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Reconstruction of extensive abdominal wall defects is difficult in many cases. We performed peritoneal reconstruction by free fascia lata transplantation and abdominal wall reconstruction with an extended trilobed rectus abdominis musculocutaneous flap. Firstly, the peritoneum is closed by free fascia lata transplantation. Then, the rectus abdominis musculocutaneous flap is prepared adjacent to the abdominal wall defect and centering on the rectus abdominis muscle body on the contralateral side. The rectus abdominis musculocutaneous flap is elevated with the first flap toward the xiphoid process on the cranial side, the second flap toward the middle axillary line on the lateral side, and the third flap toward the lower abdominal region on caudal side as an extended trilobed rectus abdominis musculocutaneous flap with a deep inferior epigastric arteriovenous pedicle and transposed to the abdominal wall defect. This method was applied to a full-thickness abdominal wall defect produced by colon cancer resection in two patients. Case 1 was a 10 × 15-cm full-thickness right abdominal wall defect, and case 2 was an 8 × 14-cm full-thickness left abdominal wall defect. The postoperative course was favorable, and no complication, such as abdominal incisional hernia, developed. The rectus abdominis musculocutaneous flap could be collected from the same surgical field, and its preparation as an extended musculocutaneous flap widely beyond the range of the muscle body was possible. By preparing a trilobed flap, the flap-donor region could also be easily closed. This method may be useful for reconstruction of extensive full-thickness abdominal wall defects. Level of Evidence: Level V, therapeutic study.

Several grafting materials have been used in revision rhinoplasty to correct overresected dorsum. Autologous materials are generally preferred, but have the drawbacks of additional surgical time and donor site morbidity. Tutoplast-processed fascia lata (TPFL) offers a commercially available alternative to autologous fascia grafts. We reviewed the results of 42 revision rhinoplasty procedures that used TPFL with or without autologous cartilage to correct overresected dorsum. Forty-two patients with overresected dorsum underwent revision rhinoplasty with multilayered TPFL at our institution between 2005 and 2012. Saddle nose deformities were classified into one of three types, according to severity. Surgical results were evaluated as excellent, good, or fair by an otolaryngologist who compared preoperative photographs with pictures taken at final follow-up. Surgical complications were analyzed. Of the 42 patients who underwent rhinoplasty with multilayered TPFL, 36 were treated with TPFL alone, while autologous cartilage was used concurrently in six. Twenty-six (62 %) of the patients showed excellent aesthetic improvement, 11 (26 %) showed good improvement, and five (12 %) showed fair improvement. There were no major complications. Minor complications included edema in six patients, major resorption in three, and minimal resorption in nine. Patients with mild or moderate saddle nose deformity had better surgical results than those with more severe deformity. There are many possible methods to correct overresected dorsum. Multilayer TPFL is safe alternative to autologous rib cartilage grafts. Level of Evidence: Level IV, therapeutic study.

Thoracoabdominal defects usually result from trauma, tumour resection, infection or they may be congenital. Reconstruction of these defects is absolutely necessary, for function preservation, especially in cases of full-thickness and complex defects. Use of flaps or combination of flaps and alloplastic materials is usually the key to a successful reconstruction. Several different methods for the reconstruction of thoracoabdominal defects have been described with very good to excellent results. We present the case of a 69-year-old patient who presented to our unit with a rapidly growing mass on the right lateral thoracoabdominal wall. After full-thickness tumour resection, the defect was reconstructed by using a free anterolateral thigh flap along with the central part of the vastus lateralis muscle and a larger surrounding part of the fascia lata. The ipsilateral greater saphenous vein was dissected to mid-calf, reversed and anastomosed to the femoral artery in an end to side fashion thus creating an arteriovenous loop which was later divided in the middle, for anastomoses with flap’s vessels. Flap survived in its entity without any complication from the donor or the recipient site. The patient had an uneventful recovery and left the hospital 7 days later. No abdominal wall herniation was noted on 3 months of follow-up. Single-stage reconstruction of complex lateral thoracoabdominal defect by using free anterolateral thigh together with a part of the fascia lata and an arteriovenous loop might be a reliable solution in cases where proper vessels are not available for anastomosis or other options are not feasible.

