The tensor fascia lata tfl flap has been successfully used for decades for coverage of hip defects, particularly trochanteric pressure sores. This technique preserves the lateral thigh skin and employs subcutaneous tunneling to overcome the traditional drawbacks of the conventional extended tensor fascia lata flap. To overcome this disadvantage, we designed a tfl perforatorbased island flap that was harvested from a site near the defect and involved transposition within 90 degrees without full isolation of the pedicles. This point can be incorporated in the flap to keep the tfl perforator as a lifeboat in the rare circumstance when the distal perforators are of poor quality or injured during dissection. Split thickness skin graft in place over donor site of tensor fascia lata flap. Tensor fascia lata tfl flap is a versatile myofasciocutaneous flap. Reconstruction of radiated gluteal defects following sarcoma. Abdominal wall reconstruction with tensor fascia latae pedicle flap a. The incorporation of the synthetic mesh into the tissue allows it to. Recently i have begun to think of the tensor fascia lata muscle tfl as the undiscovered country of hip pain.
The tensor fascia lata tfl flap is one of the wellknown flaps with a reliable and constant pedicle. A portion of external table of iliac crest can be harvested with the. The tensor fascia lata myocutaneous flap in gynecologic. A musclefascia flap most commonly harvested with an overlying skin paddle. It is useful to grip the flap with a suture to dissect it properly. The combined flap consisting of the anterolateral thigh flap and the tensor fasciae latae perforator flap is considered suitable for the repair of massive skin soft tissue defects. The defect was covered with a tensor fascia lata tfl flap. Tensor fascia lata i a major cause of unexplained hip pain. This band, also called the it band, is an elongated strip of fascia a type of connective tissue located in the.
A useful and reliable technique for reconstruction of. The tensor fasciae latae is a tensor of the fascia lata. And yet this complex muscle has rarely been mentioned as a potential root cause. While conventional treatments like static stretching, massage and trigger point release therapy are useful in the acute stages, they wont provide lasting relief from tensor fasciae latae pain. The tensor fascia lata vy retroposition flap northwestern. Free tensor fasciae latae musculofasciocutaneous flap in.
This technique eliminates the rotation point, puts the thickest portion of the flap over the defect, and obviates the need for skin grafts. The subcutaneous pedicle tensor fascia lata flap s sensate potential, thin skin, durable fascia, extensive reach, and 360 degree arc of rotation make it an appealing donor. A useful and reliable technique for reconstruction of different anatomical districts md. Tensor fascia lata tfl flap is a myofasciocutaneous flap. This includes the fact that this flap can be used as motor and sensory innervated. The deep fascia overlying the deltoid muscle is sharply cut and the flap is elevated in a plane underneath the fascia. Tensor fascia lata flap versus tensor fascia lata perforator. They concluded that pedicled tensor fascia lata flap is a good and reliable option for groin reconstruction. The junction of the proximal and middle third is often the site of a perforator that pierces the tensor fascia lata. Your tfl is a key player when it comes to lower body movement and function. Flap can also be employed to reconstruct defects within the groin, gluteal, ischial, and lower abdominal regions. Tensor fascia lata flap reconstruction in groin malignancy. It is a wellsuited procedure because it provides both a semirigid fascia layer and adequate skin coverage.
It lies between the two layers of fascia lata in the proximal third of the thigh and via the iliotibial band inserts onto the lateral tibial condyle gertys tubercle. Tfl flaps were elevated and delayed for 4 weeks in both cases. The tensor fasciae latae perforator flap and a new technique, named microdissection, for onestage accurate formation of a thin flap were presented. In the second case, parietex composite mesh was positioned underneath the tfl flap and allowed to incorporate. Operative technique the outline of the tensor fasciae latae muscle is marked on the lateral side of the thigh. When necessary, it can be transferred as a free flap to distant defects utilizing microvascular techniques. Gracilis, tensor fascia lata, vastus lateralis, rectus. Due to various features of tensor fascia lata flap, it is considered as a reliable flap for the reconstruction of many challenging defects 4, 5. The flp created was rotated cranially, passed through the subcutaneous tunnel, and placed into the. We followed the same technique of harvesting of tfl as described by. The tfl muscle flap is supplied by the ascending branch of the lateral circumflex femoral artery. This flap has served as a workhorse flap for a variety of indications such as trochanteric pressure ulcers. Tensor fasciae latae definition of tensor fasciae latae by.
