title: Reconstruction of complex soft-tissue defects around the knee joint with distally based split vastus lateralis musculocutaneous flap: a new technique.
abstract: OBJECTIVE
  The aim of this study was to report our experience of using distally based spilt vastus lateralis musculocutaneous flaps for soft-tissue defects around the knee joint - a new technique.
  
  
  METHODS
  Cadaver dissection studies were conducted in three cadavers to demonstrate perforators entering the lower third of the vastus lateralis muscle arising from the superior lateral genicular artery. Its application in eight clinical cases for the reconstruction of soft-tissue defects around the knee joint is reported.
  
  
  RESULTS
  Seven out of eight flaps survived well without any flap loss. One flap with a skin island measuring 12 × 20 cm suffered a loss of 2 cm distally. This was later treated with skin grafting. Six out of eight donor sites were closed primarily. Six patients achieved full functional range of motion by 3 months. One patient had a 10° limitation of knee extension. One patient had foot drop due to primary injury and walks with a limping gait.
  
  
  CONCLUSIONS
  This flap is a new reconstructive option for knee defects. It can reach distally up to the tibial tuberosity and does not require an intraoperative change of position. The donor site can be closed primarily and is hidden inside the clothing. The function of the knee is not affected as the majority of the muscle is kept in continuity.
authors.affiliation: Department of Plastic Surgery, B. J. Medical College and Sassoon Hospitals, Pune, Maharashtra, India. Electronic address: drparags@gmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Sahasrabudhe
authors.affiliation: Department of Plastic Surgery, B. J. Medical College and Sassoon Hospitals, Pune, Maharashtra, India.
authors.forename: N
authors.initials: N
authors.lastname: Panse
authors.affiliation: Department of Plastic Surgery, B. J. Medical College and Sassoon Hospitals, Pune, Maharashtra, India.
authors.forename: B
authors.initials: B
authors.lastname: Baheti
authors.affiliation: Department of Plastic Surgery, B. J. Medical College and Sassoon Hospitals, Pune, Maharashtra, India.
authors.forename: A
authors.initials: A
authors.lastname: Jadhav
authors.affiliation: Department of Plastic Surgery, B. J. Medical College and Sassoon Hospitals, Pune, Maharashtra, India.
authors.forename: N
authors.initials: N
authors.lastname: Joshi
authors.affiliation: Department of Plastic Surgery, B. J. Medical College and Sassoon Hospitals, Pune, Maharashtra, India.
authors.forename: A
authors.initials: A
authors.lastname: Chandanwale
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007194:India; D015601:Injury Severity Score; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000098:blood supply / Q000637:transplantation*; D052097:Quadriceps Muscle / Q000601:surgery / Q000637:transplantation*; D012189:Retrospective Studies; D018570:Risk Assessment; D012867:Skin / Q000293:injuries*; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
keywords: Distally based flap; Periarticular knee defects; Superior lateral genicular artery perforators; Vastus lateralis musculocutaneous flap