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. 2012 Jun;3(2):130-8.
doi: 10.1007/s13193-012-0145-3. Epub 2012 Mar 28.

Reconstruction of groin defects following radical inguinal lymphadenectomy: an evidence based review

Vijayashree Murthy  1 , K S Gopinath
Affiliations

Reconstruction of groin defects following radical inguinal lymphadenectomy: an evidence based review

Vijayashree Murthy et al. Indian J Surg Oncol. 2012 Jun.

Abstract

Inguinal lymph node involvement is an important prognostic and predictive factor in various neoplasms of the genitalia and lower limb. As part of the multimodality approach, these patients undergo surgery and adjuvant radiotherapy. Morbidity of inguinal lymphadenectomy includes lymphedema, lymphorrhea and infection; however the most common distressing complication is skin necrosis. Myocutaneous flaps have been the most popular form of primary or delayed groin reconstruction. This paper aims to critically review the different myocutaneous flaps used in groin reconstruction, discuss evidence based data on the versatility and utility of these flaps and discuss ways in which modifications maybe incorporated in treatment and radiation planning following groin reconstruction. A comprehensive search of the scientific literature was carried out using PubMed to access all publications related to groin reconstruction. The search focused specifically on current management, technique, safety and complications of these procedures. Keywords searched included "inguinal lymphadenectomy", "primary reconstruction", "musculocutaneus flap", "myocutaneous flap", "tensor fascia lata flap", "anterolateral thigh flap", "rectus abdominis flap". Low to middle income countries witness a huge burden of locally advanced genital malignancies and melanoma of the lower extremity. Higher tumor burden both at the primary site as well as the inguinal basin requires surgery as the primary modality of treatment. Groin reconstruction is required not only to prevent femoral blowouts but also for early administration of adjuvant radiation. The versatility of tensor fascia lata, anterolateral thigh, and rectus abdominis flaps is useful to cover the defect, provide radiation, eradicate pain and achieve good palliation. Assessment of aesthetic and functional outcomes of one flap over the other and the "ideal" form of reconstruction for groin defects needs additional investigation.

Keywords: Inguinal lymphadenectomy; Musculocutaneus flap; Primary reconstruction.

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Figures

Fig. 1
Fig. 1
Preoperative view of left sided inguinal region with enlarged lymph nodes. Note the marking of the site of inguinal lymphadenectomy along with the overlying skin and the marking of the TFL flap on the thigh
Fig. 2
Fig. 2
a Preoperative view of left sided inguinal region with enlarged lymph nodes in a male patient following partial amputation in a case of carcinoma penis. Note the marking of the site of inguinal lymphadenectomy along with the involved overlying skin and the marking of the anterolateral thigh flap on the thigh. b Showing an immediate postoperative view of the anterolateral flap covering the inguinal defect in Fig. 2a and the skin graft over the donor site
Fig. 3
Fig. 3
a Preoperative view of bilateral enlarged inguinal lymph nodes in a male patient following partial amputation in a case of carcinoma penis. Note the marking of the site of inguinal lymphadenectomy alongwith the involved overlying skin. b. Postoperative view of vertical rectus abdominis flap covering the bilateral inguinal defect after the flap has been rotated. Note prolene mesh has been used to cover the defect and the donor site has been closed primarily
See this image and copyright information in PMC

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