Current methods of autogenous fascia lata harvest for the static surgical treatment of longstanding facial paralysis often result in a high level of donor site morbidity and unsightly visual scarring on the patient’s lateral thigh due to the open technique traditionally used. With endoscopic access already being widely used in other areas of plastic and reconstructive surgery, it was hypothesised that it would be feasible to retrieve sufficient amounts of fascia lata endoscopically to achieve satisfactory static facial reanimation. In the first instance, we used an 85-year-old female cadaver selected from the regular stock at the University of Glasgow to establish if retrieval of fascia lata endoscopically was feasible. Through two small incisions on the lateral aspect of the thigh (proximally and distally), we successfully retrieved a strip of fascia lata measuring 9 × 2.5 cm. Due to the ease of access, one of the authors then performed endoscopic retrieval of the fascia lata for five patients requiring static facial reanimation. It was shown that in all cases it was feasible to retrieve sufficient amounts of fascia lata to perform static facial reanimation with a similar operating time compared to the open technique which is currently used. In addition, there were no complications related to donor site morbidity. We have shown that endoscopic access to the fascia lata for use in static facial reanimation is perfectly feasible, with no complications, minimal scarring and no significant increase in operating time compared to the traditional open technique currently used. Level of Evidence: Level V, therapeutic study.

Large total or subtotal defects of the lower lip pose a significant challenge for the reconstructive surgeon. The functional reconstructing of the oral sphincter is critical for oral competence and prevention of drooling, improving speech, and eating as well as for esthetic aspects. The authors present a case of a large partial thickness defect of the lower lip and chin following an excision of a neglected basal cell carcinoma. The defect was reconstructed with an anterolateral thigh free flap. Subsequently, due to oral incompetence and lip ectropion, a tensioned interposition unfurled sheet of fascia lata free graft and a composite V-Y advancement flap were utilized to reconstruct the continuity of the oral ring and correct the lower lip ectropion. The procedure resulted in a satisfactory dynamic functional oral sphincter together with a pleasing esthetic result.

Arthrodesis or autologous tendon interposition can relieve pain associated with arthritis of the carpo-metacarpal joint of the first ray (CMC-I), but has its limitations. The aim of this study was to assess whether trapezium resection and fascia lata allograft (Tutoplast) interposition is a good alternative. Thirty-eight such combined CMC-I arthroplasties in 36 patients with a median age of 57 years and a median follow-up of 25 months were analysed for complications; Disabilities of Arm, Shoulder, and Hand questionnaire (DASH) scores; pain; and patient satisfaction. Complications occurred in 13 of the 36 patients (36%). The median DASH score was 25, and pain was reduced in 22 patients (85%). Thirteen of the 36 patients (36%) were not satisfied. Trapezium resection and fascia lata allograft interposition do not seem to be good alternatives for CMC-I arthritis.

Knowing the vascular network and properties of the vascular pedicle is of crucial importance for elevation of the tensor fascia lata (TFL) transpositional or free flap; therefore, the origin of the lateral circumflex femoral artery (LCFA), its diameter at the site of origin, the length of the vascular pedicle, the number of lateral branches, the number of terminal branches and the anastomosis of the LCFA ascending branch are of utmost importance for successful elevation and clinical application of this flap. The study was conducted on clinical (100 angiographic images of the femoral artery) and autopsy (48 preparations) material. The first part of the study comprised analysis of the angiographic images that were used to obtain the information on LCFA. The diameter of LCFA at its origin was measured to be 0.44 cm, while it was 0.33 cm at the origin of ascending branch. The mean value of the diameter at the bifurcation of the terminal branches of ascending branch (inside tensor fascia lata muscle) was 0.24 cm. It has been established that the vascular pedicle of the tensor fascia lata flap (ascending branch of LCFA) is anastomosed with the superior gluteal artery in all cases. Measurement of the tensor fascia lata muscle revealed an average length of 15.91 cm, width of 3.55 cm and thickness of 1.98 cm. Injection of colour-ink into the ascending branch LCFA that enters directly into the TFL muscle was used to measure the extent of the TFL flap vascularization and on the average, the TFL flap was 20.32 cm long and 16.57 cm wide while the surface was 17.52 cm3.

