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PubMed1996

The "Eve" procedure: the transfer of vascularized seventh rib, fascia, cartilage, and serratus muscle to reconstruct difficult defects.

Very few microvascular units entertain the possibility of simultaneous vascularized transfer of bone, cartilage, muscle, and gliding fascia. In exceptionally complex conditions with loss of an essential joint, adjacent bone and functional muscle, reconstruction of all these structures at once may be necessary. At the same time, gliding tissue is often required to cover tendons. Reconstruction in one sitting prevents formation of dense scar tissue due to multiple interventions. Additionally, less bone resorption is seen if vascularized bone is used. Therefore, a more undisturbed tissue composition at the end is guaranteed. Moreover, rapid rehabilitation of moving function is possible with improvement in the final result. Finally, morbidity is lowered by using a single donor site, and costs are minimalized. We present four unique cases in which the seventh rib including the costochondral junction with overlying serratus muscle, branches of the thoracicus longus nerve, and adjacent fascia have been transferred as a microvascular unit to reconstruct two severely damaged hands and two other complex injuries. In analogy with the Bible story of the creation of "the woman," it is called the "Eve" procedure. The vascularized rib was used to reconstruct a first and fourth metacarpal bone, the ascending ramus of the mandible, and the clavicle. The rib cartilage was sculptured in four cases to reconstruct an articular surface. The serratus muscle served as coverage and filling for lost tissues. It also was used as a soft bed for facial nerve repair. In two cases muscle reinnervation was performed. The fascia provided gliding tissue surrounding reconstructed tendons or articular surfaces. In all cases a high degree of function was obtained with a good cosmesis. Rehabilitation was uneventful, and no reinterventions have been necessary. Donor-site morbidity was low. Therefore, this flap proved to be successful in complex injuries where bone, cartilage, muscle, and gliding tissue were needed simultaneously. Dynamic reconstruction was attempted in two cases and was successful in one.

Adolescent↗

PubMed1996

The subcutaneous pedicle tensor fascia lata flap.

The presence of a consistent subcutaneous vascular plexus allows carrying of a distal skin island safely on the iliotibial tract. A distal skin island can be designed on the lateral thigh and can be raised on a subcutaneous pedicle that is proximally supplied by the lateral femoral circumflex artery. This technique preserves the lateral thigh skin and employs subcutaneous tunneling to overcome the traditional drawbacks of the conventional extended tensor fascia lata flap. The subcutaneous pedicle tensor fascia lata flap's sensate potential, thin skin, durable fascia, extensive reach, and 360 degree arc of rotation make it an appealing donor site for coverage of lower midsection and pelvic defects or for penile reconstruction.

Abdominal Muscles↗

PubMed1996

Advantages of autologous fascia versus synthetic patch abdominal reconstruction in experimental animal defects.

Although prosthetic patches (i.e., expanded polytetrafluoroethylene) are commonly used to repair abdominal fascial defects, autologous tissue is preferred in the presence of wound contamination. This study was undertaken to discover (1) whether fascial grafts are revascularized and incorporated as living tissue, and (2) whether fascial grafts are more resistant to bacterial contamination than prosthetic patches. In the first experiment, 18 New Zealand White rabbits underwent full-thickness resection of the central abdominal wall preserving only panniculus carnosus and skin. Six control animals had only skin repaired, and all developed large ventral hernias. Twelve animals had the defect repaired with thoracodorsal fascia patches. At 3- and 6-week intervals, no hernias were present and all patches were incorporated with minimal contraction. Fluorescein angiography verified revascularization from the surrounding abdominal wall. Next, 36 rabbits underwent similar resection followed by repair with either autologous fascia (n=18) or expanded polytetrafluoroethylene (n=17). Six rabbits of each repair group were inoculated with 10(4) Staphylococcus aureus and twelve rabbits with each repair were inoculated with 10(9) S. aureus. All rabbits receiving 10(4) S. aureus were infection-free survivors. Seven of the twelve expanded polytetrafluoroethylene-repaired animals receiving 10(9) S. aureus developed necrotizing wound infections and died. Only 2 of 12 rabbits with autologous fascia repairs died from wound sepsis and 1 died of diarrhea with a healed wound. Differences in wound infection rates achieved statistical significance, whereas survival differences approached significance (Fisher's exact test), suggesting that revascularized fascial grafts may be more resistant to bacterial contamination than expanded polytetrafluoroethylene patches at this concentration (10(9) S. aureus).

Abdominal Muscles↗

PubMed1999

Lower eyelid reconstruction with a cheek flap supported by fascia lata.

