Fascia Lata Harvesting: The Donor Site Closure Morbidity

Abstract

Objective: Fascia lata (FL) is a worldwide adopted source of autologous grafts. In our Department, the endoscopic endonasal transphenoidal surgery (EETS) has been performed regularly for anterior and middle cranial fossa lesions, and FL graft has commonly been a practical resource in repairing tissue defects after EETS. Enough, we used routinely harvesting FL to restore symmetry in facial palsy. To our known, this is the biggest case series about FL harvesting to repare tissue defects after EET. The purpose of our study was to evaluate our experience with the harvesting of FL, in particularly the donor site morbidity. Study design: This is a prospective study case series, which evaluated by questionnaire the morbidity of FL donr site. Methods: The details of 44 patients were analyzed from 2011 to 2016. Thirty-eight patients needed cranial base reconstruction and 6 patients needed facial reanimation. Results: Adequate length of FL was harvested in all our patients. There were no intraoperative complications. We did not use drain in any case. We analyzed 18 women (40%) and 26 men (59.9%). The estimated median age at presentation was 51.53. Conclusion: For little FL's gap, diameter until 3 × 6 cm, it's possible to suture FL's margin with Nylon, but for bigger gap it's necessary to reconstruct with allograft to avoid muscle bulge or compartmental syndrome.

Fascia Lata: Another Workhorse for Complex Skull Base Reconstruction

“…While rare, more serious complications have been reported including long-term hypoesthesia and muscle herniation through the opening in the fascia. 27 Overall, our study demonstrated a success rate of 92% (46/50) in cases where FL was employed for reconstruction. It should be underscored that this was in the setting of complex defects and high-risk clinical scenarios, including predominantly high flow CSF leaks (and in the 10 cases of low flow CSF leak, all were associated with complicating factors), revision surgeries, expanded endonasal approaches, skull base malignancies, and previous or planned radiation therapy.…”

“…While rare, more serious complications have been reported including long-term hypoesthesia and muscle herniation through the opening in the fascia. 27…”

“…24 With respect to autologous grafts, fascia lata (FL) has been described as a free autograft in dural reconstruction, initially in open skull base cases, given its inherent pliability, durability, ability to mucosalize readily in the nasal cavity, and low donor-site morbidity. [25][26][27][28] The utility of FL for endonasal reconstruction has also been suggested, with modifications including the FL button graft described by Luginbuhl et al, which provides 2 layers of FL sutured together and sequestered at the level of the bony defect in a dual inlay and onlay fashion . 29 Although the NSF has been firmly established as the workhorse of reconstruction of the mucosal layer of a skull base defect, there has been limited study on the applicability and indications for the use of FL in skull base reconstruction.…”

Endoscopic Endonasal Transsphenoidal Surgery for Resection of Craniopharyngioma in Pediatric Population: A Comprehensive Review of the Literature

“…18 43 44 45 46 47 48 Previous studies reported CSF leak in 0 to 58% of children who underwent tumor resection via EETS and it was successfully managed without further complications. 12 15 16 21 25 26 27 29 30 33 36 38 39 40 49 Intraoperative insertion of a lumbar drain prior to the resection and removing it at postoperative day 5 to 7 may minimize the risk of postoperative CSF leak. 6 50…”

“…18,[43][44][45][46][47][48] Previous studies reported CSF leak in 0 to 58% of children who underwent tumor resection via EETS and it was successfully managed without further complications. 12,15,16,21,[25][26][27]29,30,33,36,[38][39][40]49 Intraoperative insertion of a lumbar drain prior to the resection and removing it at postoperative day 5 to 7 may minimize the risk of postoperative CSF leak. 6,50 Endoscopic Endonasal Transsphenoidal Surgery versus Transcranial Approach Fahlbusch et al performed transsphenoidal surgeries in 29% of their patients.…”