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The tensor fascia lata muscle flap is a Mathes–Nahai type I (one single dominant pedicle). While this muscle flap can be used for a variety of reasons, we choose this flap mainly for three reasons: (a) to reconstruct groin or pelvic defects (including the area of the iliac wing) as a V–Y advancement flap or as a rotational flap, (b) as part of a chimeric free flap when a targeted muscle reinnervation is being performed, and (c) when a knee soft tissue reconstruction with a concurrent patellar tendon reconstruction is needed, as the iliotibial tract can be transformed into a relative strong tendinous structure. While the flap can be harvested as a muscular flap only, we almost always harvest it as a musculocutaneous flap, with the skin overlying the muscle in the lateral aspect of the leg. Two-thirds of the proximal skin from the anterior superior iliac spine (ASIS) to the knee can be safely harvested without concerns; however, an extended skin paddle can also be harvested. If the skin paddle harvest extends distally to the proximal two-thirds, then one needs to understand that the blood supply to the distal aspect is often unreliable. As a result, a delay procedure is recommended in these cases. The skin paddle design can be made in a V or a more circular pattern depending on the reconstructive needs and the shape of the wound that needs to be covered. It needs to be noted that the muscle, even though small, is significantly bulky and that needs to be taken into account when deciding the suitability of the flap for the proposed reconstruction. The vascular pedicle anatomy is consistent with adequate length (6 cm) and good diameter (2 mm), making it an easy target for microvascular anastomosis. The functional donor site defect morbidity is minimal; however, it can leave a significant cosmetic defect, which needs to be discussed, especially with female patients.

The latest procedural statistics from the American Society of Plastic Surgeons rank liposuction as the second most common aesthetic surgical procedure performed by board certified plastic surgeons. In the author’s experience, 40% of liposuction cases involve the extremities and the great majority of these cases are carried out on female patients. Individuals who are close to their ideal body weight and have a disproportionately high distribution of fat in the lower extremities in relation to their trunk are still the best candidates for thigh liposuction. Poor patient selection and overextraction resulting in excessive skin laxity and contour deformities are the most common causes of inferior aesthetic results following contouring of the thighs. There are five zones of adherence in the thighs and these are areas that should be avoided during liposuction procedures: (1) the gluteal crease, (2) the posterior distal thigh above the popliteal crease, (3) the lower lateral thigh area of the iliotibial tract, (4) the lateral gluteal depression, and (5) the mid-medial thigh area. The author’s approach to thigh contouring involves the use of VASER-assisted liposuction since it is associated with less blood loss, good skin retraction, and a relatively comfortable postoperative course for the patient. Patients with significant skin laxity are best treated with thighplasty or VASER-assisted thighplasty depending on the degree of lipodystrophy present. Preoperative planning of upper extremity contouring involves a comparison of the relationship between the excess arm fat and the skin envelope of the arm. In cases of arm lipodystrophy with good skin tone, VASER-assisted liposuction allows for easier fat extraction with good skin retraction. Poor skin tone, regardless of the amount of arm fat, usually dictates that an open tightening procedure be performed in order to properly contour the arm. Patients with poor skin tone and a significant amount of excess arm fat are best treated by a VASER-assisted brachioplasty.

The anterolateral thigh (ALT) compartment has four anatomical limits: the rectus femoral muscle medially, the iliotibial tract laterally, the anterior superior iliac spine (ASIS) inferiorly, and the lateral femoral condyle inferiorly. A superficial fascia, with subcutaneous tissue, covers the entire muscular structure. The deepest fascia in the lateral part is formed by the tensor muscle of the fascia lata connected with the fascia lata to compose the iliotibial band, which provides stability in the knee joint.

The pivot shift is a dynamic test of knee laxity which correlates with subjective sensations of knee instability. As the knee flexes from full extension, the tibia subluxes, both in anterior translation and internal rotation, so that the lateral femoral condyle moves ‘downhill’ to the posterior edge of the tibial plateau under the influence of the compressive joint load. With further knee flexion, the tension in the iliotibial tract eventually overcomes the load which has maintained the subluxation and then the tibia is suddenly reduced to its anatomical articulation. Thus, the envelope of laxity of the pivot shift shows a pattern of simultaneous gradual pathological anterior translation and internal rotation, occurring over approximately 35° of knee flexion, followed by a relatively sudden reduction, which is a falling back posteriorly and externally to the anatomical position. It is desirable to measure both tibial translations and rotations to understand each injured knee, because differing patterns of injury may explain the wide range of tibiofemoral movements, such as the relative amount of tibial translation versus rotation, that have been reported during the pivot shift.

Fascia lata is a band of tissue that comprises the deep fascia of the lower limb. It is attached superiorly to the sacrum and coccyx and laterally to the iliac crest. Anteriorly, the fascia lata is attached to the inguinal ligament and the superior ramus of the pubis.

An 83-year-old woman underwent a left cruciate-substituting guided-motion total knee replacement (TKR) without primary patellar resurfacing (Journey®, Smith&Nephew, Switzerland) due to end-stage osteoarthritis.

A 75-year-old woman underwent a cruciate-retaining fixed-bearing total knee replacement (TKR; Triathlon, Stryker, Switzerland) of the left knee without primary patellar resurfacing. The patient presented to our clinic 18 months after primary TKR due to persistent left-sided lateral knee pain.

The posterolateral corner (PLC) of the knee is a complex functional unit consisting of several important ligaments and is responsible for posterolateral stabilization of the joint [1]. There is some variability in the definition of the posterolateral corner (PLC) in the literature, but most descriptions include the lateral collateral ligament (LCL), the anterior oblique band (AOB), the popliteal tendon (PT) with the anterolateral ligament (ALL), the popliteomeniscal fascicles, and the popliteofibular ligament (PFL), as well as the posterolateral capsule including the arcuate ligament (AL) and the fabellofibular ligament (FFL) [1]. These structures are reinforced by the biceps femoris tendon and the iliotibial tract.