Role of Vastus Lateralis Myofascial Free Flap in Reconstruction of Head and Neck Defects

Abstract

Objectives: There is a paucity of data regarding the role of the vastus lateralis free flap (VLFF) in head and neck reconstruction. Our objectives were to (1) describe the flap outcomes in this setting and (2) identify ideal clinical scenarios for its use. Methods: Retrospective review of 7 patients undergoing reconstruction with a VLFF at an academic tertiary institution between 2009 and 2013. Demographics, indications, complications, and outcomes were retrieved. Results: There were 4 males and 3 females with a mean age of 54.7 years. Indications included skull base reconstruction (n = 3/43%), scalp/calvarial defect (n = 2/28%), maxillary (n = 1), and exposed pharyngeal cervical spine hardware (n = 1). The myofascial component length ranged from 7 to 20 cm, and width ranged from 6 to 11 cm, with a mean area of 102 cm2 (range, 35-240). The mean pedicle length was 11.3 cm. Handheld (n = 3) or implantable (n = 4) Doppler was used for monitoring, and there were no flap losses. The flap was skin grafted in 3 cases with no reported graft loss. The mean intensive care unit stay was 1.1 days (0-3) and length of stay was 7.8 days (5-13). Complications included wound infection (n = 1) and myocardial infarction (n = 1) in a patient with significant comorbidities. The donor site was closed primarily in all cases, with no significant donor site morbidity reported. Conclusions: The VLFF is an underutilized option in head and neck reconstruction. This flap provides a large amount of soft tissue that can be harvested in supine position and with minimal donor site morbidity. Given its long pedicle and variable myofascial component that can be tailored to a wide range of defects, the VLFF appears ideal for skull base reconstruction.