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PubMed2000

Groin dissection.

This review provides a brief history of groin dissection, including studies on anatomical considerations and technique. A groin dissection for complete ablation of the node-bearing areolar tissue in the inguinal and iliac regions and with negligible morbidity requires careful attention to the pathophysiology of cancer in lymphatics, pre- and postoperative care, and surgical technique, including coordinated use and general, plastic, vascular, and orthopedic surgical principles.

Groin↗
PubMed1998

Groin complications associated with collagen plug closure of femoral arterial puncture sites in anticoagulated patients.

A retrospective study was conducted to determine the frequency and nature of groin complications when the Vasoseal (Datascope Corp., NJ) hemostasis device was used on 204 occasions to enable removal of the groin sheath in anticoagulated patients. The patients had undergone balloon angioplasty (53%), coronary stenting (20%), and diagnostic angiography (27%). Complications included vascular surgery in 5% including 2 embolized collagen plugs, failure to achieve hemostasis (2%), late external bleeding (2%), purulent discharge (1.5%), a minor ooze of blood (7%), hematomas >6 cm (6%), and hematomas < or = 6 cm (7%). One or more complications occurred with 64 of 204 (30.5%) uses. Multivariate analysis identified diagnostic angiography to be associated with a reduced risk of complications [odds ratio (OR) 0.25], while stent procedure (OR 2.7) and female gender (OR 2.5) were associated with increased risk. This complication rate is similar to other reported series except for a higher rate of vascular surgery. The high incidence of anticoagulation in our study patients (94%) may explain this difference. We recommend caution and adherence to the recommended technique when the device is used in anticoagulated patients.

Aged↗
PubMed2002

Plasma lidocaine concentrations after local anesthesia of the groin for cardiac catheterization.

This study aimed to investigate serum lidocaine concentrations after subcutaneous infiltration of the groin for cardiac catheterization. One hundred twenty-six patients for planned heart catheterization received five different dosages (5-25 ml) of lidocaine 2% for local anesthesia of the groin in a randomized manner. All of them received an arterial sheath and 13 received both an arterial sheath and a venous sheath for right heart catheterization. Blood samples were taken before as well as 15, 30, and 120 min after subcutaneous application of the drug. Although in 33 patients with an arterial sheath (no venous sheath) excessive doses of lidocaine 2% (20-25 ml) were used, neither symptoms of intoxication nor toxic plasma levels were observed. However, in patients receiving an additional venous sheath, toxic plasma levels were obtained in a third of the cases. One of them showed symptoms of intoxication.

Adult↗
PubMed2004

Groin soft tissue tumors--a challenge for local control and reconstruction: a prospective cohort analysis.

BACKGROUND AND OBJECTIVES: Groin soft tissue tumors are associated with high local recurrence rates of 16-48% and postoperative complications in 40-68%. Neoadjuvant chemoradiation and aggressive reconstructive techniques were utilized to improve local control and complication rates in this challenging area. METHODS: Nine patients in this prospective series were treated with neoadjuvant chemoradiation (30 mg IV doxorubicin x 3d followed by 300 cGy/d x 10d) followed by surgery and two patients received radiation (5,000 cGy with tissue spacer) followed by surgery for tumors with a pelvic/retroperitoneal component. Surgery included resection plus reconstruction of the abdominal wall, myocutaneous flaps for large defects, and vascular reconstruction as necessary. RESULTS: The 11 consecutive patients presented with Stage I (30%), II (40%), or III (30%) disease. Four patients (36%) were operated on for possible incarcerated hernia prior to referral and two (18%) presented with recurrent tumors. Pathology included 10 sarcomas and 1 desmoid tumor; tumor grade was low (30%), moderate (40%), or high (30%). Local control (mean follow-up 55 months; minimum follow-up 36 months) and limb salvage rate was 100%. Minor wound complications not requiring re-operation occurred in three patients, lymphedema in two, and there were no postoperative hernias. CONCLUSIONS: Preoperative therapy provides excellent local control of groin soft tissue tumors. Current surgical techniques allow extensive resection with limb salvage, dependable primary wound healing and long-term integrity of the abdominal wall.

