Vastus Lateralis Myocutaneous Flap Research Articles

Salvage treatment of acute respiratory failure after autogenous tissue flap transplantation for chronic empyema with chest wall sinus: a case report and literature review

BackgroundChronic empyema with chest wall sinus is a difficult and complex disease caused by multiple causative factors. It is difficult to control local infection due to its possible combination of bronchopleural fistula (BPF) and residual bone.The relevant literature emphasizes some risk factors for empyema progression after pneumonectomy, while the correlation between empyema and BPF after pneumonectomy increases mortality by infecting the remaining lungs. After pneumonectomy, the lung function of the contralateral side is particularly important.Case presentationThis paper reports a 62-year-old male patient who underwent right pneumonectomy for squamous cell carcinoma of the lung 12 years ago and began to develop empyema with anterior chest wall sinus 3 years ago. After admission, chest computed tomography (CT) showed right pleural effusion and formation of chest wall sinus. According to his clinical symptoms and imaging examination, he was diagnosed as chronic empyema with chest wall sinus.Due to the huge residual cavity of the patient,the clinical effect of using free vastus lateralis myocutaneous flap combined with pedicled pectoralis major muscle flap to fill the abscess cavity was satisfactory,but acute respiratory failure occurred due to left lung aspiration pneumonia after operation.ConclusionsAfter a series of treatment measures such as tracheal cannula, tracheotomy, anti-infection, maintenance of circulatory stability, and rehabilitation training, the patient was ultimately rescued and cured. Postoperative follow-up showed that the muscle flaps survived and empyema was eliminated.

Preliminary experience of autologous free myocutaneous flap combined with free dermal graft in the treatment of refractory empyema with bronchopleural fistula

ObjectivesTo explore the effects of autologous free dermal graft combined with free myocutaneous flap on bronchopleural fistula (BPF) with empyema, we summarized and analyzed two cases. MethodsTwo patients with refractory empyema and BPF were treated with autologous free dermal graft combined with free myocutaneous flap. The treatment included debridement of empyema, rib resection drainage, repair of bronchopleural fistula, and free vastus lateralis myocutaneous flap transplantation to eliminate the empyema. After the free dermal graft was harvested from the healthy skin around the incision, it was inserted into the fistula and sutured with the surrounding pleural tissue. The keys to the operation lies in the anastomosis of the lateral circumflex femoral artery (LCFA), vein and nerve that supply the vastus lateralis muscle flap to the thoracodorsal vessels and nerves. After surgery, the empyema, air leakage, and the survival of the myocutaneous flap were observed. ResultsThere was no disease recurrence after follow-up for seven and six months, respectively. Re-examination of the chest computed tomography (CT) or magnetic resonance imaging (MRI) indicated that the abscess cavity had disappeared. No necrosis of the myocutaneous flap was observed after surgery. ConclusionThe application of autologous free dermal graft combined with free vastus lateralis myocutaneous flap transplantation is effective in the treatment of patients with bronchopleural fistula with refractory chronic empyema, and the clinical effect is satisfactory.

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

Adequate coverage of the soft tissue defects from wide resection of sacropelvic malignancies remains challenging. The vastus lateralis flap has been described for coverage in the setting of trauma and infection. This flap has not been described for coverage of sacropelvic tumor defects. This is a retrospective cohort study of adult patients who underwent wide resection of a primary sacropelvic malignancy with reconstruction employing a pedicled vastus lateralis flap at two tertiary care centers. Patient demographics, tumor staging, and rate of complications were assessed. Twenty-eight patients were included, with a median age of 51 years. The most common primary tumor was chondrosarcoma followed by chondroblastic osteosarcoma. The median follow-up was 1.1 years. There were 10 cases of wound infection requiring re-operation and three cases of flap failure. We describe a pedicled vastus lateralis flap for coverage of defects after wide resection of sacropelvic malignancies. A large proportion of our cohort had independent risk factors for wound complications. Even with a cohort with high baseline risk for wound complications, we show that the use of a pedicled vastus lateralis flap is a safe reconstructive option with a wound complication rate in line with the literature.

The role of vein grafts in reconstructive head and neck microsurgery

ObjectiveFree tissue transfer is widely used for head and neck reconstruction. In certain circumstances, vein grafting is required to elongate free flap pedicles to connect them to appropriate recipient vessels. Because of controversy regarding the use of interposition vein grafts in free tissue reconstruction, this paper reports vein graft indications, techniques, safety, and outcomes for head and neck microvascular surgery. MethodsTwenty-six patients (23 men and 3 women) who underwent interposition vein grafting concurrent with free tissue transfer were included in this study. The most common reason for head and neck reconstruction with vein graft was tumor recurrence, followed by flap salvage. The interposition vein grafts were applied in two manners as temporary arteriovenous (A–V) loop and conduit to extend the length of the free flap for venous drainage. ResultsThe most common reconstructions were anterolateral thigh flaps (15 cases), followed by vastus lateralis myocutaneous (3 cases) and radial forearm (2 cases) flaps. The common recipient vessels were superior thyroid artery, superficial temporal artery and external jugular vein. The free flap loss rate was 7.7% with vein grafts and 4.9 without vein grafts (p = 0.380). The free flap complication rate was 50.0% and 16.8% in patients with and without vein grafts, respectively (p < 0.001). Radiation therapy, chemotherapy, prior neck dissection, and prior free flap transfer were more common in the vein graft group (all p < 0.001). The hospital stay was significantly longer for the vein graft group than for the non–vein graft group (29.5 vs. 19.0 days; p = 0.001). ConclusionOverall free flap survival rates of 92.3% and 95.1% in the vein and non-vein graft groups, respectively – indicating the reliability of the vein grafts in challenging head and neck reconstructions, particularly in salvage cases and patients with multiple reconstructions. Level of evidenceLevel 3.

Evaluation of alloplastic mandibular reconstruction combined with a radial forearm flap compared with a vastus lateralis myocutaneous flap as the first approach to two-stage rehabilitation in advanced oral cancer

After continuity resection of the mandible, reconstruction of continuity with a reconstruction plate and soft tissue can be an alternative to immediate osseous reconstruction in patients with advanced oral cancer. We evaluated exposure of the plate in such reconstructions by comparing the results of a radial forearm flap (RFF) with a vastus lateralis myocutaneous flap (VLMF). We also analysed the resection margins and the incidence of secondary osseous reconstructions after one year free from relapse. We retrospectively examined all 48 mandibular reconstructions in which a reconstruction plate and RFF or VLMF had been used between 2007 and 2016. Exposure rates of plates were assessed and local (size and site of resection) and systemic risk factors (age, sex, treatment with radiation, and smoking) evaluated. Reconstruction plates, together with a RFF, were significantly more likely to be exposed than those with a VLMF (p = 0.01). There was significantly more exposure in the RFF group in mandibular defects larger than 6 cm, in contrast to the VLMF group (p = 0.002). Younger age (p < 0.001), lower body mass index (BMI) (p = 0.05) and smoking (p = 0.011) led to more exposure. In seven cases a second operation was necessary due to macroscopically invaded or close margins. Thirty-one patients had no bony reconstruction because of local recurrence, distant metastases, inadequate resection margins, poor general condition, or a second (different) tumour. Exposure of the plate after mandibular reconstruction happens less often with the VLM flap than with the RFF. The two-step approach can be an option in the treatment of advanced oral cancer.

Versatility of the vastus lateralis myocutaneous free flap for treatment of defects involving cerebro spinal fluid leak

Versatility of the vastus lateralis myocutaneous free flap for treatment of defects involving cerebro spinal fluid leak

Combined free flaps with arteriovenous loops for reconstruction of extensive thoracic defects after sternal osteomyelitis.

Various local flaps have been described for patients suffering from sternal osteomyelitis and are regarded as a standard procedure for defect reconstruction. In contrast, the use of microsurgical free flaps has been reported anecdotally only. We present our experiences with the combination of an arteriovenous loop and a free flap transfer in defects larger than half of the sternum. Between January 2012 and October 2014, eight patients with a mean age of 68 years who suffered from extensive deep sternal osteomyelitis were operated in a consecutive series. After radical surgical debridement, the defect size comprised all three thirds of the sternum. Defect reconstruction was achieved by means of free flap transplantation using the vastus lateralis myocutaneous flap, rectus abdominis, and bipedicled latissimus dorsi/parascapular flap. As local recipient vessels were depleted in all patients, the pedicle of the flap was anastomosed to a high-flow and short-length subclavian arteriovenous loop as recipient vessel in all cases. The immediate postoperative course in all patients was uneventful despite one axonal injury to the femoral nerve at the donor site. There was no partial or total flap loss. During a mean follow-up of 9 months, one patient suffered from a local infection at the donor site. In all patients, a successful defect reconstruction could be achieved. Depletion of local recipient vessels as an obstacle for free flap reconstruction can be overcome by creating an arteriovenous loop. Even extensive defects are adequate for defect reconstruction using a single or, in extreme cases, bipedicled free flap.

