Versatility of Vastus Lateralis muscle flap for groin and pelvic wound: An Updated Anatomical Description and Clinical Applications

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Siska, Nicole Gherlone, Ray Fodor, Dylan Suriadinata, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7114201/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Nov, 2025 Read the published version in European Journal of Plastic Surgery → Version 1 posted 9 You are reading this latest preprint version Abstract Purpose: To evaluate the use of the vastus lateralis (VL) muscle flap for groin and pelvic wound coverage, particularly in cases involving complex vascular exposure or high risk of contamination. Cadaveric dissection and two clinical cases were analyzed to assess the utility of the VL muscle flap. Methods: Bilateral dissections were performed on five fresh cadavers to measure anatomical parameters of the VL and rectus femoris muscles, focusing on technical aspects for the flap dissection, muscle length, vascular supply, and flap dimensions. Two case examples are then presented in patients who underwent reconstructive procedures using the VL flap: one for coverage following femoral bypass and another for a pelvic defect after ligation of the external iliac artery. Results: Cadaveric dissections confirmed the VL muscle's consistent vascular anatomy and adequate length, extending beyond the rectus femoris musculotendinous junction by an average of 4.3 cm. The flap’s dimensions and robust blood supply suggest suitability for reconstructive applications in the groin and pelvis. Clinically, the VL flap successfully provided coverage in both patients with minimal donor-site morbidity and preserved lower extremity function. Conclusion: The VL muscle flap is a reliable option for groin and pelvic reconstruction, offering sufficient reach, volume, and reduced donor-site morbidity compared to other muscle flaps. Further studies are needed to confirm its advantages in broader clinical settings. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Wound complications following vascular procedures in the groin are a significant concern, with reported incidences as high as 39% in patients undergoing arterial revascularization in the United States. 1 , 2 The groin region is particularly susceptible to these complications due to the potential for dead space and contamination, coupled with the frequent presence of risk factors for impaired wound healing, such as advanced age, smoking, and diabetes mellitus. 3 – 6 Deep infections in this area can have devastating consequences, including limb-threatening or life-threatening outcomes that may necessitate debridement, repeated graft interventions, or even amputation and hip disarticulation. 1 Muscle flap coverage for groin wound complications offers several advantages, including enhanced vascularity for improved healing, elimination of dead space, and the formation of new lymphatic channels to manage lymphatic leakage. 4 Since 1980, the sartorius muscle flap has been a mainstay for re-operative groin coverage due to its proximity, ease of harvest, and minimal functional deficit post-harvest. 7 In smaller groin defects, the sartorius muscle as a turn-over flap can also be an appropriate reconstructive option. 8 However, in large defects, the sartorius flap's reliability is inconsistent, largely due to its often-insufficient size and segmental blood supply. 4 , 9 To address these limitations, the rectus femoris (RF) flap was introduced in 1989, offering greater bulk and more dependable vascularity as a Type II muscle, primarily supplied by the profunda femoris artery. 10 , 11 The RF flap, however, has been criticized for potential loss of knee extension. 12 , 13 Despite these advancements, there remains a need for alternative muscle options that provide reliable coverage in complex cases. The vastus lateralis (VL) muscle, one of the four quadriceps muscles, presents a promising regional option for groin coverage. It provides a consistent blood supply from the descending branch of the lateral circumflex femoral artery and segmental innervation from the femoral nerve, which may preserve some functionality of the remaining muscle post-harvest. 14 Prior studies have suggested that the use of the VL muscle in anterolateral thigh flaps, or as a standalone flap, results in minimal morbidity to the knee extensor mechanism, 15 highlighting it an ideal option for groin reconstruction that does not incur functional limitation. In this report, we describe a series of cadaveric dissections to assess the extent of the vastus lateralis muscle distal to the myotendinous junction of the rectus femoris. Additionally, we present two cases in which the VL muscle was utilized as a flap for groin coverage and as a pedicled flap for coverage within the pelvic cavity. This investigation aims to determine the potential for extended reach into the lower abdomen and pelvis when using the VL as a pedicled flap. Methods We conducted bilateral lower extremity dissections on five fresh cadavers (2 male, 3 female) to assess anatomical parameters pertinent to the rectus femoris and vastus lateralis muscles. All procedures were performed in accordance with the principles outlined in the Declaration of Helsinki. Institutional review board exemptions were obtained for cadaveric studies at the Cleveland Clinic Foundation. The authors affirm that human research participants provided informed consent for publication according to Cleveland Clinic Foundation protocol for all intraoperative and postoperative figures and videos. Measurements were obtained using a surgical ruler. An incision was made extending from the anterior superior iliac spine (ASIS) to the lateral aspect of the patella. Skin flaps were elevated medially and laterally. Muscle fascia was incised longitudinally to expose the VL and RF muscle bellies and tendons (Fig. 1 A). The lengths of the rectus femoris and vastus lateralis muscles were measured from the ASIS to the musculotendinous junction. Additionally, the tendon lengths were recorded from the musculotendinous junction to their respective insertions on the patella. We also measured the length of the vastus lateralis muscle distal to the musculotendinous junction of the rectus femoris, as well as the overall dimensions of the vastus lateralis muscle. The interval between RF and VL was then opened. The descending branch of the lateral circumflex femoral artery (LCFA) was carefully dissected from its origin at the external iliac artery to its point of entry into the vastus lateralis muscle. We documented the distance from the ASIS to the site where the descending branch entered the muscle. Additionally, the length of the vascular pedicle from its entry into the muscle to the branch supplying the rectus femoris was measured (Fig. 1 B, B’). A muscle sparing flap was then elevated and inset into the groin deep to the sartorius and rectus femoris (Fig. 2 ). Results The mean cadaveric age was 75.0 ± 5.0. The mean BMI 23.0 ± 3.1. The mean height 171.2 ± 9.6cm (Table 1 ). No significant difference was found with regards to laterality for any of the muscle or tendon measurements. The mean ASIS to RF length was 37.0 ± 1.7cm. The mean ASIS to VL length was 41.2 ± 1.9cm. The mean rectus femoris tendon length was 5.9 ± 1.2cm. The mean vastus lateralis tendon length was 4.8 ± 1.6cm. The VL muscle belly terminated on average 4.3 ± 1.0cm more distal to the RF musculotendinous junction. The average vastus lateralis dimensions were 28.0 x 12.8 cm and surface area was 357.0 ± 52.4cm 2 (Table 2 ). Table 1 Cadaver Demographics (N = 5 cadavers) Average ± SD (in cm) Age 75.0 ± 5.0 BMI 23.0 ± 3.1 Height (in cm) 171.2 ± 9.6 Table 2 Muscle Measurements (N = 10 dissections) † ASIS to Rectus Femoris Length (in cm) 37.0 ± 1.7 Rectus Femoris Tendon Length (in cm) 5.9 ± 1.2 ASIS to Vastus Lateralis Length (in cm) 41.2 ± 1.9 Vastus Lateralis Tendon Length (in cm) 4.8 ± 1.6 VL Length Beyond RF Musculotendinous Junction (in cm) 4.3 ± 1.0 Average Vastus Lateralis Dimensions (in cm) 28.0 x 12.8 Average Vastus Lateralis Surface Area (in cm 2 ) 357.0 ± 52.4 † Note: No Significant difference was seen in measurements in laterality or sex of cadavers. The average site of entry of the descending branch of the lateral circumflex femoral artery to the muscle relative to ASIS was 19.9 ± 2.7cm. The average vascular pedicle length from the entry of the LCFA to the muscle from the