The use of a cheek rotation flap is a well-known method for reconstruction of a large defect of the lower eyelid. In this technique, a separate lining tissue supporting the cheek flap is required for full-thickness reconstruction. Previously, a chondromucosal graft or conchal cartilage has been used to support this flap. Recently, we have used a homologous or autologous fascia lata as support for the cheek flap instead of rigid tissues like cartilages. A fascia lata strip is fixed with tolerable tension to the medial canthal tendon and lateral orbital rim. The inner surface of the fascia and the cheek flap is lined with a buccal mucosa graft to decrease irritation of the conjunctiva and cornea. We present here seven patients in whom this procedure was used for lower eyelid reconstruction following resection of a malignant skin tumor. Based on follow-ups of 7 to 22 months, the functional and aesthetic results have been good in all cases. This procedure may be applicable for total or subtotal reconstruction of the lower eyelid.

Aged↗

PubMed1999

Use of a temporoparietal fascia-covered silastic implant in nose reconstruction after foreign body removal.

A total of 47 consecutive patients with paraffinoma of the nose underwent surgery for paraffinoma removal and insertion of temporoparietal fascia-covered Silastic implants between January of 1990 and June of 1996. There are several advantages to our procedure, and we obtained satisfactory outcomes with it. A bilateral alar rim incision was sufficient for our procedure. The Silastic implant could be sculptured easily, was not absorbed, and produced excellent cosmetic results. The fascia was highly bioadaptable and survived beneath the dermis through revascularization, even in the places where the paraffin material remained. The fascia reinforced the thinned skin that resulted after paraffinoma removal and, therefore, prevented exposure of the Silastic implant. The telangiectasia of paraffinoma of the nose improved in some patients after surgery.

Adult↗

PubMed2002

Prefabricated superficial temporal fascia flap combined with a submental flap in noma surgery.

The authors report their experience with a new procedure: the combination of a prefabricated superficial temporal fascia flap and a submental flap performed in an African hospital on five patients with cheek deformities caused by noma. The prefabricated superficial temporal fascia flap makes the inner lining of the cheek, which is anchored on the peripheral scar tissue. The submental flap is released during the second operation and makes the outer lining. The main advantages are the excellent aesthetic color of this last flap and the short distance between the donor site and the recipient site. Moreover, the submental flap is positioned in a single operation (when the outer-lining reconstruction is performed with a deltopectoralis flap, a third operation is necessary to cut the pedicle). None of the flaps failed, and the functional results were good. The prefabricated superficial temporal fascia flap and submental flap are versatile and reliable flaps, with reasonably long vascular pedicles, that can be used successfully, even under suboptimal conditions in weak patients with huge defects of the face.

Adolescent↗

PubMed2004

Tensile transmission across the lumbar fasciae in unembalmed cadavers: effects of tension to various muscular attachments.

STUDY DESIGN: Traction was applied to muscles attaching to the posterior and middle layers of lumbar fascia (PLF, MLF). Effects on fasciae were determined via tensile force measures and movement of markers. OBJECTIVES: To document tensile transmission to the PLF and MLF when traction was applied to latissimus dorsi (LD), gluteus maximus (GM), external and internal oblique (EO, IO), and transversus abdominis (TrA) in unembalmed cadavers. SUMMARY OF BACKGROUND DATA: A previous study on embalmed cadavers applied traction to muscle attachments while monitoring fascial movement but did not test TrA or the MLF. METHODS: The PLF and MLF were dissected then marked on eight unembalmed cadavers. A strain gauge was inserted through fascia at L3; 10N traction was applied to each muscle attachment while photographs and tension measures were taken. Movement of fascial markers was detected photographically. Fascial widths were also measured. RESULTS: Tension was clearly transmitted to fascial vertebral attachments. Tensile forces and fascial areas affected were highest for traction on LD and TrA in the PLF and for TrA in the MLF. Movement of PLF markers from tension on LD and TrA occurred bilaterally between T12 and S1. Effects from other muscles were variably bilateral, with those from GM and IO occurring below L3 and those from EO occurring above L3. Tensile forces were relatively high in the MLF and its width was less than half that of the PLF. CONCLUSIONS: Low levels of tension are effectively transmitted between TrA and the MLF or PLF. Via them, TrA may influence intersegmental movement.

Aged↗

PubMed2006

Effects of tensioning the lumbar fasciae on segmental stiffness during flexion and extension: Young Investigator Award winner.

STUDY DESIGN: Biomechanical study of unembalmed human lumbar segments. OBJECTIVE: To investigate the effects of tensioning the lumbar fasciae (transversus abdominis [TrA]) aponeurosis) on segment stiffness during flexion and extension. SUMMARY OF BACKGROUND DATA: Animal and human studies suggest that TrA may influence intersegmental movement via tension in the middle and posterior layers of lumbar fasciae (MLF, PLF). METHODS: Compressive flexion and extension moments were applied to 17 lumbar segments from 9 unembalmed cadavers with 20 N lateral tension of the TrA aponeurosis during: 1) "static" tests: load was compared when fascial tension was applied during static compressive loads into flexion-extension; 2) "cyclic loading" tests: load, axial displacement, and stiffness were compared during repeated compressive loading cycles into flexion-extension. After testing, the PLF was incised to determine the tension transmitted by each layer. RESULTS: At all segments and loads (<200 N), fascial tension increased resistance to flexion loads by approximately 9.5 N. In 15 of 17, fascial tension decreased resistance to extension by approximately 6.6 N. Fascial tension during cyclic flexion loading decreased axial displacement by 26% at the onset of loading (0-2 N) and 2% at 450 N (13 of 17). During extension loading, fascial tension increased displacement at the onset of loading (10 of 17) by approximately 23% and slightly (1%) decreased displacement at 450 N. Segment stiffness was increased by 6 N/mm in flexion (44% at 25 N) and decreased by 2 N/mm (8% at 25 N) in extension. More than 85% of tension was transmitted through the MLF. CONCLUSIONS: Tension on the lumbar fasciae simulating moderate contraction of TrA affects segmental stiffness, particularly toward the neutral zone.

Biomechanical Phenomena↗

PubMed2004

Anterior vaginal wall hammock with fascia lata for the correction of stage 2 or greater anterior vaginal compartment relaxation.

PURPOSE: We determined the efficacy of the anterior vaginal wall hammock (AVWH) using fascia lata for the correction of anterior vaginal compartment relaxation. MATERIALS AND METHODS: A total of 58 patients with stage 2 or greater anterior vaginal compartment relaxation underwent an AVWH procedure with autologous or allograft fascia lata from June 1998 to March 2001. Patients were evaluated preoperatively with a history and pelvic organ prolapse quantitative examination. Postoperatively patients were evaluated at 6 weeks, 6 months and yearly thereafter with pelvic organ prolapse quantitative staging of the anterior, middle and posterior compartments. Objective cure was defined as stage 0 or 1 relaxation. Subjective cure was defined as no symptoms of pelvic pressure or a vaginal bulge. RESULTS: Of the 69 (89%) patients who underwent surgery 58 were available for followup. Median age of the population was 61.9 years and median followup was 24.7 months (range 12 to 57). There were 11 objective failures (19%) in the anterior compartment, of which 1 (2%) was symptomatic. Two patients (4%) had enteroceles that required surgical correction. Of the patients 16 (28%) had new onset or worsening stage 2 posterior relaxation at a median of 15.2 months postoperatively, including 7 (12%) who were symptomatic and underwent subsequent repair. CONCLUSION: The AVWH procedure with fascia lata is safe and effective for correcting stage 2 or greater anterior compartment relaxation. The whole pelvic floor must be evaluated and repaired to minimize the progression of prolapse of the middle and posterior compartments.

Adult↗

PubMed2006

How can an underlaid fascia graft form the middle layer of a reconstructed tympanic membrane?

OBJECTIVE/HYPOTHESIS: Autogenous fascia is a material popularly applied as a connective tissue graft for reconstruction of the tympanic membrane. The objective was to establish how an underlaid fascia graft can form the middle layer of a reconstructed tympanic membrane. STUDY DESIGN: In the underlaid technique, the graft is laid on the medial surface of the tympanic remnant without removal of the mucous membrane, which is covered with entodermal epithelium. Interestingly earlier authors have regarded this fact as natural, though, if it is really so, it must be a result of an unexpected, special mechanism that apparently contradicts the general rules of transplantation. METHODS: Experimental operations were performed on one ear of 114 adult, male guinea pigs. The posterior quadrants of the tympanic membrane were removed, and the perforation was closed with an underlaid temporal fascia graft. Examinations were made after different survival times. The temporal bones were removed immediately, and specimens were processed histologically. RESULTS: The graft proved to be well adapted to the margin of the tympanic membrane. The epithelium of the outer surface grew both from the meatal skin and from the margin of the tympanic remnant. In connection with the regeneration of the mucous membrane of the inner surface, unexpected, special events were observed. The originally intact epithelium of the mucous membrane was annihilated, and disappeared completely. Consequently, the fibrous layer of the tympanic remnant and the graft came into direct contact and grew together. The regeneration of the mucous membrane started at the margin of the graft. CONCLUSIONS: The histologic observations described have clarified the problem of the underlaid technique.

Animals↗

PubMed2004

Relaxation incision and fascia lata grafting in the surgical correction of penile curvature in Peyronie's disease.

The purpose of this study was to evaluate the effects of treatment of curvature in Peyronie's disease with a relaxation incision and fascia lata grafting. Between 2000 and 2002, this technique was used for 12 patients with a 1-year history of plaque and curvature of more than 35 degrees. Penile degloving was performed with a circumferential incision. The tunica defect was closed with fascia lata grafting after a relaxation incision. For all patients, penile curvature was corrected and normal erections were achieved. No complication was observed in 9 to 24 months (mean, 10 months) of follow-up monitoring. The initial results suggested that tunica albuginea incision and fascia lata grafting could represent an alternative for the treatment of curvature in Peyronie's disease. Further studies are warranted.

Adult↗

PubMed2005

Reconstruction of extensive composite mandibular defects with large lip involvement by using double free flaps and fascia lata grafts for oral sphincters.

BACKGROUND: Extensive composite mandibular defects involving large lip defects are the most difficult to repair among head and neck reconstructions. This study presents the authors' approach using double free flaps and fascia lata grafts for oral sphincters. METHODS: Ten patients were studied after ablative oral cancer surgery. Segmental defects of the mandible ranged from 6 to 14 cm. Cheek defects ranged from 9 x 6 cm to 15 x 12 cm, and intraoral defects ranged from 9 x 7 cm to 16 x 16 cm. Upper lip defects ranged from 10 percent to 50 percent, and lower lip defects ranged from 50 percent to 90 percent. A fibula osteocutaneous flap was used for reconstruction of mandibular defects and intraoral lining, and an anterolateral thigh flap was used for cheek and lip defects. Then, a sheet of fascia lata graft was used to reconstruct the oral sphincter. The tendon graft was passed into the subcutaneous layers of the reconstructed lip, woven into the remaining orbicularis oris muscle of the lip, and anchored to the upper lip near the philtral columns to complete the oral ring with adequate tension. RESULTS: Free flap survival was 100 percent. Complications included one patient with neck hematoma and distal anterolateral thigh flap necrosis, three patients with neck wound infection, and one patient with osteomyelitis of the mandible. All but one patient had adequate oral competence. All the patients were able to resume a soft diet. The speech ability was nearly normal for all the patients, and all the patients had gained an acceptable appearance. CONCLUSIONS: For extensive composite mandibular defects combined with large lip defects, immediate reconstruction with double free flaps and a fascia lata graft for oral sphincter has proved to be a useful option for better functional and cosmetic results.

Adult↗

PubMed2006

Multifragmented cartilage wrapped with fascia in augmentation rhinoplasty.

BACKGROUND: Dorsal nasal contour can be improved by using fragmented or crushed cartilage grafts wrapped with fascia in patients with dorsal nasal deformities. METHODS: The authors obtain cartilage from the ear concha that is fragmented or crushed. Fascia is harvested from the temporal region. Multifragmented cartilage is wrapped with deep temporal fascia, making a roll. After creating a cavity in the nasal dorsum, the bone is rasped and the combined roll graft is introduced, and appropriate modeling of the graft is mandatory. The authors have operated on 115 patients with this procedure, 68 primary operations and 47 secondary operations, over a 13-year period. RESULTS: In the great majority of cases, results were excellent. To avoid deviation of the roll graft, it is important to prepare a straight cavity. Especially in secondary cases, seroma is manifested by swelling and reddish skin color, which is removed with a 2-mm incision made with a no. 15 knife and constant pressure over the nose for some minutes. The authors have observed only five primary cases with seroma and 13 secondary cases. CONCLUSIONS: This procedure in the authors' hands has given magnificent aesthetic long-lasting results and a "natural appearing" outcome.

Adult↗

PubMed2003

Hatchet-shaped tensor fascia lata musculocutaneous flap for the coverage of trochanteric pressure sores: a new modification.

The tensor fascia lata flap is one of the appropriate choices for the coverage of trochanteric pressure sores. The authors designed a new, hatched-shaped tensor fascia lata musculocutaneous flap with distal Z-plasty closure and applied it to four trochanteric defects in 4 patients. Satisfactory results were obtained in all patients. The hatchet-shaped tensor fascia lata musculocutaneous flap is very safe, reliable, and practical. Designing the flap in a hatchet shape allows one to use the proximal and well-vascularized portion of the flap in the trochanteric pressure sore area. Another important advantage is the possibility of reuse resulting from recurrence. Prevention of a "dog-ear" deformity at the recipient site provides a smooth contour on the lateral aspect of the thigh. Another advantage is the tension-free Z-plasty closure of the donor site without need of grafting.

Adolescent↗

PubMed2005

Use of fascia component of the anterolateral thigh flap for different reconstructive purposes.

The anterolateral thigh flap is commonly used for reconstruction of soft-tissue defects located at various sites of the body. This versatile flap offers many advantages to the reconstructive microsurgeons for the treatment of difficult defects. From 2000 to 2005, 70 anterolateral thigh flaps were transferred to reconstruct soft-tissue defects. We retrospectively reviewed these patients and found that the fascia lata component of the flap was used for different purposes in 19 patients. The fascia lata component of the flap was used for suspension of the flap in lip reconstruction in 12 patients, for reconstruction of dural defect in the scalp in 2 patients, for reconstruction of tendon defects in the forearm in 3 patients, and for reconstruction of fascia defect in the abdominal wall in the remaining 2. Complete loss of the flap was seen in an anterolateral thigh flap (5.2%) that was used for lower lip reconstruction. One flap necrosed partially (5.2%), and it was treated with surgical debridement and transposition of latissimus dorsi musculocutaneous flap. The objective of this study is to focus on the reliability of the fascial component of the anterolateral thigh flap. Although many authors have described other advantages of the anterolateral thigh flap extensively, this peculiarity has not been stressed adequately. Anterolateral thigh flap offers a thick and vascular fascial component with large amounts that can be used for different reconstructive purposes, and it should be taken into consideration as an important advantage of the flap, together with other well-known advantages.

Adolescent↗

PubMed2006

Free tensor fascia lata perforator flap as a backup procedure for head and neck reconstruction.

Free tissue transfer is an essential part of the head and neck reconstruction. Despite several flap options, free perforator flaps have become very popular for head and neck. Anterolateral thigh perforator flap has multiple advantages among other options and is preferred by most of the reconstructive microsurgeons. Besides its advantages, sometimes it is impossible to harvest an anterolateral thigh perforator flap, and the surgeon has to shift to another option. Between January 2002 and June 2005, 5 tensor fascia lata perforator flaps were used for head and neck reconstruction because anterolateral thigh perforator flap could not be elevated due to absence or insufficient musculocutaneous perforators. Only 1 flap was reexplored and salvaged by redoing the venous anastomosis. All flaps survived without any other problem. Donor sites were covered by split-thickness skin grafts in 4 patients and closed directly in 1 of them. Doppler examination is important in planning of anterolateral thigh perforator; if the signals of the perforators are absent or very weak, the surgeon can shift to another flap. This decision may also be made during the operation when insufficient perforators are seen. Based on our experience, tensor fascia lata perforator flap is a safe alternative when anterolateral thigh perforator harvest is not possible. Tensor fascia lata perforator flap can be harvested from the same anatomic region with almost same morbidity.

Adult↗

PubMed1997

Lip augmentation with preserved fascia lata.

BACKGROUND: Presently available techniques for lip augmentation have an assortment of limitations. OBJECTIVE: To provide a safe, reliable method of lip augmentation on a long-term basis. METHODS: Through a stab incision in each quadrant, chips of human cadaver, banked fascia lata were inserted into intralabial pockets. RESULTS: Fascia lata grafting proved to be a simple effective technique of lip enhancement. Over the period of follow-up, enhancement was evident in most cases and no allergic reactions or infections occurred. Lip motion was satisfactory and paresthesia were minor. CONCLUSIONS: Fascia lata grafting is a simple, controlled technique for graded lip enhancement.

Fascia Lata↗

PubMed1984

Congenital fascial dystrophy--a noninflammatory disease of fascia: the stiff skin syndrome.

Our patient's disease was similar to the persons with stiff skin syndrome described by Esterly and McKusick (1). Stony-hard indurations of the skin and deeper tissue were generalized but most pronounced in the buttocks, thighs, and legs, with limitation of joint mobility and particularly extensive contractures in the lower limbs. The disease was noticed when the patient was 18 months old, and was nonprogressive within a follow-up period of 12 years. There was no visceral involvement except functional impairment of the lungs, probably due to thickened thoracic fascia. Biochemical, histologic, and electron microscopic studies of the skin and muscle were not remarkable. In skin fibroblasts, collagen synthesis was increased and was accompanied by elevated activity of the prolylhydroxylase and lysylhydroxylase, whereas the transferases were not altered. The fascia was considerably thickened, but contained no inflammatory infiltrates. The significant electron microscopic finding was the presence of amianthoid-like collagen fibers in the fascia.

Biopsy↗