The vastus lateralis free flap has been previously described, but little has been written recently regarding use of this flap. A series of cases is presented describing the vastus lateralis free flap in extremity reconstruction.

Twelve patients with extremity defects were operated on by a single surgeon over a two year period. Half the patients were men and half were women and the ages ranged from 30 to 68. Eleven of the defects involved the lower extremeties: there were three soft tissue defects following infection in diabetics, three cases of osteomyelitis, one sarcoma resection, one case of exposed orthopedic hardware, and one acute post-traumatic soft tissue loss. One additional case involved a post-traumatic upper extremity radius nonunion and soft tissue defect. All flaps were skin grafted and all flaps survived. One flap to the heel dehisced post-operatively and required a secondary procedure to re-inset it. No cases required debulking. All donor sites healed uneventfully with no hematomas, infection, or secondary thigh weakness or knee instability. Three patients complained of scar widening and some lateral thigh numbness.

The vastus lateralis muscle has fairly constant anatomy and is easily raised. When used for the lower extremity, the proximity of the donor site and recipient site faciltates the reconstruction and allows for most of the patient to be covered to maintain body temperature. The vascular pedicle is long and vessel diameter quite large, further facilitating its use as a free flap. The muscle can be harvested segmentally, leaving residual muscle behind to minimize donor weakness. Finally, the muscle is an excellent fall-back option when harvesting the anterolateral thigh flap as a perforator flap. If the perforator to the overlying skin is too small or damaged during the dissection, the vastus lateralis can be used instead.