Cutaneous vascularization of the femoral triangle in respect to groin incisions

• Published in: Journal of vascular surgery Vol. 64; no. 3; pp. 757 - 764
• Main Authors: Tremblay, Cécilia, BSc, Grabs, Detlev, MD, PhD, Bourgouin, Daniel, MD, FRCS(C), Bronchti, Gilles, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2016
• Subjects: Aged; Aged, 80 and over; Angiography; Cadaver; Dissection; Embalming; Epigastric Arteries - anatomy & histology; Epigastric Arteries - diagnostic imaging; Epigastric Arteries - surgery; Female; Femoral Artery - anatomy & histology; Femoral Artery - surgery; Groin; Humans; Iliac Artery - anatomy & histology; Iliac Artery - diagnostic imaging; Iliac Artery - surgery; Male; Middle Aged; Necrosis; Regional Blood Flow; Skin - blood supply; Surgery; Thigh - blood supply; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - methods; Vascular System Injuries - etiology; Vascular System Injuries - prevention & control; Wound Healing
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2015.04.385

Objective The purpose of this anatomic study was to describe the cutaneous vascularization of the femoral triangle and its variation to evaluate the potential consequences of the classic incisions used in vascular surgery. The ultimate goal was to suggest surgical approaches that would take into account the vascularization of the inguinal region to potentially reduce the vascular lesions and wound complications at the groin. Methods The cutaneous arteries of the femoral triangle were studied in 11 lower limbs from 6 human embalmed cadavers. The technique included embalming of the cadavers, radiopaque latex injection, radiographs, and anatomic dissection. Results The comparison of the vascular patterns revealed that despite the high variability of the arborization of the cutaneous arteries, their distribution patterns share many characteristics. The main vascularization of the femoral triangle comes from three arteries: the superficial circumflex iliac, the superficial epigastric, and the external pudendal. The first two arteries originate generally through a common trunk that buds laterally from the femoral artery at about 1.5 cm below the inguinal ligament. This study shows that the classic vertical incision at the groin would lead to damage of the cutaneous branches that cross over the femoral artery in its proximal part (the superficial epigastric artery in 82% and the common trunk of the superficial epigastric and circumflex iliac arteries in 18%); these lesions could lead to the postsurgical disruption of the dermal blood flow. Conclusions The classic incisions could disrupt the cutaneous blood supply and thus increase the risk of tissue necrosis around the wound, explaining the observed postsurgical complications and infections. We propose to lower the vertical incision to start 2 cm under the inguinal ligament to reduce lesions of the cutaneous arteries and the potential devascularization of the wounds.