The proximal vastus lateralis flap: An anatomical and radiological study

Abstract

Soft-tissue reconstruction following acetabular or proximal femur resection for bone tumors is challenging. The vastus lateralis flap has been proposed as an advancement or rotational flap to cover soft-tissue defects for such locoregional indications. We performed an anatomical and a radiological study to assess the vascularization of the proximal vastus lateralis muscle achieved through the transverse branch of the lateral circumflex femoral artery in order to decrease the morbidity of the classical flap retrieval technique. Five fresh adult cadavers were dissected bilaterally. Each vastus lateralis dissection was prealably injected with contrast-media agent through the lateral circumflex artery and CT scan images was recorded. A descriptive and an analytical study were carried out. The median length and width of the entire muscle were 31.2cm (Q1-Q3: 29.7-33.3) and 12.7cm (Q1-Q3: 7.0-14.9), respectively; the median surface area of the entire vastus lateralis muscle was 282cm2 (Q1-Q3: 172.6-455.6) cm2. The median length and width of the perfused area were 13.3cm (Q1-Q3: 12.3-16.6) and 9.4cm (Q1-Q3: 6.9-8.8) cm, respectively; the median surface of the perfused area was 89.4cm2 (Q1-Q3: 67.4-110.5) cm2. The mean length of the pedicle measured on the CT scan was 6.3cm (95% CI: 5.5-7.1). The proximal vastus lateralis flap as a pedicled muscular flap supplied by the transverse branch of the lateral circumflex femoral artery is a muscular flap that can be used by reconstructive and orthopaedic surgeons to repair soft-tissue defects around the hip joint without undue damage to the functional apparatus of the knee.