Abdominal Wall↗
PubMed2006

Principles for the management of toe-to-hand transfer in reexploration: toe salvage with a tubed groin flap in the last step.

Failure of the transferred toe in toe-to-hand transplantations is a catastrophe and a devastating complication for both the patient and the reconstructive surgeon, as in all microvascular tissue transfers. Management of the toe transfer in the case of reexploration is still a challenging issue, even for experienced microsurgeons. In this report, basic principles for a successful outcome are proposed, based on experience with more than 500 toe-to-hand transfers. Although the requirements for each case may vary, technical details and some basic salvage strategies receive special emphasis. When faced with a problem, the first step should be focused on perceiving the problem differently from under completely normal conditions. The problem may occur at any stage of the procedure. The basic orientations are focused on vasospasm, a thrombus inside the lumen, possible intimal damage that may be caused during the surgery or by a thrombus, or technical failures regarding anastomoses. After all possible revisional procedures have been carried out, if the proper arterial inflow and/or venous outflow are still not provided, or if the general health status of the patient is no longer suitable for additional lengthy procedures, the tubed groin flap can be used to salvage the transferred toe. Between 1996-2004, eight tubed groin flaps were used to salvage transferred toes in the last step of the revisional procedure, with satisfactory results. In conclusion, close follow-up and prompt reexploration when needed are both essential to salvaging transferred toes. Proper surgical strategies and decision-making in reexploration are highly important factors in achieving a successful outcome. In prolonged and recurrent revisional steps, the creation of a tubed flap by means of a reliable flap is an effective procedure as the last step of the salvage procedure.

Adult↗
PubMed1998

Anatomosurgical implications derived from an embryological study of the Scarpa's triangle with particular reference to groin lymphadenectomy.

OBJECTIVE: To clarify some anatomical controversies of the fascial structures and lymph node development of the inguinal region through an embryological study in relation to the surgical techniques of groin lymphadenectomy. METHODS: Sections of the femoral triangle belonging to four fetuses whose crown-rump (CR) length ranged from 70 to 310 mm, corresponding to a developmental age of 11 and 35 weeks, were studied. RESULTS: The femoral fascia is formed of one layer and is not divided into superficial and deep layers. The cribriform fascia has a morphogenetic origin different from that of the femoral fascia and it is defined by the thickening of the connective tissue filling the fossa ovalis and therefore would be more correctly named lamina cribrosa. The deep inguinal lymph nodes originate directly from the superficial lymphatic tissue located in the fossa ovalis. This last observation supports the fact that no lymph nodes are present beneath the femoral fascia distal to the lower margin of the fossa ovalis. CONCLUSIONS: The results of this study, from a surgical point of view, support the technique of total or radical inguinal-femoral lymphadenectomy with preservation of the femoral fascia and, from an anatomical point of view, resolve some of the contradictory statements reported in the anatomical literature regarding morphogenesis and terminology of the structures of the Scarpa's triangle. In addition, the present study provides useful anatomic and terminological landmarks to those surgical oncologists (gynecologist, urologist, dermatologist, etc.) dealing with malignant diseases requiring groin dissection practices. In addition, it could represent a useful background for a future more precise surgical terminology which represents a vital issue for institutional studies with multiple surgeons as well as for large multi-institutional studies.

Fascia↗
PubMed2001

Biochemical study of collagen in adult groin hernias.