Dissection proceeds toward the vascular pedicle, which is visualized in the under surface of the. Illustration of the fascia lata flap flp technique proposed in the paper. The subcutaneous pedicle tensor fascia lata flaps sensate potential, thin skin, durable fascia, extensive reach, and 360 degree arc of rotation make it an appealing donor. To our knowledge, the tfl flap has not been previously described for use in the reconstruction of extensive oncologic gluteal defects. The flap can be harvested without a skin paddle, using only the muscle and fascia. Endoscopic harvest of the tensor fasciae latae muscle flap. Static suspension can create better facial symmetry as well as improve some of the most difficult sideeffects of facial paralysis including drooling and biting of the inner gum. The fascia lata is a fibrous sheath that encircles the thigh like a subcutaneous stocking and tightly binds its muscles. Authors introduce a new technique for repairing a pelvic floor defect using a tensor fascia lata flap. Tensor fascia lata flap is one of the good alternatives. Tunnelled tensor fascia lata flap for complex abdominal wall. Tensor fasciae latae flap, anatomy and technique the tfl itself is a small, thin, flat muscle that is located on the lateral aspect of the upper thigh. This was carried out as a single stage procedure in 14 cases. The musculocutaneous pedicled flap, using tensor fasciae latae muscle tfl, is a technique of abdominal wall repair, and it is becoming a more frequent reconstructive procedure.
Proximal femoral resection and tensor fascia lata flap for. While the patient is in a single position for an anterior to posterior lateral chest wall reconstruction, free tfl andor alt flap reconstruction is an. T1 tensor fascia lata musculocutaneous flap for trochanteric pressure ulcer coverage. A week doesnt seem to go by without my seeing a new client who says theyve tried everything for hip pain. The fascia lata stripper is engaged and, with the stripper held as close to the leg as possible, it is pushed superiorly while gentle tension is held on the silk suture pulling the. The gracilis muscle flap was first described in 1976 and is one of more common flaps used for reconstruction of the vagina andor vulva. Defektdeckung mit musculustensorfasciaelataelappen. The word tensor comes from the latin word tendere which means to tense. An atlas of microsurgery techniques and principles. Vy tensor fascia lata for trochanteric pressure sore. Dec 21, 2015 the tensor fasciae latae tfl, likewise called tensor fasciae femoris, is one of the 10 muscles of the gluteal area, occurring from the outer lip of the iliac crest, the anterior remarkable iliac spinal column, and the deep fascia lata, on the outside of the hip. Thus, a triangular flap is detached laterally over the fibres of the gluteus minimus in the direction of the tensor fascia lata.
Jun 27, 2018 the tensor fasciae latae tfl muscle flap can be used for reconstruction of decubital ulcers in the trochanteric or ischial region. It is a versatile flap with many uses in reconstructive plastic surgery like in management of pressure sores, facial reanimation and as a free flap in head and neck reconstruction. The strength of the fascia lata reconstruction is weaker than that of using mesh. Nov 18, 2014 the tensor fascia lata flap is a reliable flap having good vascularity and composed of skin, subcutaneous tissue, fascia, and muscle. The tensor fasciae latae tfl, likewise called tensor fasciae femoris, is one of the 10 muscles of the gluteal area, occurring from the outer lip of the iliac crest, the anterior remarkable iliac spinal column, and the deep fascia lata, on the outside of the hip. It was concluded that the pedicled tensor fascia lata flap is a versatile, reliable, easy, and less time consuming procedure for the coverage of defects around trochanter, groin, lower anterior abdomen, perineum, and ischial region. As a small muscle, it lies in between the 2 layers of fascia lata in the proximal.
The muscle name describes what the muscle does and where its located. The subterm subcutaneous tissue and fascia was selected as the deepest layer in the flap and is specified as fascia. We describe a new technique of integrating a polypropylene mesh with a pedicled tfl flap prior to flap harvest and tunnelling it subcutaneously to correct contaminated abdominal wall defects. As a pedicled flap, its strong fascial layer has the. Clinical study versatility of pedicled tensor fascia lata. Reconstruction of radiated gluteal defects following. Dissection proceeds toward the vascular pedicle, which.
Tensor fascia lata musculocutaneous flap for trochanteric. The vy tensor fascia lata allows a covering similar to the classical flap, simplifies primary closure and essentially presents the possibility of numerous reutilizations. Sohaibakhtar,mohdfahudkhurram,andarshadhafeezkhan post graduate department of burns, plastic and reconstructive surgery, jnmc, amu, aligarh, india. Bhanu prakash usmle, fmge and neet pg 45,624 views. Mar 08, 2011 tunnelled tensor fascia lata flap for complex abdominal wall reconstruction frederick wang, 1 samuel buonocore, 2 and deepak narayan 2 1 division of plastic and reconstructive surgery, department of surgery, university of california, san francisco, san francisco, california, usa. Wangensteen first reported the tensor fascia lata flap for abdominal wall reconstruction. In 1934, wangensteen, first described it for abdominal wall reconstruction. Its from latin and translates to stretcher of the wide band. The fascia lata is an investment for the whole of the thigh, but varies in thickness in different parts. Apr 30, 20 tensor fascia latae flap saravanamuthu marimuthu. Can i bill for harvest of of left tensor fascia lata graft. Tensor fasciae latae definition of tensor fasciae latae. Indications deep decubital ulcers in the gluteal or ischial area after debridement and exhaustion of conservative measures.
