Elsevier

The Journal of Arthroplasty

Volume 30, Issue 12, December 2015, Pages 2338-2342
The Journal of Arthroplasty

Limitations of the Vastus Lateralis Muscle as a Substitute for Lost Abductor Muscle Function: An Anatomical Study

https://doi.org/10.1016/j.arth.2015.06.047Get rights and content

Abstract

Abductor insufficiency after hip arthroplasty resulting from an impaired gluteus medius and minimus remains an unsolved problem in orthopaedic surgery. The vastus lateralis (VL) was described as a functional substitute for abductor insufficiency in 2004. We carried out a macrodissection of twelve cadaveric hemipelvises to investigate the innervation of the VL and adjacent muscles to assess the extent the VL can be safely transferred. Results showed that direct muscle branches to proximal portions of the VL are too short to allow a significant shift; the shift may be as small as 13 mm. Nerves that supply the VL also extend to the vastus intermedius. This innervation pattern makes it impossible to shift the VL significantly without damaging branches to both.

Section snippets

Materials and Methods

Twelve cadaveric hemipelvises with legs from eight specimens (four paired and four unpaired) were investigated using macrodissection techniques. All limbs were embalmed in a formalin-based solution. No cadaver showed evidence of previous trauma or surgery at the femur or hip joint. The thighs were examined according to a standardized dissection protocol. Each lower limb was placed supine on the dissection table and the hip joint was approached anteriorly.

The ascending branch of the lateral

Results

In all cases, the VL was innervated in a two-fold manner: from the proximal and the distal aspect. The shortest proximal branches, which were two to four in number, had a mean length of 36 mm (range: 19–50 mm). The muscle branches to the VL and to the VI were interwoven with vessels of the ascending and transverse branches of the LCFA. The short muscle branches to the VL coursed at a mean angle of 50 degrees (range: 30–70 degrees) in an anteroposterior direction and at a mean angle of 48

Discussion

The VL flap has attracted significant interest in recent times. Initially it was used as a musculocutaneous transplant to cover regional defects in the hip, thigh and knee 7., 8., 9., 10., 11., later as a free flap for reconstruction of head and neck defects 3., 12., 13.. One of the features of the VL that renders it suitable for this purpose is its long and high-caliber vascular pedicle with little anatomical variation [1]. Donor site morbidity is reportedly low and no functional impairment

References (25)

  • J.L. Bovet et al.

    The vastus lateralis musculocutaneous flap in the repair of trochanteric pressure sores: technique and indications

    Plast Reconstr Surg

    (1982)
  • R.V. Dowden et al.

    The vastus lateralis muscle flap: technique and applications

    Ann Plast Surg

    (1980)
  • Cited by (0)

    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2015.06.047.

    View full text