Use of Vastus Medialis Rotational Muscle Flaps to Cover Infected and Exposed Reverse Saphenous Vein Graft Following Traumatic Femoral Artery Injury

Use of autologous and prosthetic grafts is one of the key concepts in open vascular reconstruction surgery. Despite taking different measures, there is still a chance of vascular graft infections due to various patient and surgery-related factors. Some of the vascular grafts might lose the overlying soft tissue cover, leading to graft exposure. Both these complications pose a significant threat to the graft viability. A graft with threatened viability poses a risk to the supplying end organ, limb, or life. Therefore, vascular graft exposure and graft infections should be promptly addressed and managed aggressively. Proper debridement of infected soft tissue, targeted antimicrobial therapy, and achieving soft tissue cover are the main principles of managing graft infections. Negative pressure therapy over temporary soft tissue cover and vascularized muscle flaps is the mainstay of achieving sustained soft tissue cover. This case report describes a patient with an open fracture and a vascular injury complicated with repeated graft trauma, infection, and graft exposure being successfully managed by the use of vascularized muscle flaps. It suggests the potential use of vastus medialis rotational flaps to achieve the soft tissue cover over the vascular exploration sites in the medial aspect of the lower part of the thigh.