Efficacy and morbidity of autologous fascia lata sling cystourethropexy

PURPOSE: Sling cystourethropexy for intrinsic sphincter deficiency has more recently been accepted as effective surgical treatment for all types of stress urinary incontinence. We report our experience using autologous fascia lata for sling cystourethropexy, regarding treatment efficacy, harvest site morbidity and patient satisfaction. MATERIALS AND METHODS: A retrospective data base review identified all women who underwent sling cystourethropexy using autologous fascia lata for stress urinary incontinence. A followup survey study using questionnaires (Black and Urogenic Distress Inventory-6) combined with questions regarding pad use, satisfaction and leg morbidity was done. RESULTS: A total of 100 women who could be contacted and who had undergone autologous fascia lata sling cystourethropexy performed by a single surgeon between 1993 and 2002 were surveyed. Mean patient followup was 4.4 years (range 0.8 to 9.3). Of the women 85% stated that they were dry or improved and 93% were pain-free at the harvest site by 7 days. There was no harvest site infection and no lower extremity thrombotic complication. Of the patients 83% indicated that the procedure had a positive effect on their life with only 4% stating that it had a negative effect, while 77% were satisfied with the procedure, 82% would recommend the procedure to a friend with incontinence and 83% would undergo the procedure if making the decision again. CONCLUSIONS: Autologous fascia lata sling cystourethropexy is associated with high patient satisfaction and treatment efficacy comparable to that of other sling cystourethropexy materials, as determined by questionnaire. Harvest site morbidity is low. Sling cystourethropexy using autologous fascia lata should be considered as a primary surgical approach in women with stress urinary incontinence.     

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.     

Total abdominal wall reconstruction with two tensor fascia lata myocutaneous flaps

Summary 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, whenever 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.     

Total abdominal wall reconstruction with two tensor fascia lata myocutaneous flaps

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.     

Results of reconstruction of massive irreparable rotator cuff tears using a fascia lata allograft

Background:Despite the advances in surgical treatment options, massive rotator cuff (r-c) tears still represent a challenge for orthopedic surgeons. This study assesses the effectiveness of fascia lata allograft in reconstruction of massive and irreparable r-c tear and to evaluate the healing and functional outcomes.Results:Postoperative constant score increased from 32.5 preoperatively to 88.7 postoperatively. The most important was the pain relief from 2.4 preoperatively to 14.1 postoperatively and range of motion. The results of the MRI were not reliable, but the ultrasound was satisfactory. Finally, there was no infection or rejection of the graft in any of the patients.Conclusions:Despite advances in surgical methods, there is still not a universally accepted treatment for massive and irreparable rotator cuff tears, because the standard methods have dubious results, with excessive retear rates and poor outcomes, necessitating the need for new repair strategies. We documented significant clinical improvement using fascia lata allograft in the repair of massive irreparable r-c tear, acting as scaffold to bridge the defect, enhancing the healing at the repair site.     

Intermediate term failure of pubovaginal slings using cadaveric fascia lata: a case series

PURPOSE: The pubovaginal sling procedure using autologous fascia has become the gold standard for treating intrinsic sphincter deficiency and stress urinary incontinence in women. A recent modification has been the use of cadaveric fascia as the sling material. We recently reported similar results for cadaveric fascia lata in 121 women and autologous fascia lata in 46 at a mean followup of 12 months. We have now identified 8 patients who experienced intermediate term failure at 4 to 13 months using cadaveric fascia lata. MATERIALS AND METHODS: We retrospectively reviewed the records of 8 of 121 patients who received a pubovaginal sling using cadaveric fascia lata between February 1997 and June 1999 and had recurrent stress incontinence after 4 to 13 months. We reviewed the type of fascia, surgical technique, preoperative and postoperative urodynamics, surgical history and medical co-morbidities. RESULTS: We identified 8 patients who underwent a pubovaginal sling using cadaveric fascia lata and had recurrent stress urinary incontinence at a mean of 6.5 months (range 4 to 13) after the procedure. Fresh frozen fascia from a local tissue bank was used and the surgical technique was identical in all cases. Postoperatively urodynamics confirmed recurrent intrinsic sphincter deficiency. Previous incontinence surgery had been done in 7 of the 8 patients. Patient co-morbidities included neurological disease, diabetes mellitus, previous pelvic irradiation and previous pelvic surgery. CONCLUSIONS: We identified a higher than expected intermediate term failure rate using fresh frozen cadaveric fascia lata. This risk must be weighed against the advantages of decreased operative time and patient morbidity. Longer followup and larger numbers are necessary to determine how much of a problem exists and what patient characteristics are relevant when selecting cadaveric grafts.     

Three-layer reconstruction with fascia lata and vascularized pericranium for anterior skull base defects

Summary Background. We report an assessment of the efficiacy of a triple layer graft composed of fascia lata and vascularized pericranium for anterior skull base reconstruction. This technique is based on the concept that vascularized tissue over a free flap may promote vascularization and rapid wound healing. Method. A large fascial graft is prepared from the fascia lata and divided in two pieces and trimmed to a size larger than the bone and dural defect. Vascularized pericranium is harvested after bicoronal incision and elevating the bifrontal scalp flap down to the supraorbital rims. First is dural repair, which is performed with fascia lata placed between the brain and remaining dura. Second, fascia lata is placed over the skull base defect and secured with mini titanium screws over the cranial surface of the orbital ridges. Third, vascularized pericranium is laid between the two layers of fascia lata. Findings. We studied 17 patients of whom 2 had malignancy, 6 had olfactory groove meningioma, 6 had skull base fracture and rhinorrhea, 1 case had orbital meningioma, 1 had invasive pituitary adenoma and 1 had basal encephalocele. The transbasal approach was used as a single procedure in 13 cases. The extended transbasal approach combined with a transfacial approach was used in 3 cases and with a pterional approach in 1 case. In each patient, reconstruction of the cranial base was performed with triple layer graft of fascia lata and vascularized pericranium. The patients were followed-up 2 months to 5 years. None of the patients experienced postoperative cerebrospinal fluid leakage, meningitis, abscess, brain herniation and tension pneumocephalus. Interpretation. Fascia lata with vascularized pericranium is highly reliable, tensile and well suited for reconstruction of the anterior skull base.     

