Extrusion of enucleation implants: treatment with secondary implants and autogenous temporalis fascia or fascia lata patch grafts.

We performed one autogenous fascia lata graft and 11 autogenous temporalis fascia grafts in eight patients with extrusion of an orbital enucleation implant and in four patients with a bulging implant who could not wear a prosthesis. Excluding one patient with inadequate follow up, 10 of the 11 patients (91%) successfully retained their implant. One patient had severe conjunctivitis followed by anterior migration of his implant 2 1/2 years after patch grafting, necessitating replacement of the implant. We conclude that autogenous temporalis fascia patch grafting is an effective treatment for orbital enucleation implant extrusion or a bulging implant.     

自体阔筋膜代袢的研究

腘静脉外肌袢形成术是治疗下肢深静脉严重血液倒流性病变的优选手术之一,但手术还存在一些不足之处,如肌袢长度不够,术后肌袢粘连等。本实验结果说明,自体阔筋膜移植后不发生退行性变化,其顺行性和最大抗拉强度与正常对照相比也未下降,从形态学和材料力学角度阐明了自体阔筋膜袢代替肌腱袢的可行性,为临床应用提供了实验依据。     

关节镜下自体阔筋膜补片桥接冈上肌治疗不可修复性巨大肩袖撕裂

目的探讨关节镜下阔筋膜补片桥接冈上肌治疗不可修复性巨大肩袖撕裂的临床疗效。方法回顾性分析2015年7月至2017年7月采用关节镜下阔筋膜补片桥接冈上肌治疗的不可修复性巨大肩袖撕裂患者10例,男4例,女6例;年龄(61.3±2.9)岁(范围57~67岁);右肩7例,左肩3例;7例患肩为主力侧。术前症状持续时间(14.0±13.5)个月(范围1~48个月),2例有外伤史,所有病例均为初次手术。术后1周、6个月、1年、2年时行MR检查,评估阔筋膜补片桥接不可修复性巨大肩袖撕裂的转归愈合情况,并采用美国肩肘外科协会(American Shoulder&Elbow Surgeons,ASES)评分、美国加利福尼亚大学洛杉矶分校(University of California Los Angeles,UCLA)评分、Constant-Murley评分评估肩关节功能。结果全部病例均可重建水平力偶,未出现围手术期并发症。术后2年ASES评分为(92.2±3.5)分(范围88.3~98.3分)、UCLA评分为(31.6±2.0)分(范围28~34分)、Constant-Murley评分为(85.2±5.4)分(范围78~93分),均较术前[分别为(32.7±16.2)分(范围15~75分)、(9.8±4.9)分(范围6~23分)、(32.4±15.7)分(范围14~72分)]提高,差异有统计学意义(t=11.254,P=0.000;t=12.111,P=0.000;t=8.948,P=0.000);疼痛视觉模拟评分为(0.6±0.5)分(范围0~1分),较术前的(6.4±1.3)分(范围3~8分)明显降低,差异有统计学意义(t=11.326,P=0.000)。术后2年MRI显示9例患者阔筋膜补片同肩袖残端愈合良好,1例发生再撕裂并出现补片吸收现象。10例患者肩关节前屈、外展、内旋外旋活动度均明显改善,但存在不同程度的力弱(3~4级)。结论关节镜下阔筋膜补片桥接冈上肌治疗不可修复性巨大肩袖撕裂能有效改善肩关节功能,自体阔筋膜补片通过桥接可以与肩袖组织愈合。     

The antigenicity of fascia lata allografts

OBJECTIVE: To determine whether commercially available fascia lata allograft material contains donor antigens. MATERIALS AND METHODS: Human leukocyte antigens (HLA) class I and II were assessed in: (i) freeze-dried fascia lata allografts; (ii) a Tutoplast fascia lata graft (Mentor Urology, Santa Barbara, CA, USA); (iii) an acellular dermal graft; and (iv) a successful donor fascia sacrocolpopexy graft one year after implantation, using a polymerase chain reaction sequence-specific primer-based assay. RESULTS: The donor for both the freeze-dried fascia lata and Tutoplast fascia lata was fully HLA-typed. At one year after implantation, antigens from the implanted sacrocolpopexy graft matched the host blood antigens. The antigenicity of the acellular dermal graft could not be ascertained because this material interfered with the assay. CONCLUSION: Donor fascia lata grafts prepared by freeze-drying or by the Tutoplast technique retain donor antigens. The significance of this antigenicity is unknown. All donor antigens are replaced by host antigens after implantation.     

