Neo-inguinal reconstruction: algorithm for layered vascularized tissue coverage using plug flap following oncologic inguinal resection.

Abstract

<h4>Purpose</h4>Tumors in the inguinal region are challenging to resect and reconstruct, especially when the inguinal ligament is violated. Without the shelving effect of the inguinal ligament in the setting of extensive local tissue deficit and major vessel exposure, there is an elevated risk of postoperative bowel incarceration and potential damage to the femoral neurovascular bundle.<h4>Methods</h4>This is a retrospective case series of patients who underwent radical resection of pelvic tumors with inguinal ligament involvement. In addition to mesh placement, local flaps were layered to function as soft tissue plugs to avoid bowel herniation.<h4>Results</h4>Six patients with a mean age of 65.5 years were included. There were five cases of liposarcoma and one case of metastatic lung cancer. The inguinal ligament was resected in 4 patients and divided in 2 patients. The rectus abdominus was used in 3 cases and the rectus femoris in 2 cases to cover the mesh. The omentum was used in 2 patients and the sartorius in 1 patient to act as a soft tissue plug. The first inguinal ligament resection patient did not have a soft tissue plug, which resulted in incarcerated inguinal hernia. One patient with soft tissue plug developed inguinal hernia 19 months after surgery after returning to heavy labor work but did not require surgery.<h4>Conclusion</h4>Patients undergoing extensive oncologic resection can benefit from neo-inguinal reconstruction by implementing a soft tissue plug between the femoral vessels and the mesh.