The free vastus lateralis muscle flap. A smart less used flap for soft tissue reconstruction of the weight-bearing foot. (December 2020)

• Record Type: Journal Article
• Authors: Jiga, Lucian P.; Jandali, Zaher; Merwart, Benedikt; Skibinska, Katarzyna
• Is Part Of: Injury. Volume 51(2020)Supplement 4
• Page Start: S34
• Page End: S40
• Publication Date: 2020-12
• Subjects: Vastus lateralis -- Muscle flap -- Free -- Soft tissue reconstruction -- Foot; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2020.03.019
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: The vastus lateralis free muscle flap as smart alternative for coverage of weight-bearing foot. Skin-grafted muscle free flap for reconstruction of the weight-bearing foot using free muscle flaps. Low donor-side morbidity after compartmental harvesting of the distal component of the vastus lateralis flap. Abstract: Background: The lateral circumflex femoral artery one of the most favoured donor-site for a wide array of free flaps including either cutaneous, fascial and muscle components or a combination thereof. Here, we provide evidence on the safe use of the free vastus lateralis muscle flap and its feasibility for optimal soft tissue coverage of the weight-bearing foot. Methods: Eighteen consecutive patients with soft tissue defects of the heel ( n = 3, 16.6%) and plantar aspect of the mid- and forefoot ( n = 15, 83.3%) of either post traumatic ( n = 10), diabetic ( n = 6) or ischemic ( n = 2) etiology, received nineteen free vastus lateralis muscle free flaps covered with split-thickness skin grafts. The postoperative results in terms of wound healing, weight-bearing function, patient satisfaction were evaluated. In patients with chronic conditions ( n = 8) the AOFAS (American Orthopaedic Foot and Ankle Society) scoring system was used preoperatively and 6 months postoperatively for evaluation of reconstruction outcomes. Results: All flaps survived. Their complete anatomical integration allowed regaining normal walking in all patients. In five patients, partial loss of the skin graft which either healed spontaneously or necessitated a redo skin grafting was noted. One patient developed a late flap-skin interface ulcer, which was solved by primary excision and direct closure. Compared with the preoperative values, the mean AOFAS score in the evaluated patients ( n = 8) improved significantly (34.13 vs. 77.63, p < 0.001). Conclusion: The skin-grafted free vastus lateralis muscle flap can safely be used as a "smart" tool for coverage of weight-bearing foot providing optimal cushioning and functional results without fearing donor-side morbidity.