Algorithmic approach to lower abdominal, perineal, and groin reconstruction using anterolateral thigh flaps.

Lower abdominal, perineal, and groin (LAPG) reconstruction may be performed in a single stage. Anterolateral thigh (ALT) flaps are preferred here and taken as fasciocutaneous (ALT-FC), myocutaneous (ALT-MC), or vastus lateralis myocutaneous (VL-MC) flaps. We aim to present the results of reconstruction from a series of patients and guide flap selection with an algorithmic approach to LAPG reconstruction that optimizes outcomes and minimizes morbidity. Lower abdomen, groin, perineum, vulva, vagina, scrotum, and bladder wounds reconstructed in 22 patients using ALT flaps between 2000 and 2013 were retrospectively studied. Five ALT-FC, eight ALT-MC, and nine VL-MC flaps were performed. All flaps survived. Venous congestion occurred in three VL-MC flaps from mechanical cause. Wound infection occurred in six cases. Urinary leak occurred in three cases of bladder reconstruction. One patient died from congestive heart failure. The ALT flap is time tested and dependably addresses most LAPG defects; flap variations are suited for niche defects. We propose a novel algorithm to guide reconstructive decision-making.

Expanding the Applications of the Pedicled Anterolateral Thigh and Vastus Lateralis Myocutaneous Flaps

We describe our experience in expanding the use of pedicled anterolateral thigh and vastus lateralis myocutaneous flaps. A total of 33 patients underwent 34 flaps between March 2003 and January 2012. The defects included 18 ischial, 3 trochanteric, 5 lower abdomen, 2 perineogenital, 1 groin, and 5 knee defects. There were 29 proximal pedicled (2 of which were preexpanded), 3 distal pedicled, and 2 propeller flaps. Complications included 1 total necrosis, 1 partial necrosis, 3 wound dehiscence in recipient site, 1 hematoma, and 1 donor-site dehiscence. The total flap survival rate was 94%. There were no donor-site morbidities except poor cosmesis in the skin-grafted sites. Pedicled anterolateral thigh flap is highly versatile with a wide arc of rotation. A proximal pedicled flap can be used for lower abdomen, perineogenital, ischial, and trochanteric defects and the distal pedicled or a propeller flap for knee and proximal lower leg defects.

Lower Extremity Reconstruction Using Vastus Lateralis Myocutaneous Flap versus Anterolateral Thigh Fasciocutaneous Flap

BackgroundThe anterolateral thigh (ALT) perforator flap has become a popular option for treating soft tissue defects of lower extremity reconstruction and can be combined with a segment of the vastus lateralis muscle. We present a comparison of the use of the ALT fasciocutaneous (ALT-FC) and myocutaneous flaps.MethodsWe retrospectively reviewed patients in whom free-tissue transfer was performed between 2005 and 2011 for the reconstruction of lower extremity soft-tissue defects. Twenty-four patients were divided into two groups: reconstruction using an ALT-FC flap (12 cases) and reconstruction using a vastus lateralis myocutaneous (VL-MC) flap (12 cases). Postoperative complications, functional results, cosmetic results, and donor-site morbidities were studied.ResultsComplete flap survival was 100% in both groups. A flap complication was noted in one case (marginal dehiscence) of the ALT-FC group, and no complications were noted in the VL-MC group. In both groups, one case of partial skin graft loss occurred at the donor site, and debulking surgeries were needed for two cases. There were no significant differences in the mean scores for either functional or cosmetic outcomes in either group.ConclusionsThe VL-MC flap is able to fill occasional dead space and has comparable survival rates to ALT-FC with minimal donor-site morbidity. Additionally, the VL-MC flap is easily elevated without myocutaneous perforator injury.

