Use of the Anterolateral Thigh and Vertical Rectus Abdominis Musculocutaneous Flaps as Utility Flaps in Reconstructing Large Groin Defects

BACKGROUND: Groin dissections result in large wounds with exposed femoral vessels requiring soft tissue coverage, and the reconstructive options are diverse. In this study we reviewed our experience with the use of the pedicled anterolateral thigh and vertical rectus abdominis musculocutaneous flaps in the reconstruction of large groin wounds. METHODS: Groin reconstructions performed over a period of 10 years were evaluated, with a mean follow up of two years. We included all cases with large or complex (involving perineum) defects, which were reconstructed with the pedicled anterolateral thigh musculocutaneous or the vertical rectus abdominis musculocutaneous (VRAM) flaps. Smaller wounds which were covered with skin grafts, locally based flaps and pedicled muscle flaps were excluded. RESULTS: Twenty-three reconstructions were performed for large or complex groin defects, utilising the anterolateral thigh (n=10) and the vertical rectus abdominis (n=13) pedicled musculocutaneous flaps. Femoral vein reconstruction with a prosthetic graft was required in one patient, and a combination flap (VRAM and gracilis muscle flap) was performed in another. Satisfactory coverage was achieved in all cases without major complications. No free flaps were used in our series. CONCLUSIONS: The anterolateral thigh and vertical rectus abdominis pedicled musculocutaneous flaps yielded consistent results with little morbidity in the reconstruction of large and complex groin defects. A combination of flaps can be used in cases requiring extensive cover.

A man with chronic recurrent ulcers at the axillac and groins.

Langerhans cell histiocytosis is an uncommon disease. There are various skin manifestations of this disorder. We report a 15 year-old patient with Langerhams cell histiocytosis, who first presented with polyuria, polydipsia and right elbow pain. A few years later, he developed chronic recurrent ulcers at his axillae and groins, simulating hidradenitis suppurativa. Histopathology and ultramicroscopic study showed Langerhans cells infiltrating the lesions. He also had fingernail changes without any evidence of fungal infection. Hidradenitis suppurative-like lesions with nail changes are rare manifestations of this disorder.