[Clinical evaluation and repair strategies for complex inguinal wounds].

Abstract

Objective: To explore the clinical evaluation and repair strategies for complex inguinal wounds. Methods: This study was a retrospective case series study. From September 2020 to October 2025, 15 patients with complex inguinal wounds who met the inclusion criteria were admitted to Beijing Jishuitan Hospital of Capital Medical University. There were 10 males and 5 females, aged 12 to 79 years. Preoperatively, the involvement of vital structures and infectious status in the inguinal region was precisely evaluated through medical history inquiry, physical examination, and multiple auxiliary examinations. After timely management of femoral artery lesions, precise debridement was carried out. The sizes of inguinal wounds after debridement ranged from 11.0 cm×4.0 cm to 20.0 cm×9.0 cm. According to the wound bed conditions after debridement, well-vascularized tissue flaps were selected to obliterate the wound cavity and achieve wound closure. The following data were recorded, including the involvement of femoral vessels by the wound, the exposure and retention or removal of prosthetic vascular grafts, management of the femoral artery in patients with radiotherapy, the type and size of the adopted tissue flaps, the methods of wound closure at the donor site, the preoperative bacterial culture results of wound exudate samples, and the results of intraoperative histopathological examination of wounds. The survival of tissue flaps and wound healing were observed two weeks postoperatively. During follow-up, the appearance of tissue flaps, recurrence of wounds, patency of femoral artery, swelling of the affected limb, scar formation of the donor sites, and occurrence of abdominal wall hernia at the donor site of rectus abdominis myocutaneous flap were observed. Results: All inguinal wounds involved femoral vessels. Exposure of the prosthetic vascular graft was observed in 4 patients, among which the prosthetic vascular graft was preserved in three patients and removed in one patient. Among patients with radiotherapy, two patients received preoperative covered stent implantation, one patient underwent intraoperative femoral artery resection and prosthetic vascular vessel grafting, and the femoral artery in the remaining patients was successfully preserved without rupture. Eleven cases of inguinal wounds were repaired with thoracoumbilical flaps combined with rectus abdominis myocutaneous flap, one case was repaired with tensor fasciae latae myocutaneous flap combined with sartorius muscle flap, one case was repaired with tensor fasciae latae myocutaneous flap combined with rectus femoris muscle flap, and two cases were repaired with pedicled anterolateral thigh flap chimerized with vastus lateralis muscle flap. The sizes of tissue flaps ranged from 13.0 cm×6.0 cm to 26.0 cm×14.0 cm. Only the donor site wound in one patient was covered with split-thickness skin graft, and the donor site wounds in the remaining 14 patients were closed by primary suture. The preoperative bacterial culture results of wound exudate samples showed monomicrobial infection in 7 patients and mixed infection of two types of bacteria in 8 patients. The results of intraoperative histopathological examinations of wounds revealed inflammatory changes without neoplastic component. The tissue flaps in all patients survived completely, and the wounds healed well at postoperative two weeks. During postoperative follow-up of 6 months to 3 years, most of the tissue flaps maintained good appearance, while a small number of tissue flaps presented mild bulkiness. No wound recurrence was observed. Computed tomography angiography confirmed patent femoral arteries in 14 patients, and obvious relief of preoperative lower limb swelling was achieved in 9 patients. The donor site wound with skin grafting showed unremarkable scarring in one patient, while mild linear scars were noted at the donor sites in the other 14 patients. No abdominal wall hernia occurred at the donor sites of rectus abdominis myocutaneous flaps. Conclusions: For complex inguinal wounds, optimal clinical repair outcomes can be achieved via preoperative precise evaluation of large blood vessels, prosthetic vascular grafts, and soft tissue infection, and adequate vascular intervention, intraoperative precise debridement, followed by wound closure using well-vascularized tissue flaps.