Use of the Vastus Lateralis Muscle Flap With a Grooving Procedure in the Surgical Treatment of Chronic Osteomyelitis of the Femur

Abstract

Severe femoral fractures may be associated with devascularization of cortical bone, soft-tissue loss, and significant morbidity. After surgical treatment of these femoral fractures, chronic infection may ensue and requires additional reconstructive procedures. Local muscle flap coverage is used to treat chronic osteomyelitis. A new procedure-the vastus lateralis muscle flap with grooving of the femoral shaft-was used for the treatment of chronic osteomyelitis of the femoral shaft. The authors present 6 patients with chronic osteomyelitis of the femur who were treated with a vastus lateralis muscle flap. Five of the patients were male and the other was female. The average age of the patients was 33.8 years (range, 17-54 years). All patients experienced infection during the early postoperative period. Drainage of abscess, debridement, sequestrectomy repair of fistula, and mini fenestration were performed at least 3 times, and antibiotics were administered several times. During the operations, tissue samples were evaluated for bacterial cultivation. Staphylococcus aureus was seen in 4 patients, S. epidermidis in 1 patient, and Pseudomonas aeruginosa in the remaining patient. A vastus lateralis muscle flap with grooving of the infected femoral shaft is presented. The authors have not encountered a recurrence of infection during a minimum 3.9 years of follow-up. They think this technique is an alternative to the current techniques for the surgical treatment of chronic osteomyelitis of the femur.

Diagnosis and treatment of pediatric chronic osteomyelitis in developing countries: prospective study of 96 patients treated in Kenya

“…Antibiotic therapy alone is not sufficient because of its poor kinetics in bone with sequestration and fistulas. In the literature, different operative techniques have been described, from simple surgical cleansing of necrotic areas to radical excision of focuses with microvascular flap reconstruction, to Papineau technique, to continuous bone washing after sequestrectomy, with or without antibiotic, to bone resection using Ilizarov devices, to Lautenbach method, and to Belfast technique in two sessions [14][15][16][17][18][19]. Scientific publications on chronic osteomyelitis in developing countries are very few and even fewer are literature studies conducted in children [2,12,13,16,17].…”

Pedicled vastus lateralis myocutaneous flap for sacropelvic defects after wide oncologic resection: Wound complications and outcomes

“…Vastus lateralis flaps have been employed as free flaps for craniofacial as well as head and neck reconstruction 47–50 . Modified vastus lateralis flaps have also been used for coverage of defects after chronic femur osteomyelitis, complex hip infections, necrotizing fasciitis, and chronic wounds 13,14,16,17,51–54 …”

“…[47][48][49][50] Modified vastus lateralis flaps have also been used for coverage of defects after chronic femur osteomyelitis, complex hip infections, necrotizing fasciitis, and chronic wounds. 13,14,16,17,[51][52][53][54] To our knowledge, a pedicled vastus lateralis myocutaneous flap has not been described for coverage of defects after resection of sacropelvic tumors. Observing that the use of gastrocnemius flaps for coverage of proximal tibia and distal femur defects after sarcoma resection about the knee has led to decreased wound complications, we hypothesized that a pedicled vastus lateralis flap can serve as an analog for sacropelvic and proximal femur tumors.…”

Inferiorly based thigh flap for reconstruction of defects around the knee joint

“…The vastus lateralis is too bulky giving unacceptable appearance and donor site problem. [11] The gastrocnemius flap is one of the good alternatives, but the low volume of the distal part of the muscle is a disadvantage, which is incapable of providing good coverage in large defect in suprapatellar region. [212] The sural artery flap can also be used due to its thin and pliable nature, but its size is limited.…”