rectus femoris branch was 9.2 ± 0.8cm (Table 3 ). Table 3 Pedicle Dimensions (N = 10 dissections) † Average ± SD (in cm) ASIS to Pedicle Insertion 19.9 ± 2.7 Rectus Femoris Tendon Length (in cm) 9.2 ± 0.8 † Note: No Significant difference was seen in measurements in laterality or sex of cadavers. Case Studies Case 1 The patient was a 74-year-old female with type 2 diabetes who required a revision of a right groin femoral bypass using a polyethylene terephthalate (PTE) synthetic graft. A VL muscle flap was meticulously designed to cover the vascular pedicle and to fill the dead space within the right groin, while enabling primary closure of the overlying skin. During the procedure, the septum between the rectus femoris (RF) and vastus lateralis (VL) was identified and carefully separated. The RF muscle was then retracted medially, exposing the descending branch of the lateral circumflex femoral artery, situated beneath the VL muscle. The VL muscle was divided using a LigaSure energy device to minimize tissue trauma and thermally induced muscle necrosis from conventional monopolar electrocautery. The vascular pedicle was traced proximally to the level of the rectus femoris branch—which served as the pivot point—and was preserved. Great care was taken to dissect and preserve the femoral motor nerve branches. The muscle flap, measuring 10 x 6 cm (Fig. 3 A), was then tunneled beneath the RF and sartorius muscles and securely inset with 2 − 0 Vicryl sutures to provide full coverage of the PTE graft (Figs. 3 B-D). Two channel drains were placed, one in the subcutaneous space above the muscle flap and the other at the muscle flap donor site, before the skin was closed primarily. The patient had an uneventful immediate post-operative course, demonstrating full knee extension and strength one week following the surgery. Unfortunately, she succumbed to COVID-19 six weeks after the operation. There were no reported post-operative wound healing complications in the right groin up until the time of her death. Case 2 The patient, a 28-year-old female, underwent a kidney-pancreas transplant complicated by the development of an external iliac pseudoaneurysm. The allograft was entirely lost and subsequently removed, during which a bypass was performed to restore blood flow to the right lower extremity. Unfortunately, this procedure was complicated by an infection, leading to an acute hemorrhage that required an emergent return to the operating room. A temporary covering stent was placed over the external iliac artery on post-operative day 7. During a subsequent vascular revision surgery, it was discovered that the infection was caused by a missed retrocecal enterotomy, likely sustained during removal of the allograft. The surgical team performed a washout of the pelvic area, followed by a colonic diversion. Two days later, vascular surgery was conducted to ligate the right external iliac artery, followed by a femoral-femoral bypass using an autologous vein. Given the concern for residual contamination, it was critical to cover the ligated external iliac artery stump to promote healing and prevent a catastrophic blowout. Initially, a pedicled turnover flap using the rectus femoris was planned, with the muscle transposed through a tunnel beneath the inguinal ligament. However, intraoperative assessment revealed that the rectus femoris was approximately 3 cm too short to adequately cover the exposed iliac stump. Upon further examination, it was noted that the bulk of the rectus femoris muscle terminated several centimeters higher than the vastus lateralis muscle. This led to the decision that the vastus lateralis would have sufficient length for complete coverage of the iliac stump within the pelvis. The right vastus lateralis was carefully elevated using a LigaSure energy device, preserving its blood supply via the descending branch of the lateral circumflex femoral artery/vein. An additional 5 cm of muscle was obtained distal to the terminal portion of the rectus femoris, which provided the necessary length to cover the external iliac stump. Careful attention was given to preserving the motor branches of the femoral nerve supplying the other quadriceps muscles. The vastus lateralis muscle was then tunneled beneath the rectus femoris and sartorius muscles, with its pivot point located at the level of the rectus branch of the descending lateral circumflex femoral artery. The middle portion of the vastus lateralis flap was positioned to cover the femoral-femoral bypass at the groin level, while the distal component was tunneled under the inguinal ligament into the pelvis (Fig. 4 A). The muscle was secured with 2 − 0 Vicryl sutures, and 18 Fr channel drains were placed. Intraoperative fluorescence angiography confirmed that the muscle was well-perfused over the iliac stump immediately after being inset (Fig. 4 B). Initially, the groin muscle was covered with a VAC and skin grafted one week later in a planned, staged closure. A CT scan performed on post-operative day 8, as a surveillance work up, showed intact muscle coverage over the external iliac stump and well-maintained blood flow through the descending branch of the lateral circumflex femoral artery, tracing beneath the inguinal ligament and into the pelvis. The patient was instructed to avoid sitting for two weeks to prevent kinking of the vascular pedicle. No focused physical therapy for her right thigh was initiated. At a six-week follow-up appointment, she exhibited full strength (5/5) in right knee extension without any evidence of extensor lag (Video 1). Discussion The most common options for groin wound coverage include the RF and sartorius muscles. 16 However, the RF muscle flap has been associated with significant donor site morbidity, including loss of knee extension strength and extensor lag of up to 30 degrees, potentially leading to prolonged rehabilitation and, in some cases, permanent functional impairment. 17 , 18 Some studies have reported minimal long-term morbidity following RF muscle flap harvest, although these outcomes may be attributed to intraoperative techniques, such as medializing the VL and vastus medialis (VM) muscles, combined with rigorous postoperative rehabilitation. 18 Another muscle-only option for groin coverage is the gracilis muscle; however, in Case 2 , where coverage of the proximal pelvis was required, the gracilis was considered a suboptimal choice due to its less reliable distal perfusion 19 – 21 , which would have been crucial for covering the external iliac stump. A de-epithelialized ALT flap was also considered, but a muscle-only flap was deemed more suitable for contouring and filling the dead space in the pelvis and groin, with the added benefit of a shorter operative time by avoiding the need for perforator dissection. Given that reconstruction with RF, sartorius, or gracilis muscles may not be appropriate for groin wound coverage in all patients due to anatomic incompatibility or risk for postoperative complications, there is a pertinent need for a novel reconstructive option. In this report, we describe cadaveric dissection and two cases involving successful harvesting of the vastus lateralis muscle for vascular coverage in the groin and pelvis. The vascular pedicle of the VL muscle is easily identifiable, and the muscle itself is straightforward to transpose. Like the anterolateral thigh flap harvest, once the septum between the VL and rectus femoris (RF) is identified and the RF is retracted medially, the vascular pedicle becomes readily visible beneath the VL muscle. The dissection is relatively uncomplicated, provided care is taken to maintain the vascular attachment to the muscle and to avoid disrupting the perforators. Additionally, the size of the muscle flap can be adjusted according to the dimensions of the wound and the space to be filled. Our anatomical data mirrors previous dissections indicating that the dominant pedicle enters the muscle 213.7 mm from the ASIS. 22 Our muscle dimensions and surface are larger than that found by Rodaix et al., however this may be explained by the fact their measurements were taken radiographically. 