阔筋膜张肌球拍形岛状肌皮瓣

目的 探讨根据肌肉解剖形状和血管分布,将阔筋膜张肌皮瓣设计成上窄下宽,呈球拍形的岛状肌皮瓣的可行性。方法 应用阔筋膜张肌球拍形岛状肌皮瓣,修复中下腹壁大块软组织缺损4例。结果 3例全部成活,1例岛状肌皮瓣远端有小块皮肤坏死,经移植皮片而痊愈。结论 阔筋膜张肌球拍形岛状肌皮瓣是可行的,且皮瓣较窄 的上段似一个延长的蒂,使之移转灵活,而皮瓣供区的上侧面又可直接缝合,从而减少了用来修复皮瓣供区创面所需皮片的面积。     

Patch urethroplasty using a fascia lata autograft in male rabbits

INTRODUCTION: Urethral reconstruction is difficult when the genital skin is not available for surgery. We evaluate the feasibility of using the autologous fascia lata as a graft for urethral repair. MATERIALS AND METHODS: 10 male rabbits underwent urethroplasty after creation of a ventral urethral defect. The defect was repaired using a graft harvested from the fascia lata. The animals were divided into three groups and sacrificed at 2, 4 and 12 weeks postoperatively. Radiologic control was performed after 10-12 days and before sacrifice. RESULTS: In the 10 rabbits subjected to surgery, no case of death or wound infection was observed. During urethrography, a fistula was observed in 2 animals. In the remainder (n = 8), histological analysis showed the preservation of the original laminar structure without graft shrinkage or fibrosis. On the luminal side of the patch, a new line of urothelium appeared in the 2nd week after surgery. After 3 months, the new epithelium was multilayered and the graft edges were not detectable. No voiding dysfunction was detectable in 8 rabbits. CONCLUSIONS: Our study suggests the feasibility of using the autologous fascia lata for urethral patch repair.     

吻合血管的阔筋膜瓣移植修复手指软组织缺损

目的 总结吻合血管的阔筋膜瓣移植修复手指软组织缺损的临床应用结果.方法 修复8例手指软组织缺损,行一期阔筋膜瓣移植加中厚网状游离植皮,供区直接缝合,阔筋膜瓣的血管蒂与受区的血管行端端吻合.结果 1例术后发生远端小片植皮坏死,经更换敷料逐渐自行愈合.7例术后经过顺利,全部成活,取得了满意的治疗效果.结论 该筋膜瓣以旋股外侧动脉降支为血供,血运丰富、血管解剖恒定、血管蒂长易于切取,而且较薄,适宜修复手指软组织缺损.     

Use of autologous fascia lata as a pericardial substitute following open-heart surgery.

Thirteen patients requiring repeat open-heart surgery had autologous free fascia lata grafts implanted to effect complete pericardial closure. In four patients, the graft was used to augment the pericardial space because of myocardial failure and enlargement. In the remainder, fascia lata was used because shrinkage, scarring, or absence of the pericardium from prior operation prevented primary closure. No hemodynamic problems related to implantations of the grafts were seen. The harvesting of the grafts produced no functional deficits, and complications at the donor site were insignificant. Complete pericardial closure with fascia lata protects underlying myocardial structures (i.e., saphenous vein grafts) in the event that further reoperation for bleeding or infection is required. In addition, it provides for compartmentalization of the mediastinum, allowing accurate assessment of the site of postoperative bleeding.     

Free fascia lata repair for a second recurrent congenital diaphragmatic hernia

Repair of recurrent congenital diaphragmatic hernia (CDH) continues to be a difficult problem. Although several materials have been used to repair recurrent CDH, the ideal material has yet to be established. We report the successful use of an autologous free fascia lata graft to repair the diaphragm following a second recurrence of CHD. The fascia lata is one of the strongest fascia in the body and is easy to obtain without extremity functional loss even in children. This procedure is regarded as effective for the repair of recurrent CDH.     

阔筋膜瓣移植修复手背软组织缺损

目的:采用吻合血管的阔筋膜瓣移植修复手背软组织缺损,观察其临床应用效果。方法:修复12例(男8例,女4例)手背软组织缺损;右手7例,左手5例;年龄16~46岁(平均30岁)。缺损范围4 cm×6 cm~8 cm×15 cm,切取阔筋膜瓣范围5.0 cm×7.5 cm~8 cm×16 cm。行Ⅰ期中厚网状游离植皮,供区直接缝合,阔筋膜瓣的血管蒂与受区的血管行端端吻合。结果:1例术后发生远端尖部小片植皮坏死,经更换敷料逐渐自行愈合。11例术后经过顺利,全部成活,取得了满意的临床效果。结论:该筋膜瓣以旋股外侧动脉降支为血供,血运丰富,血管解剖恒定,血管蒂长以及切取容易,而且较薄,适宜修复手背软组织缺损。     