BACKGROUND: Previous works have suggested that a defect in collagen fiber structure may play a role in inguinal hernia formation. These studies focused mainly on the rectus sheath or the skin, while only few reports dealt with the transversalis fascia. According to these findings and to our previous biomechanical and histological studies suggesting that a connective tissue pathology could play a role in the genesis of groin hernias, we performed a biochemical investigation of the collagen in the transversalis fascia and rectus sheath. MATERIALS AND METHODS: The samples were collected from 40 adult patients with uni- or bilateral hernias and from 20 control subjects without hernia (autopsies and organ donors). A constant area of tissue was taken by using a calibrator. The wet and dry weights per 100 mm(2) were determined and the total collagen concentration as well as its sequential extractibility in NaCl, acetic acid, and pepsin was measured. The ratios of alpha(1)/alpha(2) chains (I) and of type I/III collagen were assessed by polyacrylamide gel electrophoresis. RESULTS: Samples collected in the control and patient sheaths showed an increased wet weight per 100 mm(2) in the patients. The wet and dry weights per unit area were increased in the patient fascias. The collagen concentration was increased in the indirect hernias. The fascias from the direct hernias (DH) presented a significantly increased collagen extractibility after pepsin digestion (5.6%), when compared to the control fascias (2.6%). The extractibility was 3.4% in the nonherniated (NH) sides. The qualitative study (ratios alpha(1)/alpha(2) (I) and I/III collagen) showed no difference between the fascia groups. CONCLUSIONS: The significant increase of collagen extractibility with pepsin in the DH fascias and at a lesser degree in the NH fascias suggests that molecular alterations of collagen could be involved in the genesis of groin hernias. This connective tissue pathology would express preferentially its effects in the inguinal region, since we have observed no major difference between the rectus sheaths of controls and those of patients.

Adult↗
PubMed2001

Pre-vascular hernia: a rare cause of chronic obscure groin pain after inguinal hernia repair.

A rare case of pre-vascular hernia is reported in a woman complaining of chronic obscure groin pain following an inguinal hernia repair. The condition was only diagnosed by means of a herniogram, emphasising the value of this investigation in unexplained groin pain. The hernia was successfully repaired using a polypropylene mesh plug, a simple technique widely employed in both femoral and recurrent inguinal hernia, but never before described in pre-vascular hernia.

Adult↗
PubMed1991

Antibiotic concentrations in the groin wound after vascular prosthetic implantation.

The kinetics of systemically and locally administered cefuroxime or ceftazidime in wound fluid were investigated in the period after vascular prosthetic implantation. Cefuroxime or ceftazidime was administered intravenously in patients. Simultaneously 250 mg ceftazidime or cefuroxime was added to preclotted blood. Locally administered antibiotics could not be detected in our samples. In groin fluid samples 24-48 h after the operation the average concentration of cefuroxime was 8.3 and of ceftazidime 5.0 mg/l. The decline of the concentration of cefuroxime or ceftazidime in groin fluid seems to be much slower than one would expect from the half-lives of the antibiotics. We conclude that cefuroxime and to a lesser extent ceftazidime are suitable as prophylactic agents in arterial reconstruction.

Aged↗
PubMed2005

The accuracy of ultrasound in the diagnosis of clinically occult groin hernias in adults.

This prospective study examined the accuracy of ultrasound in diagnosing occult groin hernias in adults. The study included 52 consecutive patients reviewed in the surgical out-patient clinic with a history suggestive of groin hernia but with a normal or inconclusive clinical examination. Each patient underwent a preliminary ultrasound examination by an experienced consultant radiologist who was aware that the patient had a history suggestive of a hernia but was blinded to the side of the symptoms. The patient then proceeded to herniography, and some patients also had surgical exploration. The results of the ultrasound were assessed in relation to the herniography, and the patients who proceeded to surgical exploration had further correlation with surgery. Ultrasound had a sensitivity of 29% and specificity of 90% compared with the herniography. Correlation with surgical findings showed ultrasound to have a sensitivity of 33% and a specificity of 100%. The sensitivity of ultrasound in detecting clinically occult hernias in a non-acute presentation is poor, and patients with normal ultrasound should be considered for further investigation.

Adult↗
PubMed2004

Successful treatment of infected vascular prosthetic grafts in the groin using conservative therapy with povidone-iodine solution.