23 The vastus lateralis muscle belly was found to extend 4.3 cm beyond the rectus femoris musculotendinous junction. The increased muscle length, long pedicle, and surface area suggests that the vastus lateralis can be a versatile option with both adequate reach and volume to fill sizeable groin defects. Additionally, a musculocutaneous variation can be harvested to both eliminate dead space and resurface any skin defects (Fig. 5 ). The functional outcomes following VL muscle harvest are variable in the literature. Kimata et al. reported a higher incidence of long-term morbidity with free or pedicled ALT flaps that included the VL muscle. 24 However, in a large series of 220 patients who underwent ALT free flap harvest, only 8% reported knee extension weakness, with universal resolution within six months. 25 Furthermore, Kuo et al. demonstrated no significant difference in isometric strength between the donor and contralateral thighs at 30 and 60 degrees of flexion following ALT myocutaneous flap harvest, which included a cuff of the VL muscle. 26 Toia et al. also reported no perceived functional deficit at six months postoperatively in a series of muscle-sparing VL flaps. 27 The variation in reported outcomes may be influenced by differences in flap harvest techniques. Studies that describe ALT myocutaneous flaps may differ significantly from those focusing on true perforator-based fasciocutaneous flaps. Lower extremity motor function can be affected by factors such as motor nerve preservation during dissection and the necessity of donor site skin grafting. Our two patients demonstrated minimal functional deficit following VL flap harvest following successful primary closure. We propose that the VL muscle is a preferable choice for groin and pelvic defect closure, as the RF muscle may play a more critical role in knee extension. While our findings are based on a limited cohort and do not definitively establish the superiority of the VL flap in terms of donor site morbidity, early recovery outcomes suggest that the VL flap may result in less morbidity compared to the RF flap. Our study is notably limited by its small sample size. Although our patients exhibited baseline knee extension and strength upon follow-up, our study lacked objective quantitative measurements of knee extension power. To our knowledge, no existing study has employed an objective measure of lower extremity function to directly compare donor site morbidity between the VL and RF muscles. The vastus lateralis remains a promising selection for reduction of donor-site morbidity in complicated groin wounds, although further studies including objective, functional evaluation of knee extension power following muscle harvest are needed Conclusion The vastus lateralis muscle presents a viable and promising option for groin and pelvic reconstruction, particularly in cases where alternative muscle flaps, such as the rectus femoris or gracilis, may be insufficient. Our findings demonstrate that the VL muscle flap can provide adequate coverage, maintain vascular supply, and reduce the risk of donor site morbidity. The two case reports underscore its effectiveness in covering complex vascular structures and filling substantial dead spaces, even in highly contaminated fields. Furthermore, cadaveric dissection reveals that the VL muscle has sufficient length, reliable vascular pedicle, and consistent anatomy, making it a versatile choice for reconstructive surgeons. Declarations Consent to Publish The authors affirm that human research participants provided informed consent for publication according to Cleveland Clinic Foundation protocol for all intraoperative and postoperative figures and videos. Funding Declaration The authors affirm that there was no funding to disclose for this project. Ethics Statement All procedures were performed in accordance with the principles outlined in the Declaration of Helsinki. Institutional review board exemptions were obtained for cadaveric studies at the Cleveland Clinic Foundation. References Audu CO, Columbo JA, Sun SJ, et al. Variation in timing and type of groin wound complications highlights the need for uniform reporting standards. J Vasc Surg. 2019;69:532–543 McPhee JT, Nguyen LL, Ho KJ, Ozaki CK, Conte MS, Belkin M. Risk prediction of 30-day readmission after infrainguinal bypass for critical limb ischemia. J Vasc Surg. 2013;57:1481–1488 Pleger SP, Nink N, Elzien M, Kunold A, Koshty A, Böning A. Reduction of groin wound complications in vascular surgery patients using closed incision negative pressure therapy (ciNPT): a prospective, randomised, single‐institution study. Int Wound J. 2018;15:75–83 Shermak MA, Yee K, Wong L, Jones CE, Wong J. Surgical Management of Groin Lymphatic Complications after Arterial Bypass Surgery. Plast Reconstr Surg. 2005;115:1954–1962 Loanzon RS, Kim Y, Voit A, et al. Risk factors and consequences of wound complications following sartorius flap reconstruction. J Vasc Surg. 2024;79:323-329.e2 Price A, Contractor U, White R, Williams I. The use of vascularised muscle flaps for treatment or prevention of wound complications following arterial surgery in the groin. Int Wound J. 2020;17:1669–1677 Méndez Fernández MA, Quast DC, Geis RC, Henly WS. Distally based sartorius muscle flap in the treatment of infected femoral arterial prostheses. J Cardiovasc Surg (Torino). 1980;21:628–31 Wu LC, Djohan RS, Liu TS, Chao AH, Lohman RF, Song DH. Proximal Vascular Pedicle Preservation for Sartorius Muscle Flap Transposition. Plast Reconstr Surg. 2006;117:253–258 Dua A, Rothenberg KA, Lavingia K, Ho VT, Rao C, Desai SS. Outcomes of Gracilis Muscle Flaps in the Management of Groin Complications after Arterial Bypass with Prosthetic Graft. Ann Vasc Surg. 2018;51:113–118 Mixter RC, Turnipseed WD, Smith DJ, Acher CW, Rao VK, Dibbell DG. Rotational muscle flaps: A new technique for covering infected vascular grafts. J Vasc Surg. 1989;9:avs0090472 Williams M, Caterson J, Cogswell L, Gibbons CLMH, Cosker T. A cadaveric analysis of the blood supply to rectus Femoris. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2019;72:616–621 Julian O, Wilcox K, Sharma D, et al. Viability of the rectus femoris muscle flap for groin wound coverage after ligation of proximal inflow. J Surg Case Rep. 2024;2024 Alkon JD, Smith A, Losee JE, Illig KA, Green RM, Serletti JM. Management of Complex Groin Wounds: Preferred Use of the Rectus Femoris Muscle Flap. Plast Reconstr Surg. 2005;115:776–783 Ver Halen J, Yu P. Reconstruction of Extensive Groin Defects with Contralateral Anterolateral Thigh–Vastus Lateralis Muscle Flaps. Plast Reconstr Surg. 2010;125:130e–132e Friji MT, Suri MP, Shankhdhar VK, Ahmad QG, Yadav PS. Pedicled Anterolateral Thigh Flap. Ann Plast Surg. 2010;64:458–461 Wübbeke LF, Conings JZM, Elshof J-W, et al. Outcome of rectus femoris muscle flaps for groin coverage after vascular surgery. J Vasc Surg. 2020;72:1050-1057.e2 Caulfield WH, Curtsinger L, Powell G, Pederson WC. Donor Leg Morbidity after Pedicled Rectus Femoris Muscle Flap Transfer for Abdominal Wall and Pelvic Reconstruction. Ann Plast Surg. 1994;32:377–382 Gardetto A, Raschner Ch, Schoeller Th, Pavelka ML, Wechselberger G. Rectus femoris muscle flap donor-site morbidity. Br J Plast Surg. 2005;58:175–182 MCCRAW JB, MASSEY FM, SHANKLIN KD, HORTON CE. VAGINAL RECONSTRUCTION WITH GRACILIS MYOCUTANEOUS FLAPS. Plast Reconstr Surg. 1976;58:176–183 Wei F-C, Mardini S. Flaps and Reconstructive Surgery. 2nd ed. Elsevier; 2016 Whitaker IS, Karavias M, Shayan R, et al. The Gracilis Myocutaneous Free Flap: A Quantitative Analysis of the Fasciocutaneous Blood Supply and Implications for Autologous Breast Reconstruction. PLoS One. 2012;7:e36367 Tayfur V, Magden O, Edizer M, Atabey A. Anatomy of Vastus Lateralis Muscle Flap. Journal of Craniofacial Surgery. 2010;21:1951–1953 Rodaix C, Auregan J-C, Lhuaire M, Feydy A, Soubeyrand M, Biau D. The proximal vastus lateralis flap: An anatomical and radiological study. Morphologie. 