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CASE REPORT   

European Journal of Oral and Maxillofacial Surgery 2018 December;2(3):52-6

DOI: 10.23736/S2532-3466.18.00140-6

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Versatility of the vastus lateralis myocutaneous free flap for treatment of defects involving cerebro spinal fluid leak

Ignacio NAVARRO , Roser PUJOL, Honorio HERENCIA, José L. CRESPO, Edurne PALACIOS, Roberto MARTÍN

Department of Oral and Maxillofacial Surgery, Virgen de la Salud Hospital, Toledo, Spain



BACKGROUND: The objective of the present article is to highlight the usefulness and versatility of the vastus lateralis myocutaneous free flap in the treatment of scalp and skull defects involving cerebrospinal fluid (CSF) leak.
METHODS: The patient was a woman with a right temporoparietal defect of both soft tissue and bone that developed a CSF leak after surgery of an aneurysm of the posterior communicating artery and ipsilateral internal carotid artery. All previous conservative and surgical reconstructive treatment had failed. Physical examination revealed a CSF leak, active infection, and associated cutaneous necrosis. Additional testing was requested with CT and MRI. After a complete evaluation of the case, the defect was reconstructed with a vastus lateralis myocutaneous free flap.
DISCUSSION: Microsurgical flaps are an option for reconstruction of scalp and skull defects. The types of flap that can be harvested include the fasciocutaneous flap, perforator flap, and myocutaneous flap. In cases where it is necessary to provide considerable soft tissue volume and seal large dead spaces and in cases of active infection, flaps including a large muscular component (myocutaneous) are a valid alternative.
CONCLUSIONS: The vastus lateralis myocutaneous free flap fulfills the conditions for reconstruction of scalp and skull defects. In our opinion, the harvesting technique, constant anatomy, soft tissue volume, low morbidity associated, and long vascular pedicle make this flap very versatile. However, it is underused.


KEY WORDS: Cerebrospinal fluid leak - Quadriceps muscle - Scalp - Reconstructive surgical procedures

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