Reconstruction of the abdominal wall using a tensor fasciae latae musculocutaneous island flap. A case report

A case is reported which provides further evidence of the reliability of a unilateral tensor fasciae latae myocutaneous island flap in the repair of a large full-thickness defect in the lower abdominal wall.     

Free tensor fasciae latae flap for abdominal wall reconstruction: overview and new innovation

Extensive abdominal wall defects may result from tumor extirpation, traumatic injury, or soft tissue infections. Extensive traumatic injuries can often disrupt the soft tissue content of the abdomen as well as the bony support provided by the pelvis. Reconstruction of the lower abdomen should aim to recreate dynamic stability. Five patients with extensive lower abdominal wall disruption following traumatic injuries or infection were treated using a novel flap for functional reconstruction. We devised a free neurotized osteomyocutaneous tensor fasciae latae (TFL) flap that would restore bony continuity by providing a vascularized bone graft and simultaneously maintain the integrity of the attachment of the tensor fascia latae muscle to the iliac crest, reestablishing musculofascial continuity. A branch of the superior gluteal nerve was harvested with this composite flap and coapted to an intercostal nerve for reinnervation, thereby creating a dynamic muscle in these patients. All patients underwent successful free tissue reconstruction with 100% flap survival. The lower abdominal wall and bony integrity of the pelvis were successfully reconstructed. Reinnervation has shown clinical signs of maintained dynamic stability. The innervated TFL osteomyocutaneous flap is an ideal option for lower abdominal reconstruction in patients with complex abdominoperineal defects with loss of bony integrity.     

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.     

Tensor fasciae latae combined with tangentially split vastus lateralis musculocutaneous flap for the reconstruction of pressure sores

Pressure sores in the ischial and the trochanteric regions are usually encountered in long-term bedridden and wheelchair-dependent patients. A number of techniques have been developed for the reconstruction of pressure sores. Tensor fasciae latae musculocutaneous flap has been extensively employed to close the trochanteric defect. Despite its utility of having a constant pedicle and proximal bulky muscle, the relative shortness of the flap and insufficient padding in the distal portion limit the applications for distant locations of pressure sores. From January 2001 to December 2003, 8 patients with ischial and trochanteric pressure sores underwent tensor fasciae latae reconstruction in combination with tangentially split vastus lateralis muscle. The descending branches of the lateral circumflex femoral arteries were also included in these flaps. All of the procedures have been successful, and no flap necrosis has been observed. Sufficient bulk of the flap and reliable distal skin paddle constitute the advantages of this flap.     

The fully rotated tensor fasciae latae perforator propeller flap in reconstruction of trochanteric pressure sores

Reconstruction of trochanteric pressure sores continues to challenge reconstructive surgeons because recurrence is not uncommon and patients typically have undergone previous surgery. We herein report on the use of a large adipocutaneous TFLPP rotated for 180° facilitating reconstruction of a recurring trochanteric decubital ulcer in a 37-year-old male morbidly obese patient with diabetes mellitus. The postoperative period showed no adverse events, and no recurrence was observed to date. The TFLPP is a valuable option because skin grafts are usually not needed for donor-site closure, the muscle is spared, and minimal donor-site morbidity as well as a less bulky appearance is observed.Level of evidence: Level V, therapeutic study.     

Modification of the tensor fasciae latae flap for reconstruction of the abdominal wall: a case report

Full-thickness periumbilical wounds after extensive abdominal surgery present a major challenge. In this case report the traditional tensor fasciae latae flap was modified, improving flap mobility while also facilitating donor defect repair.     

Use of a combined groin-tensor fasciae latae flap for reconstruction of a full-thickness defect of the abdominal wall

Two cases are presented in whom full-thickness defects of the abdominal wall were repaired by combined groin-tensor fasciae latae flaps nourished only by the superficial circumflex iliac artery. The dissection of the flap is simple and it will probably cover even the upper parts of the flank.     

Functional reconstruction of Achilles tendon defects combined with overlaying skin defects using a free tensor fasciae latae flap.

