Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 25:
Tensor Fascia Lata Myocutaneous Transplantation
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  A. 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 the patient.


PLATE XXV-2

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.

 


B. The underlying fascia has now been incised and permits easy elevation of the overlying skin island and the underlying fascia lata in a proximal direction. The skin island should be tacked to the underlying fascia with temporary sutures to prevent shearing of the skin island from the tenuous underlying fascia.


C. The flap is half-elevated from the deeper lateral muscles of the thigh.


PLATE XXV-3

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.


B. Additional length to the pedicle can be gained by tracing the branches of the lateral femoral circumflex medially deep to the rectus femoris.


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