下肢深静脉功能不全诊治的实验与临床研究

目的 寻找下肢深静脉瓣膜包窄术最佳环包材料,了解彩超对深静脉瓣膜功能不全的诊断价值和Ｇｕｏ静脉膜功能。方法 （１）观察３０条实验犬以自体大隐静脉片、自体阔筋膜和人造血管片作深静脉膜包窄术的效果;（２）对７８例彩超与经Ｇｕｏ静脉插管造影结果对比;（３）观察正常人与患者Ｇｕｏ静脉瓣膜血液动力学变化。结果 自体阔筋膜和大隐静脉逐渐挛缩呈纤维化瘢痕增生,而膨胀聚四氟乙烯人造血管的形态和结构无明显变化;彩超     

Using fascia lata to treat infective aortic false aneurysm

In patients with infective aortic false aneurysms, repair using artificial materials is in danger of becoming an additional focus for infection. We used harvested autologous fascia lata as a vascular patch in such operations on 2 patients with infected mediastinal false aneurysm after coronary artery bypass surgery. These patients have not had any recurrences of mediastinitis and false aneurysm for 4 to 6 years after the operations.     

Abdominal sacral colpopexy using autologous fascia lata

PURPOSE: Numerous techniques and materials have traditionally been used to correct vaginal vault prolapse, including cadaveric fascia, synthetic materials and autologous rectus fascia. We report our experience with autologous fascia lata used for abdominal sacral colpopexy. MATERIALS AND METHODS: A retrospective review identified all women who underwent abdominal sacral colpopexy using autologous fascia lata for vaginal vault prolapse with at least 18 months of followup. Preoperative and postoperative pelvic organ prolapse quantification (POP-Q) scores, relevant clinical and operative parameters, treatment efficacy, harvest site morbidity and patient satisfaction were assessed. RESULTS: Ten women underwent this procedure between 1999 and 2001. Mean patient age was 68.3 years (range 55 to 82). Followup was 19 to 42 months (mean +/- SD 30.5 +/- 7.78). Preoperatively POP-Q stages were II to IV in 3, 5 and 2 cases, respectively. Postoperative POP-Q scores improved to and remained at stage II or lower in all 10 patients. Mean operative time was 182 +/- 40.94 minutes (range 136 to 265). Mean blood loss was 107.5 +/- 50.07 cc (range 50 to 200). There was no morbidity associated with fascia lata harvest. Eight of the 9 women alive at review completed and returned the survey. When asked if they could return to how they were before surgery, would they still have the same procedure done and would they recommend the procedure to a friend, all respondents answered yes to each question. CONCLUSIONS: Autologous fascia lata compares favorably in efficacy to that reported for other materials in the contemporary literature and it is not associated with any significant morbidity.     

游离阔筋膜瓣移植修复小腿软组织和主要血管 缺损

目的：总结吻合血管的阔筋膜瓣移植修复小腿软组织和主要血管缺损的临床应用结果。方法：2000年9月至2008年12月,应用阔筋膜瓣移植修复5例（男4例,女1例）小腿软组织和主要血管缺损,用其携带的旋股外侧动脉降支行桥式吻合,同时修复受区肢体主要血管缺损。患者年龄19～48岁,平均34岁。切取阔筋膜瓣范围6.5cm×9cm～9cm×18cm,Ⅰ期行中厚网状游离植皮,股部供区直接缝合。结果：阔筋膜瓣全部成活,手术顺利。随访时间11个月～3.5年,平均2.5年,未发现明显的供区功能障碍,供区与受区外形较好,受区小腿经临床观察与Doppler检查,胫前和胫后动脉通畅。结论：阔筋膜瓣以旋股外侧动脉降支为血供,血运丰富、血管解剖恒定、血管蒂长以及切取容易,而且较薄,适宜修复小腿软组织和主要血管缺损。     

Evaluations of guided bone regeneration in canine radius segmental defects using autologous periosteum combined with fascia lata under stable external fixation

BackgroundAlthough bone defect is one of the most common orthopaedic diseases, treatment remains a challenge and an issue of debate. Guided bone regeneration (GBR) is primarily accompanied by barrier membranes; however, optional membranes show some inherent flaws in clinical application. The purpose of this study was to observe the healing velocity and quality of repairing canine radius segmental defect using transferred autologous periosteum combined with fascia lata, which can provide better biological safety than other materials.ResultsBone union was seen in most individuals from the autologous periosteum combined with fascia lata group, within an average of 14.2 weeks. Histopathologic and SEM examinations both showed the different osteogenesis state between groups. Necropsy confirmed US findings with regard to distance of bone defects and location.ConclusionThese findings suggest that autologous periosteum combined with fascia lata is as effective as a GBR membrane, even in long tubular bone defects. With reliable biological safety, the autologous periosteum combined with fascia lata is expected to achieve increasing application in orthopaedic trauma patients.

Level of evidence

Not applicable, animal study.     