2022;106:75–79 Kimata Y, Uchiyama K, Ebihara S, Nakatsuka T, Harii K. Anatomic Variations and Technical Problems of the Anterolateral Thigh Flap: A Report of 74 Cases. Plast Reconstr Surg. 1998;102:1517–1523 Hanasono MM, Skoracki RJ, Yu P. A Prospective Study of Donor-Site Morbidity after Anterolateral Thigh Fasciocutaneous and Myocutaneous Free Flap Harvest in 220 Patients. Plast Reconstr Surg. 2010;125:209–214 Kuo Y-R, Jeng S-F, Kuo M-H, et al. Free Anterolateral Thigh Flap for Extremity Reconstruction: Clinical Experience and Functional Assessment of Donor Site. Plast Reconstr Surg. 2001;107:1766–1771 Toia F, D’Arpa S, Brenner E, Melloni C, Moschella F, Cordova A. Segmental Anatomy of the Vastus Lateralis. Plast Reconstr Surg. 2015;135:185e–198e Additional Declarations No competing interests reported. Supplementary Files VLflapRpelvis6weekpostopkneeextension.mov Video 1 Clinical video of a 28-year-old female patient 6 weeks post op after groin reconstruction for colonic blowout with vastus lateralis showing knee extension. No notable extensor lag seen on exam. Cite Share Download PDF Status: Published Journal Publication published 19 Nov, 2025 Read the published version in European Journal of Plastic Surgery → Version 1 posted Editorial decision: Revision requested 08 Sep, 2025 Reviews received at journal 08 Sep, 2025 Reviewers agreed at journal 17 Aug, 2025 Reviews received at journal 04 Aug, 2025 Reviewers agreed at journal 24 Jul, 2025 Reviewers invited by journal 24 Jul, 2025 Editor assigned by journal 24 Jul, 2025 Submission checks completed at journal 24 Jul, 2025 First submitted to journal 13 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7114201","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":490451510,"identity":"15d85683-d83f-43b9-86ef-79a83cb1fc8e","order_by":0,"name":"Daniel Bahat","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtklEQVRIiWNgGAWjYBACAwYeIMlmw8DAfIAULQfY0oDaEkjTcpgELebsZw9+/lB2Xp6/jYHxccUvIrRY9uQlSxw4d9twxjEGZsOzfcQ47ECOgcTBttsJBvINbJKNPcRoOf/G+MfBtnMJBmwMxGq5kWMGtOUAREvDDyK0WM54Y2Zx5lwy0C+MzYaNDURoMefPMb5RUWYHDDHmgw8b/hChBQkwNjAwtpGmBQRItGUUjIJRMApGBgAAe/03oS8K9a4AAAAASUVORK5CYII=","orcid":"","institution":"Cleveland Clinic","correspondingAuthor":true,"prefix":"","firstName":"Daniel","middleName":"","lastName":"Bahat","suffix":""},{"id":490451512,"identity":"59fd1440-96a7-47d1-8462-971bb1ec8cfe","order_by":1,"name":"Robert C. Siska","email":"","orcid":"","institution":"Cleveland Clinic","correspondingAuthor":false,"prefix":"","firstName":"Robert","middleName":"C.","lastName":"Siska","suffix":""},{"id":490451514,"identity":"cdfa1c43-9be6-4b22-99d0-dd8dc24418b5","order_by":2,"name":"Nicole Gherlone","email":"","orcid":"","institution":"Ascension Saint Joseph","correspondingAuthor":false,"prefix":"","firstName":"Nicole","middleName":"","lastName":"Gherlone","suffix":""},{"id":490451515,"identity":"166ec1d5-807b-40c8-99e3-a3dacbb4b30f","order_by":3,"name":"Ray Fodor","email":"","orcid":"","institution":"Cleveland Clinic Lerner College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ray","middleName":"","lastName":"Fodor","suffix":""},{"id":490451516,"identity":"4ea32530-7e39-4905-88c1-997725b274ab","order_by":4,"name":"Dylan Suriadinata","email":"","orcid":"","institution":"Texas A\u0026M University","correspondingAuthor":false,"prefix":"","firstName":"Dylan","middleName":"","lastName":"Suriadinata","suffix":""},{"id":490451521,"identity":"6d35219d-8d4b-4715-a4ef-c01dfdfc59bd","order_by":5,"name":"Jacob Lammers","email":"","orcid":"","institution":"Cleveland Clinic","correspondingAuthor":false,"prefix":"","firstName":"Jacob","middleName":"","lastName":"Lammers","suffix":""},{"id":490451523,"identity":"7933151f-04e3-460d-805d-60db61f39001","order_by":6,"name":"Viren Patel","email":"","orcid":"","institution":"Cleveland Clinic","correspondingAuthor":false,"prefix":"","firstName":"Viren","middleName":"","lastName":"Patel","suffix":""},{"id":490451524,"identity":"5c267aa8-e5df-4ade-9533-c17ab3d91594","order_by":7,"name":"Dwayne Jackson","email":"","orcid":"","institution":"Cleveland Clinic Lerner College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Dwayne","middleName":"","lastName":"Jackson","suffix":""},{"id":490451525,"identity":"3926c9ab-0d26-4728-8b02-40ce81cf02a8","order_by":8,"name":"William Albabish","email":"","orcid":"","institution":"Cleveland Clinic Lerner College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"William","middleName":"","lastName":"Albabish","suffix":""},{"id":490451526,"identity":"a96ae7c7-6203-45c0-b41a-23f4a5104af4","order_by":9,"name":"Risal Djohan","email":"","orcid":"","institution":"Cleveland Clinic","correspondingAuthor":false,"prefix":"","firstName":"Risal","middleName":"","lastName":"Djohan","suffix":""}],"badges":[],"createdAt":"2025-07-13 15:23:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7114201/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7114201/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00238-025-02366-7","type":"published","date":"2025-11-19T15:57:35+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":87827547,"identity":"c7d1bbc0-692b-4589-b446-d53c6ec6eafb","added_by":"auto","created_at":"2025-07-29 11:57:20","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1694514,"visible":true,"origin":"","legend":"\u003cp\u003ePictures of a dissection of right lower extremity of a 74 male fresh frozen cadaver displaying A) exposure of rectus femoris and vastus lateralis (marked with *) muscle bellies and tendons. B) the opened interval between rectus femoris and vastus lateralis which is B’) magnified to show the branch of the LCFA to rectus femoris (dashed lines); The left aspect of the picture is cephalad, the right aspect of the picture is caudal.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7114201/v1/a16ff7cb0c38f9a4fd505088.jpg"},{"id":87828504,"identity":"14afcc69-61ea-4be0-8dec-f1e662b25d9b","added_by":"auto","created_at":"2025-07-29 12:05:21","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1791399,"visible":true,"origin":"","legend":"\u003cp\u003ePhotographs of a dissection of left lower extremity of a 72 female fresh frozen cadaver displaying A) muscle sparing version of vastus lateralis flap after elevation and B) after inset underneath rectus femoris and sartorius.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7114201/v1/8698ea682edb4007cf971018.jpg"},{"id":87828506,"identity":"6111cc93-0f55-4f5d-9b8b-5437c0ffdf7a","added_by":"auto","created_at":"2025-07-29 12:05:21","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1901746,"visible":true,"origin":"","legend":"\u003cp\u003eIntra-operative photography of the right lower extremity of a 74 year old female patient presenting for groin coverage of PTFE graft A) with vastus lateralis in situ (dotted lines), note Dacron graft in groin the lower right aspect of wound B) shows the vastus lateralis flap elevated prior to transposition C) shows the flap after it has been tunneled underneath rectus femoris and sartorius, note Dacron graft at base of wound and D) flap after inset, with full coverage of graft. Left is the inferior aspect of wound, right is the superior aspect of wound.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7114201/v1/5ab58a4f012e987f64e0425e.jpg"},{"id":87827554,"identity":"e213c7fe-8008-4fe9-8482-510dece3d409","added_by":"auto","created_at":"2025-07-29 11:57:21","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1089358,"visible":true,"origin":"","legend":"\u003cp\u003eIntra-operative photography of the right lower extremity of a 28 year old female presenting for groin coverage of ligated external iliac stump after colonic blow out demonstrating A) vastus lateralis after transposition adjacent to the colonic stump following management of the enterotomy with resection and diversion and after B) inset of vastus lateralis (dotted lines) over external iliac stump. The superior aspect of the photo is cephalic, the left side of the photo represents the patient’s right.\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7114201/v1/3027444ed48638c773bf291c.jpg"},{"id":87828510,"identity":"5f0886a7-e7b9-4d2a-b375-257f6f69eeca","added_by":"auto","created_at":"2025-07-29 12:05:21","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":2020371,"visible":true,"origin":"","legend":"\u003cp\u003ePhotographs of a dissection of right lower extremity of a 72 female fresh frozen cadaver displaying A) myocutaneous version of vastus lateralis flap after elevation and B) after inset underneath rectus femoris and sartorius.\u003c/p\u003e","description":"","filename":"Figure5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7114201/v1/e8740effadefee67ee4adebf.jpg"},{"id":96650968,"identity":"def38bf7-0970-4b38-b9e5-81cab9add7be","added_by":"auto","created_at":"2025-11-24 16:13:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":8947770,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7114201/v1/794cf218-df9a-4cb9-b991-e28fb919d1a1.pdf"},{"id":87827576,"identity":"c5009a23-c0a0-4d77-8166-dd15ccb372c6","added_by":"auto","created_at":"2025-07-29 11:57:24","extension":"mov","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":76000729,"visible":true,"origin":"","legend":"\u003cp\u003eVideo 1\u003c/p\u003e\n\u003cp\u003eClinical video of a 28-year-old female patient 6 weeks post op after groin reconstruction for colonic blowout with vastus lateralis showing knee extension. No notable extensor lag seen on exam.