The loss of an eye is a highly traumatic event, with severe psychological and physical implications. From November 1996 to June 2002, 32 patients underwent eye enucleation and placement of a hydroxyapatite orbital implant wrapped in autologous fascia lata; this was then fixed to the four rectus muscles. Motility was noted in all reconstructed sockets, without implant related complications. The immediate post-operative period was uncomplicated and all patients were discharged within 48 to 72 h after surgery. The orbital implant remained well positioned without dehiscence and motility was satisfactory. The follow-up ranged from 8 months to more than 5 years.

During the 5-year war in former Yugoslavia 294 patients were surgically treated for head injuries at the Neurosurgical Department of the Emergency Center, Clinical Center of Serbia in Belgrade. In addition to other problems related to direct trauma of brain tissue, some specific problems related to other tissue defects and their importance in further complications which changed the final outcome have been noted. This study analyzed methods and materials used for dura, bone, and skin reconstruction in a search for better management of this problem. We conclude that for dural reconstruction in these patients the best materials are autologous (autotransplantation of periosteum, galea aponeurotica, or fascia lata) since this results in fewer complications and better results. Local skin flaps were used for small skin defects, but more extensive skin defects required larger flaps with free skin grafting of secondary defects. Both dura and skin reconstruction should be performed as soon as possible to prevent infection and other complications, but delayed surgery is recommended for bone defects. Only bone defects with diameter over 3–4 cm were treated surgically (alloplastic material, Palacos, being used) after 6–12 months in cases with no signs of infection. This strategy yielded the best results.

Pressure sores are very common complications following spinal cord injuries and other neurological problems. We present out 15 years' experience in treating pressure sores with myocutaneous flaps. Each anatomical site is considered, divided into those in which cover was successful and those with recurrences. Over the past 8 years careful preoperative planning has been used and specific flaps for each anatomical area. Our home care system is organized to cover both domestic and medical problems. Treatment is determined after examining the wound (anatomical site, staging, infection) and underlying medical, nutritional, and neurological problems. The first choice for ischial ulcers is the VY advancement hamstring myocutaneous flap, sacral ulcers a VY myocutaneous advancement flap of gluteus maximus muscle, and for trochanteric ulcers the myocutaneous rotation flap of tensor fascia lata muscle. Using this protocol the treatment outcome of sacral and ischial ulcers has been encouraging, but in trochanteric ulcers the results have been less satisfactory. This experience supports the use of these flaps in the treatment of pressure sores in para and tetraplegic patients.

The gliding tissue that covers the distal fascia of the tensor fascia lata (TFL) is sufficiently vascularized to be used as a free graft. It consists of loose areolar tissue and fat. Because of its gliding properties it is used to provide the functions of a bursa, e.g., elbow, knee, and of mucosal sheets, e.g., ankle. This gliding tissue provides an ideal cover for nerves which must move in mobile areas.

Reconstruction of a large abdominal defect is a technically demanding procedure. A single flap is sometimes insufficient for cover. Compound procedures play an important role in solving this problem. The case of a 35-year-old man with a large abdominal hernia as a result of a traumatic defect on the right abdomen, previously covered by a skin graft, is presented. The reconstructive method was initially expansion of posterior and upper parts of the defect and also of the tensor fascia lata in situ and then deepithelization of the previous skin graft over the intestinal serosa. The defect was covered by Prolene mesh, the upper and dorsal expanded skin was approximated, and an expanded tensor fascia lata flap was transposed to complete the cover. During; follow-up examinations, there were no complications such as infection or recurrence of the hernia.

