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

The tensor fascia lata was one of the first musculocutaneous flaps to be transplanted by microsurgical techniques. 1-5 The primary indication for its use has been in situations requiring a large, sensory, innervated, durable flap, such as for heel coverage. The lateral femoral cutaneous nerve supplying sensation to the lateral aspect of the thigh may be included in the flap for restoration of sensibility.3

Several factors have resulted in the decreased use of the tensor fascia lata flap, including the ability to transplant other flaps of equal or greater size with more versatility, such as the latissimus dorsi muscle. The failure of the distal portion of the flap to regain protective sensation even after microneurorrhaphy, as well as the bulk of the proximal portion of the flap required for transplantation, has also decreased its usefulness. The donor site on the superolateral thigh often requires skin-graft closure, which further detracts from this procedure even in comparison with other possible donor sites. Closure of the thigh donor area under tension is to be avoided. Nevertheless, the tensor fascia lata free flap has been shown to be valuable in certain selected problems of difficult coverage. It is particularly useful as a local rotation or V-Y advancement flap for ischial, abdominal, and groin defects.6


The primary uses of the tensor fascia lata flap have been in the distal portions of the lower extremity, in particular on the proximal portion of the bottom of the foot. The flap has also been used successfully to cover below-knee amputation stumps with unstable coverage. The ability of the proximal portion of the flap to become reinnervated with protective sensibility has made it valuable in these isolated cases. As noted, the distal third of the flap does not regain protective sensation.

Preoperative angiography in the recipient area is required in almost all patients. Most indications for tensor fascia lata transplantation are for post-traumatic defects, and therefore the status of the vessels in the recipient region must first be evaluated to plan the flap position relative to the appropriate recipient vessels. The posterior tibial vessels, if available, are commonly used as recipient vessels for tensor fascia lata transplantation to the heel region.

Plain x rays of the extremity bone structure to be covered must be obtained to allow planning of appropriate sequestrectomies or spur removal, as necessary.

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