Groin Flap

• One of the first axial pattern flaps

• Very low failure rate

• Minimal donor site morbidity

• Mostly used to reconstruct hand and forearm defects

• Also used as regional flap
• Can be taken with iliac crest, cutaneous nerve
• Can also be transferred as free flap
Anatomy
• Based on superficial circumflex iliac artery
• Branch of femoral
• Runs parallel to inguinal ligament
• Superficial from medial border of sartorius
• Extends till ASIS
• Lymphatic and venous drainage – variable
• Should be identified for free flap transfer
• Drains through the area of pedicle
• Sensory innervation by lateral cutaneous branch of subcostal nerve
Operative technique
• Planning
• Keep axial vessel centered

• Width according to defect (upto

12cm)
• Can extend beyond ASIS 1:1

• Decide orientation of flap on hand

and mark distal margin
Steps
• Skin incised at distal margin and • Donor area sutured primarily
deepened till fascia • From lateral to medial
• Subcutaneous plane till ASIS • Avoid undermining
• Hip flexion will help approximate
• Fascia divided medial to tensor
fascia lata • SSG to be avoided as uptake is
poor
• Raised subfascially
• Dissection halts at medial border
of sartorius
• Thinning may be necessary for
better contouring and tubing
• Fat globules deep to fascia are
excised
• Avoid dissecting between fascia
and skin
• Avoid thinning along central axis
• Proximal part tubed with
interrupted sutures
• Distal part inset into defect
• Immobilise for 24-48 hrs
• Be vigilant during anesthesia
recovery
• Later, patient encouraged to
mobilise to prevent edema and
joint stiffness
• Division and inset in 3 weeks if • Delay routinely done for transfer
• Attachment line long relative to to digits
inset area
• Skin around inset area supple and
unscarred • If bleeding found to be poor
• Attachment line completely intra op, flap can be left
healed wrapped then inset later
• Otherwise
• Wait, check vascular flow
• Delay procedure