The free vastus lateralis muscle flap for soft tissue reconstruction of weight bearing foot

Abstract

Aim of the study To select appropriate treatment for soft tissue coverage of weight bearing foot after lawnmower caused injury to the heel area with large soft tissue and skin defect. Case description 8 year old patient experienced lawnmover injury to the left weight bearing foot. 8x10x6cm skin and soft tissue defect appeared on heel and Achilles tendon covering area. X rays showed small fragmentary fractures of dorsal calcaneus. Achilles tendon was not injured. Thorough debridement was performed, calcaneal fragments removed, wound was sutured on primary surgery. Antibacteric treatment with Ampicillin/Sulbactam 1000/500mg 4 times a day was prescribed for 3 weeks. After 5-6 days necrosis of skin flap appeared. Necrectomy was performed and vacuum sealing drainage therapy (Smith & Nephew, Inc. MI) used. Granulation tissue growed for 2 weeks. Afterward, a 8x8x4cm free vastus lateralis muscular flap was harvested from the right thigh and was transferred to fill defect and to reconstruct the heel. The arterial vessels from the graft were directed to the left ankle region via a direct incision and were separately and microvascularly anastomosed to the posterior tibial artery. Also 2 anastomosis of accompanying veins were made. Split-thickness skin graft from the anterior left thigh area was taken, auto dermoplasty of left heel area was made directly on the vastus lateralis muscular flap. Conclusions Patient postoperative course was uneventful. He was discharged at postoperative day 10. Weight bearing on affected foot started after 6 weeks. In 3 months post operative observation no recurrence of necrosis, fistulas or pain was evident.