The composite vastus medialis–patellar complex osseomuscular flap as a salvage procedure after complex trauma of the knee—an anatomical study and clinical application  E. Polykandriotis, R. Stangl, H.H. Hennig, J.K.M. Lennerz, W.M. Frank, M.D. Loos, R.E. Horch  British Journal of Plastic Surgery  Volume 58, Issue 5, Pages 646-651 (July 2005) DOI: 10.1016/j.bjps.2005.01.008 Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 1 X-ray of the knee region directly after trauma. The dia- and supracondylar fractures are evident. British Journal of Plastic Surgery 2005 58, 646-651DOI: (10.1016/j.bjps.2005.01.008) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 2 X-ray directly postoperatively after knee fusion with external fixator and screw fixation of the vascularised patella. A. Supracondylar fracture. B. Patella. British Journal of Plastic Surgery 2005 58, 646-651DOI: (10.1016/j.bjps.2005.01.008) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 3 Complete healing of the knee fusion, the supracondylar fracture and the patella, 16 weeks after knee fusion with vascularised patella. Anteroposterior view. British Journal of Plastic Surgery 2005 58, 646-651DOI: (10.1016/j.bjps.2005.01.008) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 4 Complete healing of the knee fusion, the supracondylar fracture and the patella, 16 weeks after knee fusion with vascularised patella. Profile view. British Journal of Plastic Surgery 2005 58, 646-651DOI: (10.1016/j.bjps.2005.01.008) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 5 Full skin coverage of the lateral aspect of the knee and distal thigh 8 months after trauma. British Journal of Plastic Surgery 2005 58, 646-651DOI: (10.1016/j.bjps.2005.01.008) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 6 The composite vastus medialis–patellar complex osseomuscular flap. Vascular anatomy. 1. Dominant pedicle: a proximal branch from the superficial femoral artery. 2. Superficial femoral artery. 3. Descending genicular artery. 4. Osteoarticular branch. British Journal of Plastic Surgery 2005 58, 646-651DOI: (10.1016/j.bjps.2005.01.008) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 7 The ‘IPP-DGA’ distance correlates well with ‘Height’ (n=12, p=0.009). ‘Height’ is the distance between the big toe and the top of the skull. IPP is the inferior-patellar-pole. DGA is the origin of the descending genicular artery from the femoral artery. British Journal of Plastic Surgery 2005 58, 646-651DOI: (10.1016/j.bjps.2005.01.008) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions

Figure 8 Relation of apparent to real injury in high energy traumata of the lower extremity (after Yaremchuk und Brumback). A. Area of apparent injury. B. Area of real injury. British Journal of Plastic Surgery 2005 58, 646-651DOI: (10.1016/j.bjps.2005.01.008) Copyright © 2005 The British Association of Plastic Surgeons Terms and Conditions