Four cases of infected vascular prosthetic graft in the groin successfully treated with povidone-iodine solution using a conservative approach are described here. In all patients the same technique was used. After complete debridement, the prosthetic graft in the groin was completely exposed. The wound was cleansed with hydrogen peroxide and then dressed with gauze soaked in 1:10 sterile water-diluted povidone-iodine solution. The dressings were changed twice a day. The patients were supplemented by systemic therapy of an appropriate antibiotic. All patients were observed in the intensive care unit. In all patients this treatment method led to control of infection and healing of the wound. Thus, it was not necessary to remove the prosthetic graft and patients were spared a major surgical intervention. At follow-up, the prosthetic grafts remain patent without any signs of recurrence of infection.

Aged↗
PubMed2002

Open mesh versus non-mesh repair of groin hernia: meta-analysis of randomised trials based on individual patient data [corrected].

BACKGROUND: The EU Hernia Trialists Collaboration was established to provide reliable evaluation of newer methods of groin hernia repair. It involved 70 investigators in 20 countries. MATERIALS AND METHODS: Twenty eligible trials (5016 participants) of open mesh vs. non-mesh groin hernia repair were identified. Meta-analysis was performed using raw individual patient data where possible. RESULTS: Fewer hernia recurrences were reported after mesh repair. There were no clear differences between mesh and non-mesh groups in complications. Overall, those in the mesh groups had a shorter hospital stay, quicker return to usual activities and less frequent persisting pain, but individual trial results varied. CONCLUSIONS: The review provides strong evidence that open mesh repair is associated with a reduction in the risk of recurrence of between 50% and 75%. There is also some evidence of quicker recovery and of lower rates of persisting pain following open mesh repair.

Groin↗
PubMed2004

British contributions to modern herniology of the groin.

Traditional disdain for groin repair stifled recognition of British innovations. Some, relating to modern herniology, are remembered herein. Morton (1841) and Mackay (1889) showed the epigastric artery piercing Cooper's transversalis fascia (1807). Bilaminarity (Cooper, 1807) was confirmed in 1992 (Read). Thomson's iliopubic tract (1838) became part of Nyhus' repair (1960) [derived from McEvedy's repair (1950)] and laparoscopy (Ger, 1982). Retzius' space (Edinburgh, 1858) with Lister's antisepsis (1865) enabled preperitoneal herniorrhaphy (Annandale, 1876). He participated (1873) in intraperitoneal release of incarceration and reducible protrusions (Tait 1883). Cheyne's pectineus muscle plug (1893) preceded Kelly's marble prosthesis for femoral herniation (1898). Cheatle (1920) introduced posterior preperitoneal repair-ignored, rediscovered (Henry, 1936), and adopted (1952) at the Mayo clinic. Calne (1967) pioneered retrorectus Mersilene and was followed by Stoppa (1969) and Wantz (1989). Brandon (1945) blamed failure of modified Bassini's herniorrhaphies on closure at the intermediate inguinal ring instead of the internal. A similar mechanism may explain interstitial recurrence (Gilbert, 2003) after Amid-Lichtenstein repair. Lytle (1896-1986) described a muscle shutter at the internal ring, course of genitofemoral nerve, and orifice of femoral canal. Russell's congenital saccular theory (1906) was questioned by Keith (1924). Acquired connective-tissue pathology was later shown to play a systematic role in adult groin herniation (Read, 1970), confirmed by Jackson and colleagues (1996) and others.

General Surgery↗
PubMed1986

Groin dissection in malignant melanoma.

One hundred seventeen patients with malignant melanoma who had groin dissection were reviewed. The estimated 5 year survival rate for patients with node involvement was 40 percent. For patients with involved inguinal nodes only, the 5 year survival rate was 47 percent. The estimated 5 year survival rate for patients with clinically enlarged and histologically involved nodes was 37 percent and the incidence of involved deep nodes in this group was 44 percent. For patients with clinical and histologic involvement of the inguinal and deep nodes, the estimated 5 year survival rate was 30 percent. In patients with clinical involvement of the inguinal nodes, radical groin dissection with in-continuity removal of the deep nodes appeared to improve the previously reported survival rates.