Skin incisions, 23 cm in length, are made at the anterior and posterior margins of the fascia in the distal thigh fig. Use of tensor fascia lata flap for reconstruction of the. Flap may be designed as a pedicled or free flap, depending on the region requiring coverage. The muscle then inserts into your iliotibial band, which is a strong band of fascia that runs down the middle of the lateral aspect of your thigh to the tibial condyle just below your knee. Babak azizzadeh typically uses tensor fascia lata a tendonlike structure from the thighs to support and create a laugh line. Ab the design of the tensor fascia lata myocutaneous flap can be modified, allowing its use as a vy retroposition flap for treatment of trochanteric pressure ulcers. Use of tensor fascia lata flap for reconstruction of the defect created. Tensor means stretcher and the wide band in this case is the fasciae lata, which is the fascia that surrounds all of the thigh muscles. In the exstrophy case, as the flap was used to cover the anterior abdominal wall defect, the flap was released after six weeks, thus making it a two staged procedure.
Perforator vessels are always present, the anatomy is more constant and it is. On the lateral surface, it combines with the tendons of the gluteus maximus and tensor fasciae latae to form the iliotibial tract, which extends from the iliac crest to the lateral condyle of the tibia. Tunnelled tensor fascia lata flap for complex abdominal wall reconstruction. The tensor fascia lata flap is a reliable flap having good vascularity and composed of skin, subcutaneous tissue, fascia, and muscle. Besides the fact that that this muscle is expendable, it causes minimal donor site morbidity without any knee weakness 26. The subcutaneous pedicle tensor fascia lata flap houston. Intraoperative view of the fascia lata flap flp and the subcutaneous tunnel hemostatic forceps that was opened to pass the flap up to the perineal area. The anatomy and operative technique for raising the free tensor fasciae latae flap are well described. Tensor fascia lata was incised with electrocautery, and a breiskynavratil retractor was used to elevate the fatty tissue from on top of the fascia as well as from underneath. While conventional treatments like static stretching, massage and trigger point release therapy are useful in the acute stages, they. The anterior border of the marked skin flap is incised first, extending it along the inferior border as required. A useful and reliable technique for reconstruction of different anatomical districts. The pedicled tensor fascia lata tfl flap has most commonly been utilized for reconstruction of trochanteric pressure sores and lower abdominal wall defects 46. Fascia lata flap to repair perineal hernia in dogs.
This study describes the treatment of two patients with recurrent, infected abdominal wall defects using bilateral delayed and tunnelled pedicled tensor fascia lata tfl myofascial flaps. Vy tensor fascia lata for trochanteric pressure sore treatment. Tensor fascia lata tfl perforator flap can be a good alternative in these cases. Its cutaneous area is four times greater than the size of the muscle, thereby providing an exceptional amount of bulk from which a flap can be fashioned. The tensor fasciae latae is a tiny muscle, inferior to the iliotibial band. Static sling, static suspension, facial paralysis treament. Jan 03, 2014 anatomy front of the thigh fascia lata part 3 dr. Pedicled tensor fascia lata flap was performed in majority of the patients with defects over trochanter totalling around 30% 12 patients figures figures2 2 and and3 3. The fourth character 1 identifies the body part as subcutaneous tissue and fascia of the face and the qualifier c identifies the other tissue layers involved, skin, subcutaneous. One has merely to look at the long and unsuccessful history of attempts to avoid the inevitable slough after radical vulvectomy to further appreciate this fact 4.
However, a major drawback is that it also sacrifices the muscle. Release the flap laterally until the pertrochanteric tubercle is visualized. The tensor fascia lataetfl is a fusiform muscle enclosed between two layers of fascia lata with a length of 15cm approximately and overlying the gluteus minimus and some part of the gluteus medius1. Its likely pain in the tensor fascia latae tfl a common complaint that can be alleviated with the 3 steps outlined in this guide. Two boys, 4 years old and 10 months old, presenting with pelvic rhabdomyosarcoma underwent a tumor extirpation associated with a wide excision of the pelvic organs. Latae comes from the latin word lata which means side or lateral. The name tensor fasciae latae may sound like its from a different language and, well, thats because it is. Tensor fascia lata tfl musculocutaneous flaps often require a donor site graft when harvesting a large flap. Tunnelled tensor fascia lata flap for complex abdominal. N2 the tensor fascia lata tfl flap has been successfully used for decades for coverage of hip defects, particularly trochanteric pressure sores.
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