The tensor fascia lata musculocutaneous flap.

The tensor fascia lata (TFL) muscle, together with the overlying skin of the anterolateral thigh, makes a reliable musculocutaneous unit. It can be lengthened safely by taking the fascia lata and the skin of the anterolateral mid and lower thigh to within 8 cm of the knee. The skin of the longer flap is supplied by large perforating musculocutaneous arteries, the terminal branches of the vascular pedicle of the muscle. The shorter flap can easily be transposed over the trochanteric area, while the larger flap will cover not only the trochanter but also the ischial and sacral areas. The flap serves equally well as a transposition, island, or free flap. The anatomical and vascular basis of the flap is presented, together with its application in 21 patients. Possible further applications of the flap, including anterior rotation, are discussed.     

Banked cadaveric fascia lata: 3-year follow-up

Autologous fascial and synthetic materials have been widely used to repair the stress form of urinary incontinence (SUI) as well as pelvic floor prolapse. The safety and long-term durability of cadaveric fascia lata in orthopedic and ophthalmologic surgery have encouraged urogynecologists to use this material for a sling material. The rationale of placement of a sling from cadaveric fascia lata is based upon decreasing the complication rates caused by autologous and synthetic materials. However, the high costs of the commercially available tissues in Brazil have limited its use in public health. In our institution we developed a cadaveric fascia lata bank, harvesting the material according to the Brazilian Transplantation Legislation and storing it at -70 degrees C. The safety of the tissue is achieved by 25-kGy irradiation. Since 1999, 30 patients have undergone surgery using material from five donors in repairs for stress urinary incontinence and pelvic floor prolapse at a mean of 34 months' follow-up (ranging from 30 to 40 months), there was no evidence of rejection. Therefore, we have shown the safety of cadaveric fascia lata harvested and treated as described above in our group of patients.     

Reconstruction of diaphragm using autologous fascia lata: an experimental study in dogs

BACKGROUND: We investigated whether fascia lata is an appropriate material for reconstruction of the diaphragm. METHODS: A diaphragmatic defect (2 cm by 5 cm) was reconstructed with a patch of autologous fascia lata in the experimental group (n = 12) and with expanded polytetrafluoroethylene in the control group (n = 12). Maximal tensile strength at the sutured region was measured serially. RESULTS: The maximal tensile strength at the sutured region reconstructed with the fascia lata was 1.14 +/- 0.50 kgf 15 days and 2.04 +/- 0.94 kgf 30 days after operation. The values were higher than those of expanded polytetrafluoroethylene (p < 0.0001). These values of fascia lata were close to the original maximal tensile strength of the muscular region of the diaphragm (1.52 to 1.66 kgf). CONCLUSIONS: Reconstruction of diaphragm using autologous fascia lata is safe, easy, and inexpensive, and provides smooth wound healing. The only disadvantage is the necessity of a femoral incision for harvest; nevertheless, it may be worthwhile to use fascia lata in clinical trials to further assess its suitability as a reconstruction material.     

Characteristics of prosthetic mesh and autogenous fascia in abdominal wall reconstruction after prolonged implantation.

This study evaluated two types of prosthetic mesh and autogenous fascia in long-term abdominal wall reconstruction for rats. Marlex mesh, Gore-Tex patch, and autogenous fascia were implanted and left in place for 1 year. Materials were removed and evaluated using tensile strength of the material, tensile strength of the suture line, and adhesions. No change in the tensile strength of any of the materials were found at 1 year follow-up. Tensile strengths were significantly greater for Gore-Tex patch and Marlex mesh than the autogenous fascia. The Marlex mesh, however, had a weak and a strong tensile strength direction. These were significantly different (p < 0.05). Suture line tensile strength was greater for autogenous fascia and Marlex mesh than it was for the Gore-Tex patch, which was significantly weaker (p < 0.05). The greatest number of adhesions were seen in the Marlex mesh group. No significant difference was present in adhesions between Gore-Tex patch and autogenous fascia. In summary, autogenous fascia showed virtually no adhesions and good suture line strength. While it was the weakest of the three materials examined, the strength was still within the normal range and adequate for abdominal wall reconstruction.     

Scapulothoracic stabilisation for winging of the scapula using strips of autogenous fascia lata

We have used a modified technique in five patients to correct winging of the scapula caused by injury to the brachial plexus or the long thoracic nerve during transaxillary resection of the first rib. The procedure stabilises the scapulothoracic articulation by using strips of autogenous fascia lata wrapped around the 4th, 6th and 7th ribs at least two, and preferably three, times. The mean age of the patients at the time of operation was 38 years (26 to 47) and the mean follow-up six years and four months (three years and three months to 11 years). Satisfactory stability was achieved in all patients with considerable improvement in shoulder function. There were no complications.