Anatomy of Vastus Lateralis Muscle Flap Volkan Tayfur, MD,* Orhan Magden,Þ Mete Edizer, MD,þ and Atay Atabey, MD§ Abstract: A vastus lateralis muscle flap is used as a pedicled and free flap. In this study, the vastus lateralis muscles of 15 adult formalin-fixed cadavers (30 cases) were dissected. The dominant pedicle was found to be descending branch of the lateral circumflex femoral artery. The mean diameter of the artery was found to be 2.1 mm. This pedicle was located 119.4 mm distal to the pubic symphysis. The mean length of the major pedicle was found to be 56.8 mm when the dominant pedicle was chosen to nourish the flap. The dominant pedicle entered the muscle 155.8 and 213.7 mm from the greater trochanter and the anterior superior iliac spine, respec- tively. The muscle had proximal minor pedicles from the ascending and transverse branches of lateral circumflex femoral artery. These arteries had mean diameters of 1.8 and 2.0 mm, respectively. The distal minor branches were present in all of the dissections. The distal branch had a mean diameter of 1.8 mm. The origin of this distal branch was located 83.7 mm proximal to the intercondylar line. The motor nerve of the vastus lateralis was found to be originating from femoral nerve. The nerve entered the muscle 194.6 mm from the anterior superior iliac spine. Key Words: Vastus lateralis muscle flap, anatomy, head and neck reconstruction, muscle flap (J Craniofac Surg 2010;21: 1951Y1953) T he vastus lateralis muscle originates from the lateral inter- muscular septum, the gluteal tuberosity, and the greater tro- chanter. It ends in the patellar ligament with other muscles of the quadriceps femoris. It aids in the extension of a leg and also has a role in adduction and external rotation of the leg. 1 The vastus lateralis muscle is innervated by femoral nerve. Descending branch of lateral circumflex femoral artery (DB), transverse and ascending branches, and superior genicular lateral artery of popliteal artery join the blood supply of this muscle. 2,3 The vastus lateralis muscle is used as a pedicled flap for the reconstruction of gluteal defects. 4 The muscle is used as a distally based pedicled flap for the reconstruction of knee defects. 5 There are reports on the use of a vastus lateralis muscle flap for the treat- ment of hip and femur infections. 6,7 As a free flap, the vastus lateralis muscle was used for the reconstruction of skull base defects. 8 The aim of this study was to delineate the anatomy of the flap according to the surgical landmarks. MATERIALS AND METHODS In this study, latex injection via external iliac artery was performed on 15 adult cadavers (30 cases). The arterial anatomy and the innervation of the vastus lateralis muscle were dissected with 4Â loupe magnification. RESULTS The dominant pedicle was found to be DB (Table 1). The minor pedicles were found to be ascending and transverse branches of lateral circumflex femoral artery (Figs. 1 and 2). In addition, the vastus lateralis muscle was found to be receiving blood supply from super- ficial femoral artery in 3 cases (10%) and popliteal artery in 4 cases (13.3%). The origins of dominant pedicle were found to be 119.4 mm (range, 68Y137 mm) distal and 146.9 mm (range, 133Y170 mm) lateral to the pubic symphysis. The mean distance of the point where the dominant pedicle entered the muscle to the anterior superior iliac spine (ASIS) was 136.6 mm (range, 104Y178 mm). This point was 65.4 mm (range, 40Y160 mm) from the greater trochanter. The mean diameter of DB at the origin was 2.1 mm (range, 1.4Y2.9 mm). The DB was found to have a mean number of branches of 2.9 (range, 1Y8) to the vastus lateralis muscle. The distance of femoral nerve entry point to the vastus lateralis muscle was found to be 194.6 mm (range, 145Y213 mm) from the ASIS. In the distal part of the muscle, DB had a mean number of branches of 7.4 (range, 3Y10) to the vastus lateralis muscle. There were minor distal branches in all of the cases. The parameters of inferior anastomotic artery, which is the distal pedicle, were as fol- lows: the mean diameter was 1.8 mm (1Y2.6 mm); mean length, 15.1 mm (range, 6Y32 mm); distance of origin from the inter- condylar line, 83.7 mm (range, 65Y133 mm); and distance of muscle entry point to intercondylar line, 81.9 mm (range, 39Y128 mm). DISCUSSION Vastus lateralis muscle flap was reported to have the follow- ing advantages: the flap has a large tissue amount with low donor- site morbidity; it has a large and long pedicle; a simultaneous 2-team approach is possible; it has a consistent anatomy; and safe and quick dissection is possible. 1 Vastus lateralis muscle free flap has been described for head and neck reconstructions. 9,10 Jackson 11 postulated that vastus lateralis flap would be a workhorse in craniofacial surgery after tumor resection ANATOMICAL STUDY The Journal of Craniofacial Surgery & Volume 21, Number 6, November 2010 1951 From the *Department of Plastic Reconstructive and Aesthetic Surgery, Ondokuz Mayis University, Samsun; †Department of Anatomy, Dokuz Eylu ¨l University, Izmir; ‡Department of Anatomy, Ondokuz Mayis University, Samsun; and §Department of Plastic Reconstructive and Aesthetic Surgery, Dokuz Eylu ¨l University, Izmir, Turkey. Received April 26, 2010. Accepted for publication June 20, 2010. Address correspondence and reprint requests to Volkan Tayfur, MD, Department of Plastic Reconstructive and Aesthetic Surgery, Ondokuz Mayis University, 55139 Samsun, Turkey; E-mail: volkantayfur@yahoo.com The authors report no conflicts of interest. Copyright * 2010 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0b013e3181f4ee7f Copyright © 2010 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.