Adult↗
PubMedDate not supplied

Morbidity of the groin flap transfer: are we getting something for nothing?

The morbidity of pedicled groin flap transfer for upper extremity soft tissue reconstruction was investigated in 24 patients. The problems of the transferred flaps and of the donor site, and associated illness after the operation, are reported. The morbidity of groin flaps should be considered carefully, especially if transfer is planned in older patients.

Adolescent↗
PubMed1989

Recurrent vulvar carcinoma in the intervening tissue bridge in early invasive stage I disease treated by radical vulvectomy and bilateral groin dissection through separate incisions.

Early invasive stage I squamous cell carcinoma of the vulva treated with radical vulvectomy and bilateral inguinofemoral lymphadenectomy rarely recurs, particularly when the lymph nodes contain no metastatic tumor. Primary radical surgery in this patient utilized separate groin incisions, and recurrent tumor developed in the tissue bridge between the groin scar and the vulva. Reexploration showed numerous inguinofemoral nodes to subseqently contain recurrent carcinoma. Literature regarding early, "microinvasive," squamous cell carcinoma of the vulva is reviewed.

Aged↗
PubMed1996

Use of seven-flap plasty for the treatment of axillary and groin postburn contractures.

Axillary and groin contracture with limitation of abduction of the arm and leg are one of the most common complications of burns. In this paper we report the technique of using seven-flap plasty for treating axillary and groin scar contractures. The advantages of using this technique are that it does not need prolonged splinting and intense and painful physical therapy.

Adolescent↗
PubMed2026

Treatment of Established Groin Lymphatic Complications After Arterial Surgery: A Systematic Review.

BACKGROUND: To systematically review the effectiveness and safety of interventions for established groin lymphatic complications after arterial vascular surgery. METHODS: PubMed, Embase, and Cochrane CENTRAL were searched from inception to May 28, 2025. This review was registered in PROSPERO (CRD420251061708) and conducted according to PRISMA, PRISMA-S, and Synthesis Without Meta-analysis (SWiM) guidance. Eligible studies included adults with established groin lymphorrhea/lymphocutaneous fistula or seroma/lymphocele after arterial exposure in the common femoral or iliofemoral region. Prophylactic studies were excluded. Two reviewers independently screened studies and assessed full texts. Prespecified outcomes were resolution, time to resolution, length of stay, surgical site infection, wound complications, reintervention, and recurrence. Owing to substantial heterogeneity, meta-analysis was not performed. RESULTS: Eighteen retrospective single-center studies were included; no randomized trials were identified. Reported strategy-family totals were operative control (n = 240, including 55 dye-assisted cases), intranodal lymphangiography with glue embolization (n = 39), intracavitary or chemical instillation (n = 52), negative-pressure wound therapy (n = 20), radiotherapy (n = 206), and drainage or aspiration alone (n = 7). One additional cohort compared nonsurgical with surgical management. Definitions, follow-up windows, and statistical reporting were inconsistent, and arm-level denominators were frequently incomplete. Risk of bias was serious to critical across the evidence base, mainly because of retrospective design, confounding by indication, treatment-selection bias, inconsistent outcome definitions, and incomplete reporting. Using GRADE principles, certainty of evidence was very low across strategies and phenotypes. Across study arms, conduit-directed approaches for external leak and cavity-directed approaches for encapsulated collections often achieved control, but valid comparative inference was not possible. CONCLUSION: Evidence is limited to small retrospective series with heterogeneous definitions, serious to critical risk of bias, and very low certainty. Reliable comparisons between interventions cannot currently be made. Standardized phenotype-specific definitions and outcome reporting are needed to support prospective studies and future trials.

Humans↗