|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
The tensor fascia lata arises from the iliac crest from the anterior spine
posteriorly for several centimeters and inserts with the gluteus maximus
muscle through the condensed fascia of the lateral surface of the thigh,
which forms the iliotibial band or tract. The lateral femoral cutaneous
nerve, the primary sensory nerve for this flap, comes out just below the
anterior superior iliac spine, piercing the fascia there and lying in the
groove between the tensor fascia lata muscle and the sartorius. The overlying
skin island must of necessity encompass the nerve. The anterior border of
the tensor fascia lata flap begins 1 to 2 cm anterior to the anterior superior
iliac spine and extends down the anterior lateral aspect of the thigh to
an area above the lateral femoral condyle. The cutaneous territory probably
should not extend to within more than 4 or 5 cm of the lateral condyle.
The posterior border of the skin island can extend to a greater tuberosity
of the femur from the iliac crest downward, producing a flap of massive
size from 35 to 45 cm long and 15 to 20 cm wide, depending on the size of
A. The skin island has been incised circumferentially, with the lateral femoral cutaneous nerve entering the anterior superior corner. In this instance, the skin island has not been carried proximally to the iliac crest. A separate incision made before raising the flap is sometimes useful to locate and dissect the lateral femoral cutaneous nerve after it passes under the lateral aspect of the inguinal ligament. This nerve is easier to dissect before the relationship of the surrounding tissue has been disturbed by the flap dissection.
A. The skin island and the fascia have been raised more proximally, to a point where the vascular pedicle is seen entering the posterior deeper surface. These vessels arise from the lateral femoral circumflex vessels deep to the rectus femoris muscle. The major ascending branch supplies the tensor fascia lata on the deep surface. This cleft can be visualized by the deep position of fat in the fascia septum between the rectus femoris and the vastus lateralis.
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