Role of Tensor Fasciae Latae in Abdominal Wall Reconstruction

Abstract

The role of the tensor fasciae latae as autogenous tissue in reconstruction of abdominal wall defects is well established. The use of various forms of the tensor fasciae latae (free graft versus pedicled flap versus free flap) is determined by the characteristics of the defect. A review of abdominal wall reconstructions using tensor fasciae latae was completed to determine efficacy and establish guidelines for its use. Abdominal wall reconstructions from 1991 to 1994 using tensor fasciae latae were reviewed. Demographics, wound characteristics, and complications were evaluated. Twenty-seven patients with a mean follow-up of 23.6 months underwent abdominal wall reconstruction with the tensor fasciae latae: free grafts, 12; pedicled flaps, 9; and free flaps, 6. An average defect size of 14.4 x 13.1 cm was seen. Fourteen (52 percent) of the reconstructions were completed in contaminated or infected wounds. One recurrent enteric fistula was seen. Twelve (44 percent) of the patients had flap complications of which 50 percent involved partial flap necrosis. Donor site complications were seen in five patients (18 percent) and included a hematoma, seroma, and two cases of skin graft dehiscence along the edge of the wound. Tensor fasciae latae free grafts are an option for repair of abdominal hernias if abdominal soft tissue is adequate. Pedicled flaps may be used for defects of soft tissue and fascia but are limited by the arc of rotation and size of the defect. Tensor fasciae latae free flaps are versatile in orientation and may be used for supraumbilical defects. Tip necrosis is significant in both types of vascularized flaps.

Abdominal Wall Reconstruction with Mesh and Components Separation

“…17,18 Disa reported reliable repairs with fascia lata autografts in the presence of contaminated wounds when prosthetic materials were contraindicated. 19 Despite the advantages of autologous fascia lata grafts, the creation of a thigh donor site and the potential for donor site morbidity decrease this technique's desirability.…”

Staged Repair Of Severe Open Abdomens Due To High-Energy Gunshot Injuries With Early Vacuum Pack And Delayed Tissue Expansion And Dual-Sided Meshes

“…For the late definitive restoration of the abdominal wall, many flaps that provide contractile muscle and fascial support have been advocated including rectus femoris, latissimus dorsi, tensor fascia latae and vastus lateralis myofascial flaps. [7][8][9][10][11] However, due to the limited rotation arcs and/or small size of the flaps, these defects generally require more than one flap, which limits the usage of these flaps. On the other hand, both the scar and functional loss in donor site are other limiting factors.…”

“…Many methods including myofascial rotation flaps, distant flaps and tissue expansion have been advocated to repair this ventral hernia. [7][8][9][10][11][12][13][14] However, it cannot be expected to successfully close all kinds of defects byusing only one technique. The state of the components of the abdominal wall and the overall medical status of the patient are vitally important as well as the size of the defect for selecting the reconstructive technique.…”

Reconstruction of Perineum and Abdominal Wall

“…Local full-thickness abdominal wall rhomboid flaps and extended abdominal wall flaps may achieve closure of the defect but at the cost of further abdominal wall weakening. Pedicled uni-or bilateral tensor fascia lata flaps have long been used as a standard approach to restore the abdominal wall defect because thigh flaps leave the remaining abdominal wall intact ( Williams et al, 1998). For meso-and epigastric defects, however, the harvest should include distal fascia to achieve sufficient length.…”