Using the Free Vastus Lateralis Musculocutaneous or Muscle Flap for Soft Tissue Defect of Lower Extremities

Abstract

The coverage of the soft-tissue on the lower third of the leg has always been a difficult problem to tackle when the wound developed infected bone exposure. Free vastus lateralis musculocutaneous (VLMC) or vastus lateralis muscle (VLM) flap provided long pedicle, large size and infection tolerance. It is easy to harvest comparing with other free muscle flap. We had used this flap in eight patients. Of these, three were males and five females. The flap reconstruction was all used in trauma with open fracture patients. In six cases the defect was located in the distal third of lower leg, one over the heel, and one in the foot. The VLMC flap was applied in 3 cases; VLM flap with skin grafting was used in 5 cases. The size of the flap varied from 15 x 7cm to 30 x 15cm. There were four cases in the donor site with primary closure and four cases with skin grafting. An AO external fixation rod stand was applied to keep limb elevated. All flaps have survived completely. One case received emergency salvage operation due to flap congestion. No recurrence of osteomyelitis was noted. This series had demonstrated that free VLMC flap or VLM flap with skin grafting provided a reliable and easy practical modality, as well as versatility and low donor-site morbidity, for reconstruction of medium to large defects of the lower extremities.