Rekonstrukcija ingvinalne regije gracilis mišićnim režnjem u pacijentice s eksponiranom vaskularnom protezom

Sara Gudelj, Tea Barunčić, Aleksandra Pirjavec Mahić

Uvod: Eksponirani sintetski vaskularni graft u preponskoj regiji predstavlja ozbiljnu komplikaciju nakon vaskularnih zahvata s visokim rizikom infekcije te posljedičnom ekstirpcijom vaskularnog grafta i mogućeg gubitka ekstremiteta. Pravovremena rekonstrukcija mekih tkiva ključna je za smanjenje rizika razvoja infekcije i smanjenje morbiditeta. Funkcionalnost vaskularne premosnice očituje se njezinom prohodnošću, odnosno održanim distalnim protokom. Prikaz bolesnice: Prikazujemo slučaj 61-godišnje pacijentice, kod koje je nakon ponavljanih vaskularnih zahvata u desnoj ingvinalnoj regiji naposljetku došlo do nastanka defekta kože i potkožja te eksponiranja dakronske vaskularne proteze. Nakon izolacije Staphylococcus epidermidis iz rane te ciljane antibiotske terapije i primjene terapije negativnim tlakom (engl. Negative Pressure Wound Therapy, NPWT) zaostao je defekt veličine 12 × 4 cm. Zbog navedenog, učinjena je rekonstrukcija gracilis mišićnim režnjem te Thiersch plastika. Postoperativni tijek protekao je uredno, bez kompromitacije režnja, a rana je zacijelila primarnom intencijom. Zaključak: U rekonstrukciji ingvinalne regije kod pacijenta s eksponiranim sintetskim vaskularnim graftom, gracilis mišićni režanj predstavlja jednu od pouzdanih i često korištenih kirurških opcija, osobito kada su lokalni uvjeti kompromitirani.

Introduction: Exposure of a synthetic vascular graft in the groin is a serious complication following vascular surgery, associated with a high risk of infection, potential graft explantation, and possible limb loss. Prompt soft tissue coverage is crucial to minimize the risk of infection and reduce overall morbidity. The success of vascular reconstruction is primarily determined by graft patency and preservation of adequate distal perfusion. Case report: We report the case of a 61-year-old woman who developed a skin and subcutaneous tissue defect with exposure of a Dacron vascular graft following multiple vascular procedures in the right groin region. After isolation of Staphylococcus epidermidis from the wound, targeted antibiotic therapy was initiated, followed by negative pressure wound therapy (NPWT). Despite these measures, a residual soft tissue defect measuring approximately 12×4 cm, persisted. Definitive reconstruction was therefore performed using a gracilis muscle flap
combined with split-thickness skin grafting (Thiersch graft). The postoperative course was uneventful, with no evidence of flap-related complications, and complete wound healing was achieved by primary intention. Conclusion: In the management of groin defects with exposed synthetic vascular grafts, the gracilis muscle flap represents a reliable and well-established reconstructive option, particularly in patients with compromised local tissue  conditions.