Publication:

Distally based split vastus lateralis myocutaneous flap for reconstruction of post electrical injury defects around knee joint

Background Large soft tissue defects around knee joint remains challenge to reconstructive surgeon due to limited size of local fasciocutaneous flap or muscles flaps and deeper recipient vessels for free flap. Presence of electrical injury further makes it difficult due to progressive necrosis of tissue and vessel damage. We present our experience with distally based split vastus lateralis myocutaneous flap for post electric burns large soft tissue defect over knee with open knee joint in three patients.

Methods Distally based split vastus lateralis myocutaneous flap was done in three patients for large soft tissue defects over knee secondary to electric contact burns. Two of the three patients had wound with open knee joint draining synovial fluid. All patients needed skin grafting for donor area of flap. Patients were followed up for functional outcome of knee and appearance of donor area.

Results Two out of three patients had uneventful recovery. One patient with skin paddle size 24 x 17 cm. developed necrosis of distal 2-3 cm. of skin and muscle which was managed by excision of necrosed flap with advancement. Donor area of flap was skin grafted in all three patients which healed without any complications. Postoperative knee function was normal in two patients.

Conclusions This new flap is a reliable option for extensive soft tissue defects around knee secondary to high voltage electric burns where free flap is challenging due to deeper location of recipient vessels and damage due to burn injury. Donor area in upper thigh remains hidden and is with no functional deficit.