We present our experience in functional reconstruction of the Achilles tendon with large tissue defects following after trauma and infection. To cover the skin defect and to reconstruct the Achilles tendon we used the free tensor fasciae latae (TFL) flap. From 1997 to 2003 six males, ranging from 22 to 71 (average 38.6) years, underwent this reconstructive procedure. All of them had sustained a trauma with following loss of the tendon and of the overlying tissue. After initial debridements the reconstruction with a tensor fascia latae free flap was performed. To achieve a strong distal fascia lata attachment to the calcaneal bone, we developed a special method of fixation. After vertical osteotomy in the calcaneus the distal part of the fascia flap was introduced between the bone segments, which were fixed together with a spongiosa screw. For functional outcome, it was important to fix the foot in a 90 degrees position with tension on the vascularised fascia lata. The range of motion of the ankle of the reconstructed foot showed 93.7% in comparison to the normal foot. No flap failure occurred in any of the six patients. Simultaneous soft-tissue and function restoration of the foot with TFL free flap is in our opinion an optimal one-stage reconstructive procedure.     

Reconstruction of the achilles tendon and overlying skin defect with a medical plantar flap and tensor fasciae latae graft

The authors report a case of Achilles tendon and skin defect treated with an island medial plantar flap and fascia lata graft with very satisfactory results.     

Reconstruction of major abdominal wall defects using the tensor fasciae latae myocutaneous flap

Five cases of abdominal wall reconstruction using the tensor fasciae latae myocutaneous flap are described. This flap provides a deep layer of tissue of sufficient strength to prevent herniation and external cover in a single stage repair. We regard it as the method of choice in the reconstruction of major defects of the abdominal wall.     

Tensor fascia lata musculocutaneous flap for abdominal wall reconstruction

We report a case of abdominal wall reconstruction following excision of irradiated skin and a ventral hernia. A very large tensor fascia lata musculocutaneous flap was used with good results. The anatomical features of this flap make it an excellent method of abdominal wall reconstruction.     

Free tensor fasciae latae musculofasciocutaneous flap in reconstructive surgery: a series of 85 cases.

The use of tensor fasciae latae was first described as a rotation or island flap and evolved into a free flap in the late 1970s. This series of 85 patients undergoing free tensor fasciae latae transfer includes complex head and neck, abdominal wall and lower limb reconstruction. The overall success rate was 93% (79 patients), partial flap loss, 5% (four cases), and flap failure, 2% (two patients). Twelve patients (14%) required unplanned return to theatre for exploration resulting in a 75% salvage rate. We believe this series demonstrates the great versatility of this flap and highlights particular indications for its use.     

Myocutaneous flap from the tensor fasciae latae in treatment of trochanteric decubitus ulcers]

The paper presents paraplegic patient after L1-L9 subluxation due to the spine injury. Excision of trochanteric decubitus ulcer covered with the tensor fasciae latae myocutaneous flap gave permanent result.     

Treatment of femoral neck fracture with muscle-bone flap of both tensor fasciae latae and sartorius

Objective： To evaluate the effect of muscular pedicle bone grafts with sartorius or tensor fasciae latae and sartorius in fresh transcervical or subcapital fractures of the femoral neck. Methods: Thirty cases of fresh transcervical and subcapital fractures of the femoral neck were treated by the tail breakable screws and sartorius pedicle bone grafts(single muscular pedicle, SMP group). The other 23 cases were treated by cannulated pressure screws and bone grafts with the muscular pedicles of both sartorius and tensor fasciae latae (double muscular pedicles, DMP group). Results: Fifty-two cases were followed up for 3 to 5 years (mean, 4 years). In SMP group, ten cases showed poor therapeutic results. Excellent therapeutic effects were achieved in all cases of DMP group. Conclusions : The transcervical or subcapital fractures of the femoral neck can be treated by double muscular pedicles bone graft. The bone graft with double muscular pedicles is more effective than single sartorius muscular pedicles for fresh transcervical and subcapitul fractures of the femoral neck during short and medium terms.