Indications for the vastus lateralis flap in oral and maxillofacial surgery

Objective: To find out the applications, usefulness and advantages of the microsurgically anastomosed vastus lateralis flap. We evaluated the results of 60 consecutive oral and maxillofacial reconstructions and established typical indications for use of this flap. Design: The transplant was applied as a pure muscle flap in 17 cases, four of these being a split-skin flap for coverage of defects on the scalp. Further reconstructions were done with myocutaneous flaps for the tongue (n = 13), floor of the mouth (n = 16) and external skin defects (n = 6) as well as to close perforating defects (n = 8). Results: The long and high-calibre vascular pedicle, the unvarying anatomy, and the time-saving possibility of simultaneously resecting the tumour and raising the flap in the head and neck region proved to be particularly advantageous during flap transfer. The best results were obtained in extensive, deep, or perforating defects and in tongue reconstruction; neuromuscular connection of the transplant is possible. Pure muscle transplants have only a few indications for application in the oral cavity because of their tendency to shrink. Donor site morbidity was generally low; the flap was lost in 5 cases. Conclusion: This hitherto rarely used transplant is well-suited for maxillofacial reconstructions if the correct indications apply.