\u003c/p\u003e","description":"","filename":"VLflapRpelvis6weekpostopkneeextension.mov","url":"https://assets-eu.researchsquare.com/files/rs-7114201/v1/570fc43102338adee39b7f0c.mov"}],"financialInterests":"No competing interests reported.","formattedTitle":"Versatility of Vastus Lateralis muscle flap for groin and pelvic wound: An Updated Anatomical Description and Clinical Applications","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWound complications following vascular procedures in the groin are a significant concern, with reported incidences as high as 39% in patients undergoing arterial revascularization in the United States.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e The groin region is particularly susceptible to these complications due to the potential for dead space and contamination, coupled with the frequent presence of risk factors for impaired wound healing, such as advanced age, smoking, and diabetes mellitus.\u003csup\u003e\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e–\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Deep infections in this area can have devastating consequences, including limb-threatening or life-threatening outcomes that may necessitate debridement, repeated graft interventions, or even amputation and hip disarticulation.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eMuscle flap coverage for groin wound complications offers several advantages, including enhanced vascularity for improved healing, elimination of dead space, and the formation of new lymphatic channels to manage lymphatic leakage.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Since 1980, the sartorius muscle flap has been a mainstay for re-operative groin coverage due to its proximity, ease of harvest, and minimal functional deficit post-harvest.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e In smaller groin defects, the sartorius muscle as a turn-over flap can also be an appropriate reconstructive option.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e However, in large defects, the sartorius flap's reliability is inconsistent, largely due to its often-insufficient size and segmental blood supply.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eTo address these limitations, the rectus femoris (RF) flap was introduced in 1989, offering greater bulk and more dependable vascularity as a Type II muscle, primarily supplied by the profunda femoris artery.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e The RF flap, however, has been criticized for potential loss of knee extension.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Despite these advancements, there remains a need for alternative muscle options that provide reliable coverage in complex cases.\u003c/p\u003e\u003cp\u003eThe vastus lateralis (VL) muscle, one of the four quadriceps muscles, presents a promising regional option for groin coverage. It provides a consistent blood supply from the descending branch of the lateral circumflex femoral artery and segmental innervation from the femoral nerve, which may preserve some functionality of the remaining muscle post-harvest.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Prior studies have suggested that the use of the VL muscle in anterolateral thigh flaps, or as a standalone flap, results in minimal morbidity to the knee extensor mechanism,\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e highlighting it an ideal option for groin reconstruction that does not incur functional limitation.\u003c/p\u003e\u003cp\u003eIn this report, we describe a series of cadaveric dissections to assess the extent of the vastus lateralis muscle distal to the myotendinous junction of the rectus femoris. Additionally, we present two cases in which the VL muscle was utilized as a flap for groin coverage and as a pedicled flap for coverage within the pelvic cavity. This investigation aims to determine the potential for extended reach into the lower abdomen and pelvis when using the VL as a pedicled flap.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eWe conducted bilateral lower extremity dissections on five fresh cadavers (2 male, 3 female) to assess anatomical parameters pertinent to the rectus femoris and vastus lateralis muscles. All procedures were performed in accordance with the principles outlined in the Declaration of Helsinki. Institutional review board exemptions were obtained for cadaveric studies at the Cleveland Clinic Foundation. The authors affirm that human research participants provided informed consent for publication according to Cleveland Clinic Foundation protocol for all intraoperative and postoperative figures and videos.\u003c/p\u003e\u003cp\u003eMeasurements were obtained using a surgical ruler. An incision was made extending from the anterior superior iliac spine (ASIS) to the lateral aspect of the patella. Skin flaps were elevated medially and laterally. Muscle fascia was incised longitudinally to expose the VL and RF muscle bellies and tendons (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). The lengths of the rectus femoris and vastus lateralis muscles were measured from the ASIS to the musculotendinous junction. Additionally, the tendon lengths were recorded from the musculotendinous junction to their respective insertions on the patella. We also measured the length of the vastus lateralis muscle distal to the musculotendinous junction of the rectus femoris, as well as the overall dimensions of the vastus lateralis muscle.\u003c/p\u003e\u003cp\u003eThe interval between RF and VL was then opened. The descending branch of the lateral circumflex femoral artery (LCFA) was carefully dissected from its origin at the external iliac artery to its point of entry into the vastus lateralis muscle. We documented the distance from the ASIS to the site where the descending branch entered the muscle. Additionally, the length of the vascular pedicle from its entry into the muscle to the branch supplying the rectus femoris was measured (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB, B’). A muscle sparing flap was then elevated and inset into the groin deep to the sartorius and rectus femoris (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean cadaveric age was 75.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0. The mean BMI 23.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1. The mean height 171.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.6cm (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). No significant difference was found with regards to laterality for any of the muscle or tendon measurements. The mean ASIS to RF length was 37.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7cm. The mean ASIS to VL length was 41.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9cm. The mean rectus femoris tendon length was 5.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2cm. The mean vastus lateralis tendon length was 4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6cm. The VL muscle belly terminated on average 4.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0cm more distal to the RF musculotendinous junction. The average vastus lateralis dimensions were 28.0 x 12.8 cm and surface area was 357.0\u0026thinsp;\u0026plusmn;\u0026thinsp;52.4cm\u003csup\u003e2\u003c/sup\u003e (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCadaver Demographics (N\u0026thinsp;=\u0026thinsp;5 cadavers)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAverage\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (in cm)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeight (in cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e171.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003cdiv\u003eTable 2 Muscle Measurements (N\u0026thinsp;=\u0026thinsp;10 dissections)\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASIS to Rectus Femoris Length (in cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRectus Femoris Tendon Length (in cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASIS to Vastus Lateralis Length (in cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVastus Lateralis Tendon Length (in cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVL Length Beyond RF Musculotendinous Junction (in cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAverage Vastus Lateralis Dimensions (in cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.0 x 12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAverage Vastus Lateralis Surface Area (in cm\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e357.0\u0026thinsp;\u0026plusmn;\u0026thinsp;52.