50 anatomical dissections on 30 fresh cadavers with blue dye coloration of the pedicle, angiography and vascular visualization by methyl methacrylate have been performed. The transverse branch of the lateral circumflex femoral artery (LCFA) was found to be the dominant vessel to the trochanteric area. The length of the pedicle was always more than 6 cm and the caliber more than 2 mm. The main branch of the pedicle reaches the fat tissue as a large perforator vessel after leaving minor branches to the tensor fascia lata muscle (TFL). We believe that it is possible to raise the fat tissue of the trochanteric area as a lateral circumflex femoral perforator flap (LCFP-flap).

An extensive basal cell carcinoma of the mid-parietal scalp penetrating the skull and invading the posterior third of the superior sagittal sinus was successfully treated in a 60-year-old man. This was accomplished by gradually obstructing the sinus over a period of five weeks unit it was possible to resect the tumor along with 15 cm of the sagittal sinus. Total obstruction of the sinus was achieved using two miniature tissue expanders surgically placed and affixed to the vessel. By gradual filling of the expanders, it was possible, after five weeks, to demonstrate angiographically that the sagittal sinus between the two tissue expanders was obliterated. The one piece resection included a wide margin of skin, bone, dura mater and sagittal sinus. The extensive defect of the dura mater was covered by a free fascia lata graft and the scalp defect by a visor bipedicled forehead flap. The forehead donor area was skin grafted. There were no complications during surgery and the patient recovered uneventfully. There has been no recurrence after one year.

After palatoplasty operations, we are faced with a palatal fistula rate of 30% repair which is one of the most difficult tasks in Plastic Surgery. Placement of a biological material between the two anatomic layers of the palate was performed to reduce the rate of fistula formation. Commercially available “fascia lata” homograft was used in order to decrease the time of operation and avoid donor site morbidity. This method has reduced the rate of palatal fistulae to 8.3%.

Mycetoma (Madura foot) is a chronic fungal or bacterial infectious process characterized by a discharging mass. Medical treatment is generally insufficient, and surgical eradication, sometimes by amputation, is advocated. Although a benign disease, the tumor's nature may be considered malignant in view of limb's fate. Reconstruction of a foot with a free tensor fascia lata musculocutaneous flap, following large mycetoma mass resection in a 28-year-old patient is described. A year after surgery, the patient uses the leg without limitation and no recurrence is evident. This limb preservation technique, which enables rapid rehabilitation and ambulation, is superior to amputation.

An unusual case of muscle hernia in the forearm flexor compartment is reported. This was repaired with a fascia lata onlay graft from the patient's thigh. At 6 months after surgery there was no recurrence and the patient remained symptom free at the time of this report.

Colored gelatin was selectively injected into the branches of the lateral circumflex femoral artery of fetal and adult cadavers, as well as into the popliteal artery of fetuses. Using this technique, it can be shown that the distal third of the lateral thigh skin has a multi-arterial supply. When a musculocutaneous tensor fascia lata flap with a distal extension is elevated, its medial, lateral and distal arterial input is cut off, transforming its skin paddle into a skin flap with a random blood supply. In order to avoid skin necrosis, a delay three weeks prior to the definitive elevation of the flap is recommended. The delay procedure preserves the vascular supply of the skin paddle coming from the superior lateral geniculate artery and the tensor fascia lata artery, establishing an ‘axial’ pattern of vascularization, thereby enhancing flap survival.

A case of total abdominal wall reconstruction in a 22-year-old man is presented. He had an omphalocele which was covered initially with skin grafts, thus creating a huge abdominal hernia. Two tensor fascia lata flaps, each measuring 14×36 cm, were used to reconstruct the abdominal wall following delay. This method, when-ever available, is in our opinion the best and most reliable way to reconstruct the abdominal wall. Myocutaneous flaps now have extended use in plastic and reconstructive surgery [1, 3, 5, 6, 8, 10]. The tensor fascia lata (TFL) myocutaneous flap is unique in its fascial extension and large overlying skin territory which makes it ideal for abdominal wall repairs.