Summary
Introduction
Complex and extensive lower limb defects remain difficult reconstructive problems.
Conventional flaps may not be large enough or lack the versatility that allows precise
tissue positioning to optimally cover the wound. The anterolateral thigh–vastus lateralis
conjoint flap provides a superior reconstructive solution for these difficult wounds.
Methods and materials
From Jan 2010 to June 2011, seven patients were reconstructed with the anterolateral
thigh–vastus lateralis conjoint flap. Three cases were traumatic degloving injury
of the lower limb, three were open fractures of the tibia with extensive soft-tissue
loss and one was a large soft-tissue defect as a result of necrotising fasciitis.
The skin island and muscle component were raised with independent pedicles to allow
complete freedom in the inset of each flap based on a common pedicle. The descending
and oblique branches of the lateral circumflex femoral artery were used as the pedicle
of the conjoint flap in four and three cases, respectively.
Results
The mean size of the skin flap was 355 cm2 (range: 312–420 cm2) and the volume of the muscle flap was 210 cm3 (range: 42–360 cm3). All flaps survived completely and no infective complications were noted in our
patients. The skin and muscle component were widely separated to expand the area of
coverage. In cases where specific areas of the wound were severely traumatised with
significant tissue loss, the muscle component can be precisely positioned to obliterate
the dead space and to optimise soft-tissue coverage of the wound.
Conclusion
The anterolateral thigh–vastus lateralis conjoint flap is superior to conventional
flaps available for coverage of extensive defects of the lower limb. It can cover
far greater area as well as providing the versatility needed to optimise soft-tissue
coverage.
Keywords
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Article info
Publication history
Published online: September 22, 2011
Accepted:
August 21,
2011
Received:
August 8,
2011
Identification
Copyright
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