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003cem\u003eNote: No Significant difference was seen in measurements in laterality or sex of cadavers.\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eThe average site of entry of the descending branch of the lateral circumflex femoral artery to the muscle relative to ASIS was 19.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7cm. The average vascular pedicle length from the entry of the LCFA to the muscle from the rectus femoris branch was 9.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8cm (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u0026nbsp;Pedicle Dimensions (N\u0026thinsp;=\u0026thinsp;10 dissections)\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAverage\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (in cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASIS to Pedicle Insertion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRectus Femoris Tendon Length (in cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003cem\u003eNote: No Significant difference was seen in measurements in laterality or sex of cadavers.\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase 1\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient was a 74-year-old female with type 2 diabetes who required a revision of a right groin femoral bypass using a polyethylene terephthalate (PTE) synthetic graft. A VL muscle flap was meticulously designed to cover the vascular pedicle and to fill the dead space within the right groin, while enabling primary closure of the overlying skin.\u003c/p\u003e\n\u003cp\u003eDuring the procedure, the septum between the rectus femoris (RF) and vastus lateralis (VL) was identified and carefully separated. The RF muscle was then retracted medially, exposing the descending branch of the lateral circumflex femoral artery, situated beneath the VL muscle. The VL muscle was divided using a LigaSure energy device to minimize tissue trauma and thermally induced muscle necrosis from conventional monopolar electrocautery. The vascular pedicle was traced proximally to the level of the rectus femoris branch\u0026mdash;which served as the pivot point\u0026mdash;and was preserved. Great care was taken to dissect and preserve the femoral motor nerve branches.\u003c/p\u003e\n\u003cp\u003eThe muscle flap, measuring 10 x 6 cm (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003eA), was then tunneled beneath the RF and sartorius muscles and securely inset with 2\u0026thinsp;\u0026minus;\u0026thinsp;0 Vicryl sutures to provide full coverage of the PTE graft (Figs. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003eB-D). Two channel drains were placed, one in the subcutaneous space above the muscle flap and the other at the muscle flap donor site, before the skin was closed primarily.\u003c/p\u003e\n\u003cp\u003eThe patient had an uneventful immediate post-operative course, demonstrating full knee extension and strength one week following the surgery. Unfortunately, she succumbed to COVID-19 six weeks after the operation. There were no reported post-operative wound healing complications in the right groin up until the time of her death.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase 2\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient, a 28-year-old female, underwent a kidney-pancreas transplant complicated by the development of an external iliac pseudoaneurysm. The allograft was entirely lost and subsequently removed, during which a bypass was performed to restore blood flow to the right lower extremity. Unfortunately, this procedure was complicated by an infection, leading to an acute hemorrhage that required an emergent return to the operating room. A temporary covering stent was placed over the external iliac artery on post-operative day 7.\u003c/p\u003e\n\u003cp\u003eDuring a subsequent vascular revision surgery, it was discovered that the infection was caused by a missed retrocecal enterotomy, likely sustained during removal of the allograft. The surgical team performed a washout of the pelvic area, followed by a colonic diversion. Two days later, vascular surgery was conducted to ligate the right external iliac artery, followed by a femoral-femoral bypass using an autologous vein.\u003c/p\u003e\n\u003cp\u003eGiven the concern for residual contamination, it was critical to cover the ligated external iliac artery stump to promote healing and prevent a catastrophic blowout. Initially, a pedicled turnover flap using the rectus femoris was planned, with the muscle transposed through a tunnel beneath the inguinal ligament. However, intraoperative assessment revealed that the rectus femoris was approximately 3 cm too short to adequately cover the exposed iliac stump. Upon further examination, it was noted that the bulk of the rectus femoris muscle terminated several centimeters higher than the vastus lateralis muscle. This led to the decision that the vastus lateralis would have sufficient length for complete coverage of the iliac stump within the pelvis.\u003c/p\u003e\n\u003cp\u003eThe right vastus lateralis was carefully elevated using a LigaSure energy device, preserving its blood supply via the descending branch of the lateral circumflex femoral artery/vein. An additional 5 cm of muscle was obtained distal to the terminal portion of the rectus femoris, which provided the necessary length to cover the external iliac stump. Careful attention was given to preserving the motor branches of the femoral nerve supplying the other quadriceps muscles. The vastus lateralis muscle was then tunneled beneath the rectus femoris and sartorius muscles, with its pivot point located at the level of the rectus branch of the descending lateral circumflex femoral artery. The middle portion of the vastus lateralis flap was positioned to cover the femoral-femoral bypass at the groin level, while the distal component was tunneled under the inguinal ligament into the pelvis (Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003eA). The muscle was secured with 2\u0026thinsp;\u0026minus;\u0026thinsp;0 Vicryl sutures, and 18 Fr channel drains were placed. Intraoperative fluorescence angiography confirmed that the muscle was well-perfused over the iliac stump immediately after being inset (Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003eB).\u003c/p\u003e\n\u003cp\u003eInitially, the groin muscle was covered with a VAC and skin grafted one week later in a planned, staged closure. A CT scan performed on post-operative day 8, as a surveillance work up, showed intact muscle coverage over the external iliac stump and well-maintained blood flow through the descending branch of the lateral circumflex femoral artery, tracing beneath the inguinal ligament and into the pelvis.\u003c/p\u003e\n\u003cp\u003eThe patient was instructed to avoid sitting for two weeks to prevent kinking of the vascular pedicle. No focused physical therapy for her right thigh was initiated. At a six-week follow-up appointment, she exhibited full strength (5/5) in right knee extension without any evidence of extensor lag (Video 1).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe most common options for groin wound coverage include the RF and sartorius muscles.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e However, the RF muscle flap has been associated with significant donor site morbidity, including loss of knee extension strength and extensor lag of up to 30 degrees, potentially leading to prolonged rehabilitation and, in some cases, permanent functional impairment.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Some studies have reported minimal long-term morbidity following RF muscle flap harvest, although these outcomes may be attributed to intraoperative techniques, such as medializing the VL and vastus medialis (VM) muscles, combined with rigorous postoperative rehabilitation.