting the groin for vascular access (the "groin hit"). Vascular complications include venous thrombosis, arteriovenous fistula, mycotic aneurysm, ruptured pseudoaneurysm, and dissecting hematoma. Soft tissue complications include cellulitis and abscess. The latter may dissect into the extraperitoneal space. Skeletal complications include osteomyelitis and septic arthritis. This paper illustrates the radiographic spectrum of these complications. An algorithm will illustrate the radiographic evaluation of a groin mass in a drug addict.

Abscess↗