J Reconstr Microsurg 2010; 26(7): 427-431
DOI: 10.1055/s-0030-1251561
© Thieme Medical Publishers

A Novel Technique for Lower Extremity Limb Salvage: The Vastus Lateralis Muscle Flap with Concurrent Use of the Vacuum-Assisted Closure Device

Jonas A. Nelson1 , Elizabeth M. Kim1 , Joseph M. Serletti1 , Liza C. Wu1
  • 1The Division of Plastic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Further Information

Publication History

Publication Date:
22 March 2010 (online)

ABSTRACT

Free tissue transfer is an essential component of lower extremity limb reconstruction and has dramatically improved salvage attempts. In this report, we examine the use of the underutilized free vastus lateralis muscle flap and describe our treatment protocol that involves a novel application for the vacuum-assisted closure device in an effort to reduce edema and congestion in lower extremity limb salvage. Thirteen patients underwent reconstruction with 14 vastus lateralis flaps with closure occurring on average 35.2 days after injury and an average case duration of 4:34 days. We report one flap failure, one superficial abscess, and one donor site hematoma. All patients were ambulatory at 6 months. Our early experience using this underutilized flap and novel protocol demonstrate successful lower extremity reconstruction with few complications, and good function and contour. Given its advantages, this versatile flap should be included as an option in lower extremity limb salvage operations.

REFERENCES

  • 1 Khouri R K, Shaw W W. Reconstruction of the lower extremity with microvascular free flaps: a 10-year experience with 304 consecutive cases.  J Trauma. 1989;  29 1086-1094
  • 2 Reddy V, Stevenson T R. MOC-PS(SM) CME article: lower extremity reconstruction.  Plast Reconstr Surg. 2008;  121(4, Suppl) 1-7
  • 3 Bosse M J, MacKenzie E J, Kellam J F et al.. An analysis of outcomes of reconstruction or amputation after leg-threatening injuries.  N Engl J Med. 2002;  347 1924-1931
  • 4 Wolff K D, Grundmann A. The free vastus lateralis flap: an anatomic study with case reports.  Plast Reconstr Surg. 1992;  89 469-475 discussion 476-477
  • 5 Cavadas P C, Sanz-Jiménez-Rico J R. Use of the extended-pedicle vastus lateralis free flap for lower extremity reconstruction.  Plast Reconstr Surg. 2005;  115 1070-1076
  • 6 Kuo Y R, Jeng S F, Kuo M H et al.. Free anterolateral thigh flap for extremity reconstruction: clinical experience and functional assessment of donor site.  Plast Reconstr Surg. 2001;  107 1766-1771
  • 7 Wolff K D, Howaldt H P. Three years of experience with the free vastus lateralis flap: an analysis of 30 consecutive reconstructions in maxillofacial surgery.  Ann Plast Surg. 1995;  34 35-42
  • 8 Spyriounis P K, Lutz B S. Versatility of the free vastus lateralis muscle flap.  J Trauma. 2008;  64 1100-1105
  • 9 Hanasono M M, Skoracki R J. Securing skin grafts to microvascular free flaps using the vacuum-assisted closure (VAC) device.  Ann Plast Surg. 2007;  58 573-576
  • 10 Guillemaud J P, Seikaly H, Cote D, Allen H, Harris J R. The implantable Cook-Swartz Doppler probe for postoperative monitoring in head and neck free flap reconstruction.  Arch Otolaryngol Head Neck Surg. 2008;  134 729-734
  • 11 Rosenberg J J, Fornage B D, Chevray P M. Monitoring buried free flaps: limitations of the implantable Doppler and use of color duplex sonography as a confirmatory test.  Plast Reconstr Surg. 2006;  118 109-113 discussion 114-115
  • 12 Pryor S G, Moore E J, Kasperbauer J L. Implantable Doppler flow system: experience with 24 microvascular free-flap operations.  Otolaryngol Head Neck Surg. 2006;  135 714-718
  • 13 Kind G M, Buntic R F, Buncke G M, Cooper T M, Siko P P, Buncke Jr H J. The effect of an implantable Doppler probe on the salvage of microvascular tissue transplants.  Plast Reconstr Surg. 1998;  101 1268-1273, discussion 1274–1275
  • 14 de la Torre J, Hedden W, Grant III J H, Gardner P M, Fix R J, Vásconez L O. Retrospective review of the internal Doppler probe for intra- and postoperative microvascular surveillance.  J Reconstr Microsurg. 2003;  19 287-290

Liza C WuM.D. 

Division of Plastic Surgery, University of Pennsylvania

10 Penn Tower, 3400 Spruce Street, Philadelphia, PA 19104

Email: Liza.Wu@uphs.upenn.edu