Versatile design of compound vastus lateralis muscle and anterolateral thigh musculocutaneous perforator free flaps for customized reconstruction of complex skin and soft tissue defects in the extremities

Abstract

Background: Compound anterolateral thigh flaps are popular for three-dimensional reconstruction of complex soft tissue defects. We present our 10-year experience using compound vastus lateralis (VL) muscle and anterolateral thigh musculocutaneous perforator (ALTP) flaps, and introduce three versatile customizations of this flap for individualized reconstruction of complex threedimensional soft tissue defects. Methods: From May 2008 to June 2017, compound VL muscle and ALTP flaps were performed in 67 consecutive patients aged 14-75 years (62 men and 5 women). The defects were in either the lower (n = 53) or upper extremity (n = 14), and ranged in size from 8 × 4 cm 2 to 25 × 6 cm 2. Dead space volume ranged from 4 × 2 × 1 cm 3 to 20 × 3 × 2 cm 3 , and all flaps were harvested from patients' thighs as one of three types. In type A, a single perforator supplied both the skin and muscle components, with the vascular bundle penetrating the muscle component. In type B, a single perforator supplied both skin and muscle components with separate branches to the skin and muscle. In type C, separate vessels supplied the skin and muscle. Results: In the 67 patients, 65 flaps survived, and the donor site was closed directly. Vascular compromise occurred in four patients on the first postoperative day. Two flaps were salvaged after emergency re-exploration. Flap loss occurred in two patients, and these defects were repaired using other flaps. The follow-up period ranged from 8 to 60 months (mean, 11.9 months). All flaps had satisfactory appearance and texture, and no patients experienced limited hip and knee joint mobility from the donor site operation. Conclusions: Compound VL muscle and ALTP flaps are a reliable option to reconstruct complex defects of the extremities. Identifying three flap types allowed for more precise customization to cover complex defects with limited donor site morbidity.

Comparative study between early and delayed perforator flaps for reconstruction of soft tissue defects over distal third tibia

“…In the late group the time interval was ranged from (4) to (65) days after the onset of injury with an average time of 21.90 ±18.3 (SD) days. Figure (5) The duration of hospital stay in the post-operative period was significantly shorter among studied cases in the early group as compared with the late group (p-value= 0.30). Table (3) Dehiscence was more frequent in delayed as compared with early group (2 vs. 1 case in both groups respectively); but with no statistically significant difference.…”

Pedicled vastus lateralis myocutaneous flap for sacropelvic defects after wide oncologic resection: Wound complications and outcomes

“…Vastus lateralis flaps have been employed as free flaps for craniofacial as well as head and neck reconstruction 47–50 . Modified vastus lateralis flaps have also been used for coverage of defects after chronic femur osteomyelitis, complex hip infections, necrotizing fasciitis, and chronic wounds 13,14,16,17,51–54 …”

“…[47][48][49][50] Modified vastus lateralis flaps have also been used for coverage of defects after chronic femur osteomyelitis, complex hip infections, necrotizing fasciitis, and chronic wounds. 13,14,16,17,[51][52][53][54] To our knowledge, a pedicled vastus lateralis myocutaneous flap has not been described for coverage of defects after resection of sacropelvic tumors. Observing that the use of gastrocnemius flaps for coverage of proximal tibia and distal femur defects after sarcoma resection about the knee has led to decreased wound complications, we hypothesized that a pedicled vastus lateralis flap can serve as an analog for sacropelvic and proximal femur tumors.…”

“…Multiple flaps have been described for soft tissue reconstruction of large defects after sacropelvic tumor resection such as the pedicled vertical rectus abdominis musculocutaneous (VRAM), gluteal myocutaneous, latissimus dorsi, and anterolateral thigh (ALT) flaps 2,7,11 . Due to its bulk and low donor site morbidity, the vastus lateralis flap has been described for coverage in the setting of trauma, chronic wounds, and necrotizing fasciitis 12–17 . This flap has not been described for coverage of defects from sacropelvic tumor resection.…”

“…2,7,11 Due to its bulk and low donor site morbidity, the vastus lateralis flap has been described for coverage in the setting of trauma, chronic wounds, and necrotizing fasciitis. [12][13][14][15][16][17] This flap has not been described for coverage of defects from sacropelvic tumor resection.…”