Applications of the pedicled vastus lateralis flap for patients with complicated pressure sores.

The vastus lateralis muscle- or musculocutaneous flap is a well established tool in the surgery of pressure sores of the pelvic region. Its size, its constant large axial vascular pedicle originating from the lateral circumflex femoral artery, and its ability to carry quite a large skin island from the distal lateral region of the upper thigh makes this flap a very versatile one in the management of difficult situations. The vastus lateralis flap allows the simultaneous closure of defects in the trochanteric and sacral region, a technique which has not been described previously. A pedicled vastus lateralis flap may be the only remaining local salvage procedure for defects due to obstruction of internal and external iliac arteries and aortobifemoral bypass surgery. This is another application which has not yet been described in the medical literature. The outcome of a series of 38 vastus lateralis flaps and the complications are shown. The follow-up period ranged from 3 months to 4 years. One flap was lost. More complications were seen at the donor site than at the reconstructed defect. In patients who may be able to walk or stand at a later date, potential impairment of these functions has to be considered. In our opinion, the vastus lateralis flap is an excellent tool for managing large tissue defects in difficult situations.