The vascularized fascia lata free flap: an anatomical study and clinical considerations

Abstract

Purpose Fascia lata (FL) is often used as fascial component of the anterolateral thigh (ALT) flap in head and neck reconstruction. No distinct data exist on whether the FL has its own reliable vascular supply and whether the fascia alone can be harvested as a fascia lata free flap. Methods We dissected 25 thighs of 15 cadavers. The lateral circumflex femoral artery (LCFA) was identified, and the size of stained fascia and skin were measured after injection of methylene blue into the descending branch (DB). Finally, topography of fascial vessels was determined. Results Staining of fascia and skin paddle was found in all 25 cases. Ascending skin perforators of the DB of the LCFA gave off branches for supply of the FL enabling harvest of a fascia lata free flap. Septo-or musculocutaneous perforators pierced FL and entered skin within the proximal 38.6-60% of the thigh. The mean length and width of stained FL was 15.8 ± 4.1 cm and 8.7 ± 2.0 cm, respectively, and size of stained FL ranged from 40.0 to 336.0 cm 2. In 20 cases (80%), skin paddles were 2.4 times larger on average compared to corresponding FL. Conclusion We could demonstrate that the FL receives its own vascular supply from perforators of the DB originating from the LCFA. Hence, harvest of a fascia lata free flap is possible, reliable, and the size of the fascia is suitable for reconstruction of small and large defects of the head and neck.

Single-stage reconstruction of a traumatic tendocutaneous defect of the Achilles using free composite anterolateral thigh flap with vascularized fascia lata

“…While remaining attached to anterolateral thigh flap, the vascularized fascia lata received its blood supply via ascending skin perforators of the descending branch from lateral circumflex femoral artery. [ 19 ] The vascularized tendinous substitute offered the benefits of improved healing rate, less adhesion formation, greater resistance to infection and superior gliding capacity. [ 6 ] Large sheet of vascularized fascia lata could be harvested along with the anterolateral thigh flap.…”

The use of a simultaneous fascia lata‐free flap with cochlear implantation after radical Mastoidectomy

“…Plans for fascia lata-free flap based on the descending branch of the lateral femoral circumflex artery for coverage of the implant and obliteration of the mastoid and middle ear cavities were made (Figures 2,3). 10 Intraoperatively, the right ear canal blind sac was created but noted to be tenuous. The squamous epithelium lining the bony canal and tympanic membrane was removed.…”

Periosteum and fascia lata: Are they so different?

“…Most authors who seek to develop a new scaffold based on tissue engineering techniques usually go straight to their target, while bypassing fundamental tissue knowledge. The iliotibial tract, which constitutes a thickening of the fascia lata of human thigh, is a biological sheet that is already used in other reconstructive surgeries, such as duraplasty ( Finn et al, 2011 ), colpopexy ( Bock et al, 2021 ), and abdominal wall reconstruction ( Song et al, 2018 ) instead of an artificial mesh, or for head and neck reconstruction as vascularized flap ( Janik et al, 2020 ). In orthopedics, the human fascia lata (HFL) has already been employed to repair rotator cuff tear ( Matthewson et al, 2020 ), in the “anchovy” interpositional arthroplasty of the hallux metatarsophalangeal joint ( Watson et al, 2019 ), to reconstruct patellar ligament ( Sapino et al, 2019 ) or after anterior cruciate ligament rupture ( Ferretti et al, 2017 ); nevertheless, it has never been considered for CSBD treatment.…”