title: The vastus lateralis free flap for lower extremity gustilo grade III reconstruction.
abstract: BACKGROUND
  Orthopedic trauma patients with Gustilo grade III injuries to the distal third of lower extremity present challenges to optimum reconstructive management. There is no consensus on the ideal autologous tissue for transfer in large lower extremity defect reconstruction. We present a large case series utilizing the vastus lateralis (VL) free flap for lower extremity Gustilo grade III reconstruction.
  
  
  METHODS
  This is a case series of patients who underwent VL free tissue transfer for Gustilo grade III injuries. A total of 38 free tissue transfers were performed for lower extremity reconstruction, 19 of which were VL flaps. Mean interval between injury and reconstruction was 46 days (range 7-240 days).
  
  
  RESULTS
  The mean wound size was 11.37 cm x 11.42 cm and all cases underwent delayed reconstruction. Seven day flap viability was 100% and 30-day flap viability was 17/19 (89%). There were six complications: two hematomas requiring drainage, one flap dehiscence, one distal flap loss requiring a reverse saphenous vein graft extension, and two complete flap losses. Of the two failed flaps, one was attributed to heparin-induced thrombocytopenia and the other to venous congestion complicated by methicillin-resistant Staphylococcus aureus infection.
  
  
  CONCLUSIONS
  The VL free flap is a reliable and versatile flap that can be tailored and tangentially thinned to match the shape and size of a defect, and the long pedicle allows the surgeon to stay away from the zone of injury. This flap should be strongly considered for lower extremity reconstruction, especially in salvage operations for large defects. © 2015 Wiley Periodicals, Inc. Microsurgery 37:212-217, 2017.
authors.affiliation: Department of Surgery, Inova Fairfax, Falls Church, VA.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Kaminsky
authors.affiliation: School of Medicine, Virginia Commonwealth University, Richmond, VA.
authors.forename: Sean S
authors.initials: SS
authors.lastname: Li
authors.affiliation: Department of Surgery, Inova Fairfax, Falls Church, VA.
authors.forename: Libby R
authors.initials: LR
authors.lastname: Copeland-Halperin
authors.affiliation: Private Practice, Plastic Surgery & Dermatology Associates, Fairfax, VA.
authors.forename: Reza
authors.initials: R
authors.lastname: Miraliakbari
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply / Q000637:transplantation*; D006085:Graft Survival; D006801:Humans; D015601:Injury Severity Score; D007869:Leg Injuries / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D052097:Quadriceps Muscle / Q000601:surgery / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D018570:Risk Assessment; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult