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PubMed1990

Secondary ear reconstruction using deep temporal fascia after temporoparietal fascial reconstruction in microtia.

As anatomical study of the temporoparietal fascia (TPF) has advanced, there have been several reports on one-stage reconstruction of microtia using the TPF. To our knowledge, however, no report has described how to do secondary reconstruction if partial necrosis occurs, exposing the cartilage frame. Recently we treated a case of microtia that had become partially necrotic after the patient underwent one-stage reconstruction using the TPF. The deep temporal fascia was elevated to cover the necrotic portion and ensure successful placement of the skin graft. This technique greatly enhances one-stage reconstruction of the auricle using a TPF flap.

Adult↗
PubMed1990

Combined tensor fasciae latae musculocutaneous flap and sartorius musculocutaneous flap for the repair of wide defects of the lower leg.

The tensor fasciae latae musculocutaneous flap has great advantages for reconstruction of the abdominal wall, but the medial border of its territory is limited to the thigh. In order to expand the territory, a combined tensor fasciae latae musculocutaneous flap and sartorius musculocutaneous flap was devised. This flap was successfully used to resurface a large defect in the lower leg as a distally based musculocutaneous flap. The advantages of this flap are its extremely large territory, the fact that total necrosis of the flap cannot occur, and that as a proximally or distally pedicled flap it is suitable for large defects in the abdominal wall, lower leg, and gluteal region.

Adult↗
PubMed1991

Double-layered free temporal fascia flap as a two-layered tendon-gliding surface.

We report the use of a two-layered free fascial flap consisting of temporoparietal and deep temporal fascia based on a single vascular pedicle, the superficial temporal artery and vein. The flap was used to reconstruct an extensive degloving injury of the dorsum of the hand, in which multiple intact extensor tendons lay fully exposed on all sides, with exposed bone beneath them. By sandwiching the tendons between the layers of vascularized fascia, gliding surfaces were provided, both superficial and deep to the exposed tendons. The single-stage reconstruction was completed with a split-thickness skin graft. The patient returned to heavy manual work within 12 weeks of injury. He obtained an excellent range of movement without the need for tenolysis.

Adult↗
PubMed2000

Neophalloplasty in female-to-male transsexuals with the island tensor fasciae latae flap.

In the past 60 years, several different procedures have attempted to achieve a postoperative neophallus that is as aesthetic and as functional as possible after penile amputation or sex reassignment. Recently, with improvements in free tissue transfer and microvascular technique, many free flap procedures have been developed with the goal of an aesthetically acceptable neophallus of adequate bulk that enables urination in a standing position and sexual intercourse, with minimal functional and aesthetic donor-site defects. Most authors currently agree that the method of choice for penile reconstruction is microsurgical free tissue transfer, although it does not always fulfill all of the aforementioned goals in a predictable manner. In fact, complete urethroplasty, penile rigidity, and donor-site disfigurement remain challenges, thus making this operation one of the most difficult in plastic surgery. The vascular anatomy of the lateral circumflex femoral artery, which we studied in 1991 with the anatomic dissection of 27 cadavers, gave us the idea to use a long tensor fasciae latae neurovascular island flap as a donor source for neophalloplasty. Grounds for the procedure and its surgical planning have been carefully evaluated with 10 additional fresh cadaver dissections. Since 1991, we have performed five neophalloplasties using this procedure; all patients were female-to-male transsexuals. In four cases, the healing was uneventful; in one case, there was a marginal necrosis of the flap because of poor venous drainage, probably from a twisting of the pedicle. The island tensor fasciae latae provides a safe and sensate flap for phalloplastic procedure and leaves a less conspicuous donor scar.

Adult↗
PubMed2006

Reconstruction of acquired partial auricular defects by porous polyethylene implant and superficial temporoparietal fascia flap in adult patients.

BACKGROUND: Six patients with acquired partial auricular defects with various causes were treated with porous polyethylene implants and superficial temporoparietal fascia flaps. METHODS: The mean of the auricular defects was 39 percent (range, 27 to 61 percent). The defects were situated in different parts of the auricles. Helical rim implants and/or ultrathin sheet implants were used as frameworks and covered with superficial temporoparietal fascia flaps. RESULTS: The symmetry of the reconstructed ears was satisfactory, and the cosmetic appearance was acceptable for all patients. Neither skeletal collapse nor flattening of the lateral helical rim was seen in any of the patients. Minor revision was required for debulking of the pedicle in one early patient. No additional complications were encountered. CONCLUSION: The authors recommend using this single-stage combined technique for reconstruction of various types of partial auricular defects in adult patients.

Adult↗
PubMed2003

Abdominal wall reconstruction with the free tensor fascia lata musculofasciocutaneous flap using intraperitoneal gastroepiploic recipient vessels.

The authors report their experience with a method for definitive abdominal wall reconstruction using the free tensor fascia lata musculofasciocutaneous flap anastomosed to the intraperitoneal gastroepiploic vessels. This is a single-stage reconstruction capable of reconstructing reliably a full-thickness defect involving any region of the abdominal wall. The fascial component of the flap reconstructs the abdominal wall with like tissue, and the cutaneous portion of the free tensor fascia lata provides a durable and aesthetically acceptable external cover. The intraperitoneal gastroepiploic artery and vein were the first-choice recipient vessels used in all three patients. These intraperitoneal recipient vessels allow uninterrupted fascial closure, restoring structural integrity to the abdominal wall, and allow the use of free flaps with short vascular pedicles. The authors present a series of three cases of full-thickness upper and lower abdominal wall reconstruction using this method, presenting its advantages compared with other methods.

Abdominal Neoplasms↗
PubMed2007

Optimization of microsurgery: improved coverage of the latissimus dorsi vascular pedicle with vascularized serratus fascia.

The latissimus dorsi free flap is a workhorse for extremity reconstruction. One of its benefits is a long vascular pedicle that spans the zone of injury. However, it may be difficult to adequately cover this pedicle. Direct closure may be too tight, and skin grafting over the pedicle risks exposure if graft take is poor. We report a technique in which the serratus branch of the thoracodorsal artery and its overlying fascia are harvested en bloc with the thoracodorsal artery and latissimus muscle. This provides 2 flaps on a common pedicle that can easily be rotated to allow positioning and insetting. We successfully used this technique in the reconstruction of both upper and lower extremities. The serratus fascia provides excellent padded covering and is a good bed for skin grafting. The versatility of this hybrid flap will allow its use in a range of complex reconstructive procedures.

Adult↗
PubMedDate not supplied

Plantar fascia release for chronic plantar fasciitis in runners.

Plantar fascia release has been suggested to be of benefit for patients with symptoms of chronic unresponsive plantar fasciitis. However, results of this procedure have not been published. We performed 11 releases in 9 long-distance runners whose symptoms had been present for an average of 20 months and had not responded to nonsurgical treatment. The results of these operations were excellent in 10 feet and good in 1 foot at an average follow-up time of 25 months. Eight out of nine patients returned to desired full training at an average time of 4.5 months. Histologic examination of surgical biopsy specimens from these patients showed collagen necrosis, angiofibroblastic hyperplasia, chondroid metaplasia, and matrix calcification. Plantar fascia release was an effective procedure for these patients.

Adult↗
PubMed2003

Endoscopic plantar fascia release: a case series.

Plantar fasciitis is a common disabling condition that can be recalcitrant to treatment. Endoscopic Plantar Fascia Release (EPFR) has received greater attention in recent years as a viable, and possibly superior, alternative to established open procedures for the treatment of plantar fasciitis. In a series of 17 patients (17 feet) with follow-up over an average of 16 months, we report a two portal endoscopic technique of partial release of the plantar fascia, as a successful, safe and reliable procedure for the treatment of plantar fasciitis in the patient group selected. The surgical results of 17 EPFR's performed by the same surgeon were reviewed. All patients had preoperative symptoms of subcalcaneal heel pain for greater than 12 months, all having undergone nonsurgical measures for at least 12 months. Of 17 feet, all reported marked improvement of preoperative symptoms within two months. Patients' subjective assessment of the procedure was strongly supportive, 100% totally satisfied or satisfied with only minor restrictions. Postoperatively, 82.4% reported mild or no pain, and 100% had improvement in walking distance. Complications all resolved within two to six months; there were no re-operations and no infections.

Adult↗
PubMed2004

The efficacy of continuous fascia iliaca compartment block for pain management in burn patients undergoing skin grafting procedures.

UNLABELLED: Postoperative pain from split skin donor sites is often more intense than the pain at the grafted site. In this prospective, randomized, double-blind study we assessed the efficacy of a continuous fascia iliaca compartment block (FICB) in reducing the pain at the thigh donor site. Twenty patients, with a total burn surface area of 16% +/- 13% (mean +/- SD) were randomized 1:1 to receive either ropivacaine 0.2% or saline 0.9%. All patients received a general anesthesic followed by preincision continuous FICB with 40 mL of the randomized solution, then an infusion of 10 mL/h of either ropivacaine or saline until the first dressing change (72 h later). Postoperative analgesia consisted of propacetamol 2g/6h, IV patient-controlled analgesia of morphine chlorhydrate (2 mg/mL), and morphine hydrochlorate 0.5 mg/kg PO once 60 min before first dressing change. The visual analog scale (VAS) scores were compared using the Mann-Whitney U-test preoperatively, 24 and 48 h postoperatively, and during the first dressing change. The cumulative morphine consumption was compared with repeated-measures analysis of variance followed by Scheffé's method if indicated. Patients with continuous FICB had significantly reduced postoperative morphine consumption at all time points (23 +/- 20 versus 88 +/- 29 mg after 72 h, study versus control groups, respectively; P < 0.05). In both groups, VAS scores remained low but were only significantly lower for patients with continuous FICB during the first dressing change (3 [1] versus 7 [3]; median [interquartile range]; P < 0.05). We conclude that continuous FICB is an efficient method for diminishing pain at the thigh donor site. (250 words) IMPLICATIONS: Postoperative pain at the split skin donor sites is often more intense than the pain at the grafted site. This prospective, randomized, double-blind study assessed the efficacy of a continuous fascia iliaca compartment block in reducing the pain at the thigh donor site.

Adolescent↗
PubMed1992

Revisional Surgery for Severe Obesity with Fascia Banded Stoma Roux-en-Y Gastric Bypass.

The fascia banded stoma Roux-en-Y gastric bypass (RYGBP) has been effective both as a primary and revision operation for severe obesity or failure of another operation. Since May 1984, 361 primary and 100 revisional fascia banded RYGBP operations have been reported. Weight loss achieved a mean body mass index of 30 for primary and 31 for revision patients at most recent follow-up of 3-6 years (mean 4.3 years) postoperatively. Mean overweight was 28% for primary, and 34% for revision patients. Eighty percent of primary and 79% of revision patients were within 50% of ideal weight. Revision rates for these patients were 0 for primary and 1% for revision patients. Operative mortality was 0 for primary and 1% for revision patients. Since morbidity and mortality, although low, are higher for revision than primary surgery, it is important to use an effective primary operation.

Journal Article↗
PubMed2006

Skin and abdominal fascia melanization in broiler chickens.

Increased trimming and consequent carcass downgrade was experienced in a broiler flock. Condemned birds had gray to black pigmentation of the subcutaneous tissue and fat of the abdomen, and bluish pigmentation of the shanks. Histopathology revealed accumulation of melanin in these tissues. No significant bacteria were isolated. Accumulation of melanin in the skin and fascia is because of the cumulative and interactive effects of several genes. Additionally, pigmentation of abdominal fat has a high correlation with accumulation of melanin in the skin of the shanks. Although melanization of the skin and abdominal fascia is not harmful to people, it may cause severe economic losses to the producer.

Adipose Tissue↗
PubMed1996

Effectiveness of fibronectin in myringoplasty using temporal fascia.

A study of myringoplasty with temporal fascia homograft employing fibronectin was conducted in 14 ears in which the same myringoplasty procedure without fibronectin (1-5 times) had failed to afford closure of tympanic membrane perforation. Closure was obtained in eight ears. These results suggest that fibronectin is effective in myringoplasty using treated temporal fascia homograft.

Adult↗
PubMed1986

The distal pedicle fascia flap of the leg.

An anatomical study was undertaken in order to obtain data on the vascularity of the posterior fascia of the leg. Injection studies revealed there to be three "distal" pedicles; one between the peroneal and soleus muscles, emerging 10-15 cm above the lateral malleolus and two other, smaller ones, 5 cm above the medial and lateral malleolus. Clinical experience included seven cases: five with trauma and two with varicose ulcers. We had good results in five, a partial loss in one and a total loss in one. The distal pedicle fascia flap should be considered an alternative method for repairing defects in the lower third of the leg.

Adolescent↗
PubMed1983

Composition of surface layers in unfixed autologous fascia lata heart valve grafts. A transmission electron microscopical study.

Sixty-nine patients underwent aortic valve replacement with frame mounted non-fixated fascia lata grafts. Nine patients still have their fascia lata valve in place after a period of between 9 to 11 years. Fifty-two grafts were available for histo-pathologic examination. The mechanism of valve thickening was studied by transmission electron microscopy (TEM). The major factor contribution to the thickening seems to be a surface accumulation of complex proteins, fibrin and platelets. Within the valvular tissue itself, subcellular degenerative products in cell cytoplasm, the interstitium and in the sub-surface layer also contributed. The thickening never exceeded one fifth of the original thickness of the valve.

Aortic Valve↗
PubMed2000

[Functional reconstruction of the hand after electrical injury with a composite flap of the vessel nerve and fascia].

OBJECTIVE: In the case of electrical injury of the wrist, it may be necessary to transplant a long tendon, nerve and vessel for functional reconstruction. But the fibrosis of the recipient bed often makes the survival and functioning of the grafts difficult. This clinical study was to solve the problem. METHODS: A composite flap was designed consisting of the small saphenous vein, the sural nerve and the fascia of the lower-leg. The small saphenous vein and the nerve were transplanted to repair the defects of the radial or ulnar artery and the media nerve. The fascia was used to reconstruct the recipient bed for tendon grafting. RESULTS: Six cases were treated with this method with success in 5 cases. 5 to 18 months' follow-up revealed restoration of sensation and finger flexion in the 5 cases. CONCLUSION: This method is effective in alleviating tendon adhesion, accelerating functional restoration of the injured hand.

Adolescent↗
PubMed2004

Ten-year follow up after autologous rectus abdominis fascia sheath patch repair of aortic root abscess.

The infection of aortic annular tissue is a life-threatening complication of aortic valve endocarditis, the survival of which is usually with immediate surgical intervention. Optimal surgical techniques include aortic valve replacement with an aortic or pulmonary homograft, and reconstruction of cardiac structures with autologous pericardium. Here, two cases are reported with extensive aortic root infection and partial left ventricular-aortic dehiscence, who underwent left ventricular outflow tract reconstruction using a rectus abdominis fascia patch and aortic valve replacement with a Carpentier-Edwards porcine bioprosthetic graft. Both patients did well perioperatively and for 10 years postoperatively. The results may encourage alternative surgical strategies to be used when aortic valve homografts or autologous pericardium are unavailable. Notably, autologous rectus fascia patches showed excellent performance in the reconstruction of left ventricular outflow tract destruction associated with aortic root abscess.

Abscess↗
PubMed2000

Harvesting large fascia lata sheaths: a rational approach.

This article describes an "S"-shaped incision for the open approach of harvesting wide sheets of fascia lata with reference to the important anatomical landmarks. Forty-three patients required dural replacement in cases of tumors, trauma, or cerebrospinal fluid leak involving the anterior skull base. The extended anterior suberanial approach to the skull base was used for all patients. Early functional status of the operated limb in seven of the patients treated first was assessed by physical examination and then by means of the computerized Kinetic Communicator (Kin-Com; Medex Diagnostics, Canada) dynamometer. None of these patients suffered any significant immediate complications and had good results at the preliminary functional assessment. All other patients were evaluated clinically for functional deficits of the operated lower limb to further assess its morbidity. The technique described herein was shown to enhance the case and control of fascia lata harvesting. It affords low complication rate and donor limb morbidity. Donor limb morbidity did not have any deleterious effect on the patients' normal daily activities and only became apparent during strenuous physical activity.

Journal Article↗