One-Stage Posttraumatic Bladder Reconstruction and Soft-Tissue Coverage of the Lower Abdomen or Perineum

Mutilating injury on pelvis may be complicated by urinary bladder ruptures and soft-tissue avulsion of the lower abdominal wall or perineum. With retraction of the avulsed abdominal wall or perineum, as well as bladder tissue loss secondary to trauma or infection, direct closure the injured bladder often leads to excessive tension, resulting in ischemia and eventual failure of repair. The authors successfully managed 4 patients with such injuries using the pedicled vastus lateralis myocutaneous flap. No major complications occurred and intact bladders were confirmed with cystograms. Three (75%) of them were able to void normally within 1 year. It is concluded that the pedicled vastus lateralis myocutaneous flap is an ideal option for posttraumatic bladder reconstruction and soft-tissue coverage of the lower abdomen or perineum; whereas the undersurface of the muscle serves as a substitute for the missing bladder wall, the remaining part of the muscle, as well as the subcutaneous fat, provide sufficient bulk for dead space obliteration.

A new technique of transferring island pedicled anterolateral thigh and vastus lateralis myocutaneous flaps for reconstruction of recurrent ischial pressure sores

We describe island pedicled anterolateral thigh and vastus lateralis myocutaneous flaps for reconstruction of the difficult, recurrent ischial pressure sore. Rather than transfer through a subcutaneous tunnel, the flap is transferred directly through the upper thigh to the ischial defect. A total of 15 patients with 16 recurrent ischial pressure sores were treated between May 2003 and April 2005. Eleven sores were treated with pedicled island anterolateral thigh flaps and five sores with vastus lateralis myocutaneous flaps. There was no difficulty in transferring the flap to reach the ischial defect in any patient. The length of the pedicle ranged from 8.5 to 14 cm. All donor sites were closed primarily. Fifteen of the 16 flaps survived completely. Total necrosis occurred in one vastus lateralis myocutaneous flap, which was located at the distal third of the thigh. We conclude this flap can be added to the repertoire for the treatment of recurrent, difficult ischial pressure sores.

Vastus lateralis myocutaneous flap for reconstruction of defects around the groin and pelvis

We present our experience using the vastus lateralis myocutaneous flap for the repair of defects around the groin and pelvis. It is a relatively new technique, with many advantages over other flaps used in this area, though it has limitations. The history, anatomy and surgical technique of raising the flap are described and clinical cases are discussed. The importance of patient selection is highlighted.

Free Vastus Lateralis Myocutaneous (VLMC) Flap for Reconstruction of Radionecrotic Defect of the Head and Neck

Radionecrosis is a common complication in head and neck cancer patients who received post-operative radiotherapy. It is a difficult problem not only poor head and neck appearance and care but also the risk of vessels rupture and mortality. Skin grafts, local skin, or mucosal flaps that might be perfectly adequate in a non-irradiated patient are unlikely to resolve the problem in a wound that has been previously irradiated or is to undergo adjuvant radiotherapy. From Oct. 2001 to Sep. 2002, eleven patients suffered from radionecrosis after post-operative radiotherapy were included. We used free vastus lateralis myocutaneous flaps in the huge radionecrotic defects of head and neck and got a good result. Two patients with post-operative wound infection healed after debridement and wound dressing. VLMC flap not only can provide enough skin territory to cover the huge wound and defect, but also has the ability to resist wound infection. We commend VLMC flap to reconstruct the radionecrotic defect of head and neck.

Anterolateral Thigh Vastus Lateralis Myocutaneous Flap for Vulvar Reconstruction after Radical Vulvectomy: A Preliminary Experience

Background. There are many myocutaneous flap methods which have been reported for the immediate reconstruction of large vulvar defects created by deforming radical cancer surgery in the female perineum except for the anterolateral thigh vastus lateralis myocutaneous flap. The present report describes our preliminary experience with the use of this flap in a patient who underwent radical vulvectomy for locally advanced squamous cell carcinoma of the vulva.Case. A 75-year-old woman underwent radical vulvectomy with bilateral inguinal lymphadenectomy due to right vulvar squamous cell carcinoma. The large vulvar defect was immediately reconstructed by using anterolateral thigh vastus lateralis myocutaneous flap. The postoperative course was uneventful. In addition to the expected primary healing, the neovulva had a relatively normal appearance with satisfactory sensation and function and the donor defect was found to be minimal both functionally and aesthetically.Conclusion. This technique can be used as an alternative method for vulvar reconstruction after radical vulvectomy. Further studies are warranted to prove the efficacy of this myocutaneous flap in reconstructing large vulvar defects.

Vastus lateralis myocutaneous flap for reconstruction of defects around the groin and pelvis

Vastus lateralis myocutaneous flap for reconstruction of defects around the groin and pelvis