The anterolateral thigh - Vastus lateralis conjoint flap for complex defects of the lower limb

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.

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.

The mean size of the skin flap was 355 cm(2) (range: 312-420 cm(2)) and the volume of the muscle flap was 210 cm(3) (range: 42-360 cm(3)). 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.

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.