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAnother muscle-only option for groin coverage is the gracilis muscle; however, in Case \u003cspan refid=\"FPar2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, where coverage of the proximal pelvis was required, the gracilis was considered a suboptimal choice due to its less reliable distal perfusion\u003csup\u003e\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, which would have been crucial for covering the external iliac stump. A de-epithelialized ALT flap was also considered, but a muscle-only flap was deemed more suitable for contouring and filling the dead space in the pelvis and groin, with the added benefit of a shorter operative time by avoiding the need for perforator dissection.\u003c/p\u003e\u003cp\u003eGiven that reconstruction with RF, sartorius, or gracilis muscles may not be appropriate for groin wound coverage in all patients due to anatomic incompatibility or risk for postoperative complications, there is a pertinent need for a novel reconstructive option. In this report, we describe cadaveric dissection and two cases involving successful harvesting of the vastus lateralis muscle for vascular coverage in the groin and pelvis. The vascular pedicle of the VL muscle is easily identifiable, and the muscle itself is straightforward to transpose. Like the anterolateral thigh flap harvest, once the septum between the VL and rectus femoris (RF) is identified and the RF is retracted medially, the vascular pedicle becomes readily visible beneath the VL muscle. The dissection is relatively uncomplicated, provided care is taken to maintain the vascular attachment to the muscle and to avoid disrupting the perforators. Additionally, the size of the muscle flap can be adjusted according to the dimensions of the wound and the space to be filled.\u003c/p\u003e\u003cp\u003eOur anatomical data mirrors previous dissections indicating that the dominant pedicle enters the muscle 213.7 mm from the ASIS.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e Our muscle dimensions and surface are larger than that found by Rodaix et al., however this may be explained by the fact their measurements were taken radiographically.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e The vastus lateralis muscle belly was found to extend 4.3 cm beyond the rectus femoris musculotendinous junction. The increased muscle length, long pedicle, and surface area suggests that the vastus lateralis can be a versatile option with both adequate reach and volume to fill sizeable groin defects. Additionally, a musculocutaneous variation can be harvested to both eliminate dead space and resurface any skin defects (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe functional outcomes following VL muscle harvest are variable in the literature. Kimata et al. reported a higher incidence of long-term morbidity with free or pedicled ALT flaps that included the VL muscle.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003eHowever, in a large series of 220 patients who underwent ALT free flap harvest, only 8% reported knee extension weakness, with universal resolution within six months.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Furthermore, Kuo et al. demonstrated no significant difference in isometric strength between the donor and contralateral thighs at 30 and 60 degrees of flexion following ALT myocutaneous flap harvest, which included a cuff of the VL muscle.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Toia et al. also reported no perceived functional deficit at six months postoperatively in a series of muscle-sparing VL flaps.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe variation in reported outcomes may be influenced by differences in flap harvest techniques. Studies that describe ALT myocutaneous flaps may differ significantly from those focusing on true perforator-based fasciocutaneous flaps. Lower extremity motor function can be affected by factors such as motor nerve preservation during dissection and the necessity of donor site skin grafting. Our two patients demonstrated minimal functional deficit following VL flap harvest following successful primary closure. We propose that the VL muscle is a preferable choice for groin and pelvic defect closure, as the RF muscle may play a more critical role in knee extension. While our findings are based on a limited cohort and do not definitively establish the superiority of the VL flap in terms of donor site morbidity, early recovery outcomes suggest that the VL flap may result in less morbidity compared to the RF flap.\u003c/p\u003e\u003cp\u003eOur study is notably limited by its small sample size. Although our patients exhibited baseline knee extension and strength upon follow-up, our study lacked objective quantitative measurements of knee extension power. To our knowledge, no existing study has employed an objective measure of lower extremity function to directly compare donor site morbidity between the VL and RF muscles. The vastus lateralis remains a promising selection for reduction of donor-site morbidity in complicated groin wounds, although further studies including objective, functional evaluation of knee extension power following muscle harvest are needed\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe vastus lateralis muscle presents a viable and promising option for groin and pelvic reconstruction, particularly in cases where alternative muscle flaps, such as the rectus femoris or gracilis, may be insufficient. Our findings demonstrate that the VL muscle flap can provide adequate coverage, maintain vascular supply, and reduce the risk of donor site morbidity. The two case reports underscore its effectiveness in covering complex vascular structures and filling substantial dead spaces, even in highly contaminated fields. Furthermore, cadaveric dissection reveals that the VL muscle has sufficient length, reliable vascular pedicle, and consistent anatomy, making it a versatile choice for reconstructive surgeons.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eConsent to Publish\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors affirm that human research participants provided informed consent for publication according to Cleveland Clinic Foundation protocol for all intraoperative and postoperative figures and videos. \u003c/p\u003e\n\n\n\u003cp\u003e\u003cem\u003eFunding Declaration\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors affirm that there was no funding to disclose for this project. \u003c/p\u003e\n\n\n\u003cp\u003e\u003cem\u003eEthics Statement\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures were performed in accordance with the principles outlined in the Declaration of Helsinki. Institutional review board exemptions were obtained for cadaveric studies at the Cleveland Clinic Foundation.\u003c/p\u003e\n\n\n\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAudu CO, Columbo JA, Sun SJ, et al. Variation in timing and type of groin wound complications highlights the need for uniform reporting standards. J Vasc Surg. 2019;69:532\u0026ndash;543\u003c/li\u003e\n\u003cli\u003eMcPhee JT, Nguyen LL, Ho KJ, Ozaki CK, Conte MS, Belkin M. Risk prediction of 30-day readmission after infrainguinal bypass for critical limb ischemia. J Vasc Surg. 2013;57:1481\u0026ndash;1488\u003c/li\u003e\n\u003cli\u003ePleger SP, Nink N, Elzien M, Kunold A, Koshty A, B\u0026ouml;ning A. Reduction of groin wound complications in vascular surgery patients using closed incision negative pressure therapy (ciNPT): a prospective, randomised, single‐institution study. Int Wound J. 2018;15:75\u0026ndash;83\u003c/li\u003e\n\u003cli\u003eShermak MA, Yee K, Wong L, Jones CE, Wong J. Surgical Management of Groin Lymphatic Complications after Arterial Bypass Surgery. Plast Reconstr Surg. 2005;115:1954\u0026ndash;1962\u003c/li\u003e\n\u003cli\u003eLoanzon RS, Kim Y, Voit A, et al. Risk factors and consequences of wound complications following sartorius flap reconstruction. J Vasc Surg. 2024;79:323-329.e2\u003c/li\u003e\n\u003cli\u003ePrice A, Contractor U, White R, Williams I. The use of vascularised muscle flaps for treatment or prevention of wound complications following arterial surgery in the groin. Int Wound J. 2020;17:1669\u0026ndash;1677\u003c/li\u003e\n\u003cli\u003eM\u0026eacute;ndez Fern\u0026aacute;ndez MA, Quast DC, Geis RC, Henly WS. Distally based sartorius muscle flap in the treatment of infected femoral arterial prostheses. J Cardiovasc Surg (Torino). 