Cutaneous vascularization of the femoral triangle in respect to groin incisions Cécilia Tremblay, BSc, Detlev Grabs, MD, PhD, Daniel Bourgouin, MD, FRCS(C),

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Presentation transcript:

Cutaneous vascularization of the femoral triangle in respect to groin incisions Cécilia Tremblay, BSc, Detlev Grabs, MD, PhD, Daniel Bourgouin, MD, FRCS(C), Gilles Bronchti, PhD Journal of Vascular Surgery Volume 64, Issue 3, Pages 757-764 (September 2016) DOI: 10.1016/j.jvs.2015.04.385 Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 1 Illustration of the method used in this study. A, Radiograph of a radiopaque latex-injected left thigh. B, Superficial dissection of the same thigh; after removal of the skin, the cutaneous arteries are easily visible with their red latex content. C, Deep dissection to reveal the origin of each cutaneous artery. D, Same photograph of the deep dissection with the cutaneous artery outlined in different colors (detailed in Fig 2). This drawing helps identify the different cutaneous arteries on the radiograph. E, Identification of the cutaneous arteries on the radiograph of the intact thigh; note that the course of some branches is different from that observed in D as this step serves to correct for any modifications in the position of the arteries during the dissection. F, The pattern of the cutaneous arteries is transposed onto the skin together with two anatomic landmarks, the femoral artery and the inguinal ligament. Scale bar = 1 cm. Journal of Vascular Surgery 2016 64, 757-764DOI: (10.1016/j.jvs.2015.04.385) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 2 Variations observed in the patterns of the cutaneous arteries in all 11 cases studied. As in Fig 1, F, the pattern of the cutaneous arteries is projected onto the skin with respect to the femoral artery (in red) and inguinal ligament (in white). The right (A, C, E, G, I, and K) and left (B, D, F, H, and J) thighs are placed one next to the other. The cutaneous arteries were drawn in different colors: pink, superficial epigastric artery; blue, superficial circumflex iliac artery; red, superficial external pudendal artery; green, unnamed superficial arteries. Note the large interindividual variation and that present even between the right and left thighs of the same person. Scale bar = 1 cm. Journal of Vascular Surgery 2016 64, 757-764DOI: (10.1016/j.jvs.2015.04.385) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 3 A to K, Potential vascular injury caused by the classic vertical infrainguinal incision in each of the 11 vascular patterns (cases A to K) shown in Fig 2. The arteries drawn in gray are the ones that would be injured by the classic incision, and their territory is the area of, at least, a partial ischemia. The red arteries are those that would stay intact. The grayed areas on the figures correspond to the edge of the incision at risk of necrosis due to devascularization. Scale bar = 1 cm. Journal of Vascular Surgery 2016 64, 757-764DOI: (10.1016/j.jvs.2015.04.385) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 4 Proposition of a new approach for the vertical infrainguinal incision. The vascular pattern in case F of Figs 2 and 3 was used as an example to present different positions of the incision (dotted lines). Again, arteries drawn in gray would be injured, whereas the red arteries stay intact. The grayed zones on the figure correspond to the edge of the wound at risk of necrosis. A, The classic vertical infrainguinal incision leads to important vascular lesions as shown in Fig 3, F. B, If the incision would be lowered to start 2 cm below the inguinal ligament, the devascularization would be reduced to a minimum. Scale bar = 1 cm. Journal of Vascular Surgery 2016 64, 757-764DOI: (10.1016/j.jvs.2015.04.385) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 5 Consequences of other incisions proposed in the literature. A, The oblique suprainguinal incision parallel and slightly above the inguinal ligament described by some researchers leads to only minor vascular lesions. B, The lateral vertical incision described by Ploeg et al7 leads to an important lesion of the superficial circumflex iliac artery. C, The vascular lesion would be reduced if the lateral vertical incision is lowered by 2 cm. Scale bar = 1 cm. Journal of Vascular Surgery 2016 64, 757-764DOI: (10.1016/j.jvs.2015.04.385) Copyright © 2016 Society for Vascular Surgery Terms and Conditions