The composite vastus medialis–patellar complex osseomuscular flap as a salvage procedure after complex trauma of the knee—an anatomical study and clinical application

Background. In the setting of severe peringenicular trauma or complicated endoprothetic knee surgery, primary knee fusion may be the last resort for salvage of the limp. In this case, the patella looses its destination as an anterior knee stabilizer and can become a substantial donor of bone substance, especially if osseous defects are involved. Patients and Methods. 12 formalin fixated cadavers were studied in terms of vascular anatomy, pedicle reliability, arc of rotation and their relation to sex, age, and height. Moreover, the operation was performed on a suitable patient. Results. The quadriceps with the vastus medialis and the patella can be raised from the tibial tuberosity up to the entrance of the osteoarticlular branch of the superficial femoral artery into the vastus medialis muscle ca 16 cm (15–19 cm) from the inferior patellar pole. This distance correlated well to the overall heright of the cadavers (P=0.009). The vascular prerequisites were always present. In the clinical case, there was a favorable outcome with knee fusion after 4 months, despite of the lateral condylar defect. Discussion. The composite vastus medialis-patellar complex osseomuscular flap can be safely used as a source of vascularized femoral condyle substitute in the setting of primary knee fusion.