title: Segmental anatomy of the vastus lateralis: guidelines for muscle-sparing flap harvest.
abstract: BACKGROUND
  The vastus lateralis muscle is a versatile donor site for pedicled and free flaps that, despite great potential, remains unpopular. Although the muscle is classically described as a single belly, evidence exists for a more complex morphology. The aim of this study was to investigate the segmental anatomy of the vastus lateralis muscle and the feasibility of selective flap harvest.
  
  
  METHODS
  Ten cadaveric lower limbs were investigated. Muscular partitions were identified according to morphologic architecture, vascular supply, and nerve supply; guidelines for selective flap harvest were described. Twenty-three segmental vastus lateralis (n = 14) or chimeric anterolateral thigh-vastus lateralis flaps (n = 9) were raised based on neurovascular segmental supply, and used as noninnervated free flaps for reconstruction of moderate and large defects of the head and neck, trunk, or lower limbs. Intraoperative electrostimulation was used to confirm segmental innervation. Lower limb function was evaluated through the Lower Extremity Functional Scale.
  
  
  RESULTS
  The authors clearly identified three anatomical partitions, which receive a constant segmental neurovascular supply, and two aponeuroses. The authors successfully applied the proposed guidelines for flap harvesting to all 23 patients. Intraoperative electrostimulation confirmed functional integrity of both the flap and the spared partitions. All muscle flaps survived. Donor-site morbidity was negligible, with comparable mean preoperative and postoperative Lower Extremity Functional Scale values (67.7 versus 67.4; p > 0.05).
  
  
  CONCLUSIONS
  This study provides detailed knowledge on the morphologic and neurovascular anatomy of the vastus lateralis muscle, which supports the authors' guidelines for selective flap harvesting. The technique described is safe and minimizes surgical damage.
authors.affiliation: Palermo, Italy; and Innsbruck, Austria From the Plastic and Reconstructive Surgery, Department of Surgical, Oncological, and Oral Sciences, University of Palermo; and the Division of Clinical and Functional Anatomy, Innsbruck Medical University.
authors.forename: Francesca
authors.initials: F
authors.lastname: Toia
authors.forename: Salvatore
authors.initials: S
authors.lastname: D'Arpa
authors.forename: Erich
authors.initials: E
authors.lastname: Brenner
authors.forename: Carlo
authors.initials: C
authors.lastname: Melloni
authors.forename: Francesco
authors.initials: F
authors.lastname: Moschella
authors.forename: Adriana
authors.initials: A
authors.lastname: Cordova
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D005240:Feasibility Studies; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods*; D017410:Practice Guidelines as Topic; D052097:Quadriceps Muscle / Q000033:anatomy & histology* / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000379:methods*