Combined Free Partial Vastus Lateralis with Anterolateral Thigh Perforator Flap for Reconstruction of Extensive Composite Defects

Abstract

007-1226/$ see front matter q 20 i:10.1016/j.bjps.2005.04.022 * Corresponding author. Tel.: C31 1 E-mail address: sophofer@hotmail. Summary Myocutaneous (MC) free flaps are useful for many reconstructive indications. Perforator flaps have become standard of care. The anterolateral thigh flap (ALT) donor site is popular. With the ALT flap varying sizes of vastus lateralis (VL) muscle can be harvested as a MC flap. The skin islands of these flaps have a great range of freedom when dissected on their perforator. It was hypothesised that the VL–ALT perforator flap would offer adequate tissue volume combining maximal freedom in planningwithminimal donor sitemorbidity. FromNovember 2001 to February 2003 a free partial VL with ALT perforator flap was used in 11 patients to reconstruct large defects. Indications for adding a muscular component were exposed bone, skull base, (artificial) dura, or osteosynthesis material, open sinuses, and lack of muscular bulk. Flaps were planned as standard ALT flaps, after which three types of dissection were performed: I. trueMCflap; II.muscleflapwitha skin islandononeperforator,whichcouldbe rotatedup to1808; III. chimera skin perforatorflapwithmuscle being harvestedona separatebranch from the source vessel or on a side branch of the skin perforator. Mean skin size of theMCALT flaps was 131 cm. Meanmuscle part size of the MC-ALT flaps was 268 cm. Muscular parts were custom designed for all defects. No total or partial flap failures were seen. Colourmismatchwas seen in6of8patients,whenskinwasused in the facial area in this all white population. Excessive flap bulk was found in 8 of 11 patients at 6 weeks, however, only in 2of 11patients after 6months. Patientswere satisfiedwith the functional result (8 of 11 patients) as well as the cosmetic result of their reconstruction (7 of 11 patients). All less satisfiedpatientshad receivedtheirflap forexternal facial skin reconstruction.Donor sitemorbiditywasminimal. The combined free partial VLwithALTperforator flapproved valuable as a (chimera type) MC flap with maximal freedom of planning to meet specific reconstructive demands and minimal donor site morbidity. q 2005 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved. British Journal of Plastic Surgery (2005) 58, 1095–1103