The versatility of tensor fascia lata allografts for soft tissue reconstruction

The purpose of this retrospective study was to introduce our successful use of tensor fascia lata allograft to reconstruct various soft tissue defects. Since May 2021, we have applied tensor fascia lata allografts in eight cases. A frozen type of fascia of 0.6 mm thickness was used in all cases, and allografts were covered by vascularized soft tissue. We used tensor fascia lata allograft in eight cases to cover the infected wounds, donor site closure, and pedicle protections. These were abdominal wall and back reconstructions following rectus muscle and latissimus dorsi muscle harvest, coverage of infected spine wound after posterior fusion, pressure ulcer reconstruction, and pedicle protection of free and pedicle flaps. The follow-up periods were from one to 14 months. None of the cases showed wound problems after initial reconstruction using tensor fascia lata allografts. Tensor fascia lata allograft could be an excellent cost-effective surgical option comparable to autologous tissue grafts. Level of evidence: IV.     

阔筋膜张肌肌皮瓣的解剖研究与临床应用

目的　探索应用阔筋膜张肌肌皮瓣带蒂移转中 ,部分肌皮瓣发生血供障碍的原因。方法　对 16具 3 2侧用红色乳胶灌注的贮存成人尸体标本 ,进行解剖研究。结果　 12具 2 2侧肌皮瓣供血动脉走行在肌肉内 ;另有 2具 2侧肌内供血动脉与肌肉前缘较大分支并存 ;3具 4侧肌内供血动脉与肌肉深面疏松结缔组织内较大分支并存 ;3具 4侧供血动脉走行在肌肉浅面皮下组织内。解剖研究后临床又应用 8例 ,妥善保护了存在于肌肉前缘及其深浅面的血管 ,手术均获成功。结论该肌皮瓣的供血动脉不仅存在于肌肉内 ,有的在肌肉前缘或深面有较大分支 ,有的存在于肌肉浅面皮下组织内 ,手术中须避免其受到损伤 ,以确保肌皮瓣血供。     

Radio-recurrent spermatic cord leiomyosarcoma requiring radical surgery and reconstruction using a myocutaneous (tensor fascia lata) flap: a case report and review of the literature

Leiomyosarcomas (LMS) of the spermatic cord are exceedingly rare tumours. Radical inguinal orchiectomy and high ligation of the cord is the standard primary procedure. The extent of soft tissue excision required, including margins, and the precise role of adjuvant radiotherapy (RT), however, remains unclear. A 58-year-old male underwent excision of a large inguinoscrotal mass and orchiectomy. Histological examination revealed the mass to be a LMS of the spermatic cord with the tumour extending to one of the resection margins. Further surgery was nevertheless withheld for fear of creating a significant anatomical defect and hence the patient was referred for radiation therapy. He developed locoregional recurrence 2.5 years later which necessitated radical excision of soft tissues in the lower–anterior abdominal wall and inguinal region, and reconstruction using a tensor fascia lata flap. This report emphasizes the need for primary radical surgery until negative histological margins are achieved even if it involves sacrificing some adjacent normal anatomy. If margins are positive after primary surgery, re-excision should be the rule rather than the exception. Adjuvant RT, though useful, should not be considered as a substitute for complete surgical clearance. To the authors knowledge, this is the first report in medical literature of a case of spermatic cord LMS recurring after surgery and RT, requiring further radical surgery. The pathophysiology and the management of this complex and rare tumour are also reviewed.     

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。     

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。     

Long-term outcomes of autologous fascia lata sling for stress incontinence secondary to intrinsic sphincter deficiency in women

ObjectiveTo report our long-term pubovaginal sling (PVS) outcomes using fascia lata for stress urinary incontinence (SUI) secondary to intrinsic sphincteric deficiency (ISD).Methodology and methodsFollowing Institute Review Board approval, charts from women undergoing PVS with fascia lata, with at least 6 months of follow up, were reviewed. Preoperative and postoperative data collected included demographics, validated questionnaires, prior anti-incontinence procedures, associated repairs, urodynamic findings, and reoperation procedures for SUI. Success was defined as cure of SUI (no pad, UDI-6 Question 3 related to SUI at ≤ 1, and no SUI reoperation).ResultsBetween 1997 and 2013, 22 women met the inclusion criteria with mean age of 73 (52–88) years, mean BMI 29 (17–38) and mean parity 2.7 (1–4). Mean follow up was 96 months (8–190). Indication for fascia lata sling included obesity (13) and prior abdominal procedures (9), including abdominoplasty. Fifteen women had received one or more prior antiincontinence procedures and five a prior injectable agent. No perioperative complications were noted. Overall, 14 of 22 women met success criteria [UDI-6 Question 3 at 0 (10) and at 1 (4)]. Three women underwent a subsequent procedure for residual SUI with periurethral bulking agent and one is awaiting an artificial urinary sphincter.ConclusionAt long-term follow-up of over 8 years after fascia lata sling, women who underwent fascia lata sling had acceptable continence outcomes with minimal complications.     

Anatomic analysis of the vascular network and vascular pedicle of the tensor fascia lata flap (angiographic and cadaver study)

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.