The composite vastus medialis-patellar complex osseomuscular flap as a salvage procedure after complex trauma of the knee--an anatomical study and clinical application.
BACKGROUND
In the setting of severe perigenicular trauma or complicated endoprosthetic knee surgery, primary knee fusion may be the last resort for salvage of the limp. In this case, the patella looses its destination as an anterior knee stabilizer and can become a substantial donor of bone substance, especially if osseous defects are involved.


METHODS
12 formalin fixated cadavers were studied in terms of vascular anatomy, pedicle reliability, arc of rotation and their relation to sex, age, and height. Moreover, the operation was performed on a suitable patient.


RESULTS
The quadriceps with the vastus medialis and the patella can be raised from the tibial tuberosity up to the entrance of the osteoarticular branch of the superficial femoral artery into the vastus medialis muscle ca 16 cm (15-19 cm) from the inferior patellar pole. This distance correlated well to the overall height of the cadavers (P=0.009). The vascular prerequisites were always present. In the clinical case, there was a favorable outcome with knee fusion after 4 months, despite of the lateral condylar defect.


CONCLUSIONS
The composite vastus medialis-patellar complex osseomuscular flap can be safely used as a source of vascularized femoral condyle substitute in the setting of primary knee fusion.
Polykandriotis
E
E
Department of Plastic and Hand Surgery, University of Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany. elias.poly@chir.imed.uni-erlangen.de
Stangl
R
R
Hennig
H H
HH
Lennerz
J K M
JK
Frank
W M
WM
Loos
M D
MD
Horch
R E
RE
D001158:Arteries / Q000033:anatomy & histology; D001174:Arthrodesis / Q000379:methods; D001827:Body Height; D005260:Female; D005264:Femoral Fractures / Q000601:surgery; D005597:Fractures, Open / Q000601:surgery; D006801:Humans; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D007719:Knee Joint / Q000098:blood supply; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D010329:Patella / Q000601:surgery*; D011859:Radiography; D013524:Surgical Flaps / Q000098:blood supply