1980;21:628\u0026ndash;31\u003c/li\u003e\n\u003cli\u003eWu LC, Djohan RS, Liu TS, Chao AH, Lohman RF, Song DH. Proximal Vascular Pedicle Preservation for Sartorius Muscle Flap Transposition. Plast Reconstr Surg. 2006;117:253\u0026ndash;258\u003c/li\u003e\n\u003cli\u003eDua A, Rothenberg KA, Lavingia K, Ho VT, Rao C, Desai SS. Outcomes of Gracilis Muscle Flaps in the Management of Groin Complications after Arterial Bypass with Prosthetic Graft. Ann Vasc Surg. 2018;51:113\u0026ndash;118\u003c/li\u003e\n\u003cli\u003eMixter RC, Turnipseed WD, Smith DJ, Acher CW, Rao VK, Dibbell DG. Rotational muscle flaps: A new technique for covering infected vascular grafts. J Vasc Surg. 1989;9:avs0090472\u003c/li\u003e\n\u003cli\u003eWilliams M, Caterson J, Cogswell L, Gibbons CLMH, Cosker T. A cadaveric analysis of the blood supply to rectus Femoris. Journal of Plastic, Reconstructive \u0026amp; Aesthetic Surgery. 2019;72:616\u0026ndash;621\u003c/li\u003e\n\u003cli\u003eJulian O, Wilcox K, Sharma D, et al. Viability of the rectus femoris muscle flap for groin wound coverage after ligation of proximal inflow. J Surg Case Rep. 2024;2024\u003c/li\u003e\n\u003cli\u003eAlkon JD, Smith A, Losee JE, Illig KA, Green RM, Serletti JM. Management of Complex Groin Wounds: Preferred Use of the Rectus Femoris Muscle Flap. Plast Reconstr Surg. 2005;115:776\u0026ndash;783\u003c/li\u003e\n\u003cli\u003eVer Halen J, Yu P. Reconstruction of Extensive Groin Defects with Contralateral Anterolateral Thigh\u0026ndash;Vastus Lateralis Muscle Flaps. Plast Reconstr Surg. 2010;125:130e\u0026ndash;132e\u003c/li\u003e\n\u003cli\u003eFriji MT, Suri MP, Shankhdhar VK, Ahmad QG, Yadav PS. Pedicled Anterolateral Thigh Flap. Ann Plast Surg. 2010;64:458\u0026ndash;461\u003c/li\u003e\n\u003cli\u003eW\u0026uuml;bbeke LF, Conings JZM, Elshof J-W, et al. Outcome of rectus femoris muscle flaps for groin coverage after vascular surgery. J Vasc Surg. 2020;72:1050-1057.e2\u003c/li\u003e\n\u003cli\u003eCaulfield WH, Curtsinger L, Powell G, Pederson WC. Donor Leg Morbidity after Pedicled Rectus Femoris Muscle Flap Transfer for Abdominal Wall and Pelvic Reconstruction. Ann Plast Surg. 1994;32:377\u0026ndash;382\u003c/li\u003e\n\u003cli\u003eGardetto A, Raschner Ch, Schoeller Th, Pavelka ML, Wechselberger G. Rectus femoris muscle flap donor-site morbidity. Br J Plast Surg. 2005;58:175\u0026ndash;182\u003c/li\u003e\n\u003cli\u003eMCCRAW JB, MASSEY FM, SHANKLIN KD, HORTON CE. VAGINAL RECONSTRUCTION WITH GRACILIS MYOCUTANEOUS FLAPS. Plast Reconstr Surg. 1976;58:176\u0026ndash;183\u003c/li\u003e\n\u003cli\u003eWei F-C, Mardini S. Flaps and Reconstructive Surgery. 2nd ed. Elsevier; 2016\u003c/li\u003e\n\u003cli\u003eWhitaker IS, Karavias M, Shayan R, et al. The Gracilis Myocutaneous Free Flap: A Quantitative Analysis of the Fasciocutaneous Blood Supply and Implications for Autologous Breast Reconstruction. PLoS One. 2012;7:e36367\u003c/li\u003e\n\u003cli\u003eTayfur V, Magden O, Edizer M, Atabey A. Anatomy of Vastus Lateralis Muscle Flap. Journal of Craniofacial Surgery. 2010;21:1951\u0026ndash;1953\u003c/li\u003e\n\u003cli\u003eRodaix C, Auregan J-C, Lhuaire M, Feydy A, Soubeyrand M, Biau D. The proximal vastus lateralis flap: An anatomical and radiological study. Morphologie. 2022;106:75\u0026ndash;79\u003c/li\u003e\n\u003cli\u003eKimata Y, Uchiyama K, Ebihara S, Nakatsuka T, Harii K. Anatomic Variations and Technical Problems of the Anterolateral Thigh Flap: A Report of 74 Cases. Plast Reconstr Surg. 1998;102:1517\u0026ndash;1523\u003c/li\u003e\n\u003cli\u003eHanasono MM, Skoracki RJ, Yu P. A Prospective Study of Donor-Site Morbidity after Anterolateral Thigh Fasciocutaneous and Myocutaneous Free Flap Harvest in 220 Patients. Plast Reconstr Surg. 2010;125:209\u0026ndash;214\u003c/li\u003e\n\u003cli\u003eKuo Y-R, Jeng S-F, Kuo M-H, et al. Free Anterolateral Thigh Flap for Extremity Reconstruction: Clinical Experience and Functional Assessment of Donor Site. Plast Reconstr Surg. 2001;107:1766\u0026ndash;1771\u003c/li\u003e\n\u003cli\u003eToia F, D\u0026rsquo;Arpa S, Brenner E, Melloni C, Moschella F, Cordova A. Segmental Anatomy of the Vastus Lateralis. Plast Reconstr Surg. 2015;135:185e\u0026ndash;198e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-plastic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejps","sideBox":"Learn more about [European Journal of Plastic Surgery](https://link.springer.com/journal/238)","snPcode":"238","submissionUrl":"https://submission.nature.com/new-submission/238/3","title":"European Journal of Plastic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7114201/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7114201/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose:\u003c/h2\u003e\u003cp\u003eTo evaluate the use of the vastus lateralis (VL) muscle flap for groin and pelvic wound coverage, particularly in cases involving complex vascular exposure or high risk of contamination. Cadaveric dissection and two clinical cases were analyzed to assess the utility of the VL muscle flap.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e\u003cp\u003eBilateral dissections were performed on five fresh cadavers to measure anatomical parameters of the VL and rectus femoris muscles, focusing on technical aspects for the flap dissection, muscle length, vascular supply, and flap dimensions. Two case examples are then presented in patients who underwent reconstructive procedures using the VL flap: one for coverage following femoral bypass and another for a pelvic defect after ligation of the external iliac artery.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e\u003cp\u003eCadaveric dissections confirmed the VL muscle's consistent vascular anatomy and adequate length, extending beyond the rectus femoris musculotendinous junction by an average of 4.3 cm. The flap\u0026rsquo;s dimensions and robust blood supply suggest suitability for reconstructive applications in the groin and pelvis. Clinically, the VL flap successfully provided coverage in both patients with minimal donor-site morbidity and preserved lower extremity function.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e\u003cp\u003eThe VL muscle flap is a reliable option for groin and pelvic reconstruction, offering sufficient reach, volume, and reduced donor-site morbidity compared to other muscle flaps. Further studies are needed to confirm its advantages in broader clinical settings.\u003c/p\u003e","manuscriptTitle":"Versatility of Vastus Lateralis muscle flap for groin and pelvic wound: An Updated Anatomical Description and Clinical Applications","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-29 11:57:16","doi":"10.21203/rs.3.rs-7114201/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-08T12:35:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-08T07:36:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"177603270361814260298558088265928705490","date":"2025-08-17T20:15:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-04T16:23:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"64885291469787436275152696559679803898","date":"2025-07-24T16:29:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-24T15:03:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-24T10:33:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-24T10:31:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Plastic Surgery","date":"2025-07-13T15:14:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-plastic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejps","sideBox":"Learn more about [European Journal of Plastic Surgery](https://link.springer.com/journal/238)","snPcode":"238","submissionUrl":"https://submission.nature.com/new-submission/238/3","title":"European Journal of Plastic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"331f8c7d-2f5f-459f-8f3e-e4e832127494","owner":[],"postedDate":"July 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-24T16:10:07+00:00","versionOfRecord":{"articleIdentity":"rs-7114201","link":"https://doi.org/10.1007/s00238-025-02366-7","journal":{"identity":"european-journal-of-plastic-surgery","isVorOnly":false,"title":"European Journal of Plastic Surgery"},"publishedOn":"2025-11-19 15:57:35","publishedOnDateReadable":"November 19th, 2025"},"versionCreatedAt":"2025-07-29 11:57:16","video":"","vorDoi":"10.1007/s00238-025-02366-7","vorDoiUrl":"https://doi.org/10.1007/s00238-025-02366-7","workflowStages":[]},"version":"v1","identity":"rs-7114201","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7114201","identity":"rs-7114201","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}