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Prophylactic Muscle Flaps in Vascular Surgery: The Penn Groin Assessment Scale

Fischer, John P. M.D.; Nelson, Jonas A. M.D.; Rohrbach, Jeff I. M.S.N.; Wu, Liza C. M.D.; Woo, Edward Y. M.D.; Kovach, Stephen J. M.D.; Low, David W. M.D.; Serletti, Joseph M. M.D.; Kanchwala, Suhail M.D.

Plastic and Reconstructive Surgery: June 2012 - Volume 129 - Issue 6 - p 940e–949e
doi: 10.1097/PRS.0b013e31824ecb17
Reconstructive: Trunk: Original Articles

Background: High-risk patients undergoing vascular procedures through inguinal incisions experience significant benefit from undergoing prophylactic muscle flaps. The authors present a risk assessment tool, an evidence-based algorithm for using prophylactic muscle flaps, and a comprehensive cost analysis.

Methods: Data derived from the authors' previously performed retrospective cohort study of patients undergoing open vascular groin surgery were used to construct an evidence-based risk assessment tool. A multivariate regression analysis identified significant, independent predictors of complications, which were used to construct a scoring system. An institutional cost analysis and preoperative assessment algorithm were derived based on patient risk stratification and statistical analyses.

Results: Sixty-eight prophylactic flaps in 53 patients were compared with 195 open femoral access procedures without flaps in 178 patients. Multivariate regression demonstrated that obesity, smoking, reoperation, and prosthetic graft reconstruction are significant predictors of complications. A weighted risk factor score (0 to 7) was devised: obesity, for a value of 1; smoking, 2; reoperation for open groin surgery, 2; and prosthetic graft material, 2. Patients with higher scores had significantly more complications, infections, and more frequently required secondary salvage flap procedures. Using study data, the authors constructed an algorithm to guide preoperative groin assessment and use of prophylactic muscle flaps.

Conclusions: The authors provide an assessment tool, called the Penn Groin Assessment Scale, that accurately predicts groin complications. They also describe a simple algorithm to assess for prophylactic muscle coverage. Their results suggest that patients with two or more risk factors will benefit from prophylactic muscle flaps.


Philadelphia, Pa.

From the Divisions of Plastic Surgery and Vascular Surgery and the Department of Finance, Hospital of the University of Pennsylvania.

Received for publication December 9, 2011; accepted January 3, 2012.

Presented at the 28th Annual Meeting of the Northeastern Society of Plastic Surgeons, in Amelia Island, Florida, October 23, 2011, and at the Annual Meeting of the American Society of Reconstructive Microsurgery, in Las Vegas, Nevada, January 16, 2012.

Disclosure: None of the authors listed has any conflicts of interest to report.

John P. Fischer, M.D.; University of Pennsylvania, Division of Plastic Surgery, 3400 Spruce Street, Philadelphia, Pa. 19104,

©2012American Society of Plastic Surgeons