Download PDF
J Reconstr Microsurg 2012; 28(03): 211-220
DOI: 10.1055/s-0032-1306368
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Free Tensor Fasciae Latae Flap for Abdominal Wall Reconstruction: Overview and New Innovation

Charbel T. Chalfoun
1   The Plastic Surgery Group, Montclair, New Jersey
,
Michael P. McConnell
2   Private practice, Fullerton, California
,
Garrett A. Wirth
3   Department of Plastic Surgery, University of California, Irvine, Orange, California
,
Kevin A. Brenner
4   Private practice, Beverly Hills, California
,
Gregory R.D. Evans
3   Department of Plastic Surgery, University of California, Irvine, Orange, California
,
Mark Kobayashi
3   Department of Plastic Surgery, University of California, Irvine, Orange, California
› Author Affiliations
Further Information

Publication History

21 July 2011

09 November 2011

Publication Date:
07 March 2012 (online)

    Permissions and Reprints

Abstract

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.

Keywords

tensor fasciae latae - abdominal wall reconstruction - osteomyocutaneous flap
 

  • References

  • 1 Wangensteen OH. Repair of recurrent and difficult hernias and other large defects of the abdominal wall employing the iliotibial tract of fascia lata as a pedicled flap. Surg Gynecol Obstet 1934; 59: 766-780
    PubMedGoogle Scholar
  • 2 Hill HL, Nahai F, Vasconez LO. The tensor fascia lata myocutaneous free flap. Plast Reconstr Surg 1978; 61 (4) 517-522
    CrossrefPubMedGoogle Scholar
  • 3 Hill HL, Hester R, Nahai F. Covering large groin defects with the tensor fascia lata musculocutaneous flap. Br J Plast Surg 1979; 32 (1) 12-14
    CrossrefPubMedGoogle Scholar
  • 4 Nahai F. The tensor fascia lata flap. Clin Plast Surg 1980; 7 (1) 51-56
    PubMedGoogle Scholar
  • 5 Nahai F, Hill L, Hester TR. Experiences with the tensor fascia lata flap. Plast Reconstr Surg 1979; 63 (6) 788-799
    PubMedGoogle Scholar
  • 6 Nahai F, Silverton JS, Hill HL, Vasconez LO. The tensor fascia lata musculocutaneous flap. Ann Plast Surg 1978; 1 (4) 372-379
    CrossrefPubMedGoogle Scholar
  • 7 Cheng N, Shou B, Zheng M, Huang A. Microneurovascular transfer of the tensor fascia lata musculocutaneous flap for reconstruction of the tongue. Ann Plast Surg 1994; 33 (2) 136-141
    CrossrefPubMedGoogle Scholar
  • 8 Wolff KD, Hölzle F, Nolte D. Perforator flaps from the lateral lower leg for intraoral reconstruction. Plast Reconstr Surg 2004; 113 (1) 107-113
    CrossrefPubMedGoogle Scholar
  • 9 Lin MT, Chang KP, Lin SD, Lai CS, Yang YL. Tensor fasciae latae combined with tangentially split vastus lateralis musculocutaneous flap for the reconstruction of pressure sores. Ann Plast Surg 2004; 53 (4) 343-347
    CrossrefPubMedGoogle Scholar
  • 10 Williams JK, Carlson GW, Howell RL, Wagner JD, Nahai F, Coleman JJ. The tensor fascia lata free flap in abdominal-wall reconstruction. J Reconstr Microsurg 1997; 13 (2) 83-90 , discussion 90–91
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Williams JK, Carlson GW, deChalain T, Howell RL, Coleman JJ. Role of tensor fasciae latae in abdominal wall reconstruction. Plast Reconstr Surg 1998; 101 (3) 713-718
    CrossrefPubMedGoogle Scholar
  • 12 Lyle WG, Gibbs M, Howdieshell TR. The tensor fascia lata free flap in staged abdominal wall reconstruction after traumatic evisceration. J Trauma 1999; 46 (3) 519-522
    CrossrefPubMedGoogle Scholar
  • 13 Sasaki K, Nozaki M, Nakazawa H, Kikuchi Y, Huang T. Reconstruction of a large abdominal wall defect using combined free tensor fasciae latae musculocutaneous flap and anterolateral thigh flap. Plast Reconstr Surg 1998; 102 (6) 2244-2252
    CrossrefPubMedGoogle Scholar
  • 14 Ihara K, Doi K, Shigetomi M, Kawai S. Tensor fasciae latae flap: alternative donor as a functioning muscle transplantation. Plast Reconstr Surg 1997; 100 (7) 1812-1816
    CrossrefPubMedGoogle Scholar
  • 15 Koshima I, Urushibara K, Inagawa K, Moriguchi T. Free tensor fasciae latae perforator flap for the reconstruction of defects in the extremities. Plast Reconstr Surg 2001; 107 (7) 1759-1765
    CrossrefPubMedGoogle Scholar
  • 16 Kimura N. A microdissected thin tensor fasciae latae perforator flap. Plast Reconstr Surg 2002; 109 (1) 69-77 , discussion 78–80
    CrossrefPubMedGoogle Scholar
  • 17 Kobayashi MR, Brenner KA, Gupta R, Evans GRD. Functional biceps brachii reconstruction using the free tensor fasciae latae. Plast Reconstr Surg 2004; 114 (5) 1208-1214
    PubMedGoogle Scholar
  • 18 O'Hare PM, Leonard AG, Brennen MD. Experience with the tensor fasciae latae free flap. Br J Plast Surg 1983; 36 (1) 98-104
    CrossrefPubMedGoogle Scholar
  • 19 Bulstrode NW, Kotronakis I, Baldwin MAR. Free tensor fasciae latae musculofasciocutaneous flap in reconstructive surgery: a series of 85 cases. J Plast Reconstr Aesthet Surg 2006; 59 (2) 130-136
    CrossrefPubMedGoogle Scholar
  • 20 Moore K. Clinically Oriented Anatomy. 3rd ed. Baltimore: Williams and Wilkins; 1992
    Google Scholar
  • 21 Saadeh FA, Haikal FA, Abdel-Hamid FAM. Blood supply of the tensor fasciae latae muscle. Clin Anat 1998; 11 (4) 236-238
    CrossrefPubMedGoogle Scholar
  • 22 Rohrich RJ, Lowe JB, Hackney FL, Bowman JL, Hobar PC. An algorithm for abdominal wall reconstruction. Plast Reconstr Surg 2000; 105 (1) 202-216 , quiz 217
    CrossrefPubMedGoogle Scholar
  • 23 Jacobs DG, Pratt BL, Capizzi PJ. Reconstruction of the massive posttraumatic abdominal wall hernia. Probl Gen Surg 2002; 19 (4) 73-83
    CrossrefPubMedGoogle Scholar
  • 24 Levine JP, Karp NS. Restoration of abdominal wall integrity as a salvage procedure in difficult recurrent abdominal wall hernias using a method of wide myofascial release. Plast Reconstr Surg 2001; 107 (3) 707-716 , discussion 717–718
    CrossrefPubMedGoogle Scholar
  • 25 Shestak KC, Edington HJ, Johnson RR. The separation of anatomic components technique for the reconstruction of massive midline abdominal wall defects: anatomy, surgical technique, applications, and limitations revisited. Plast Reconstr Surg 2000; 105 (2) 731-738 , quiz 739
    CrossrefPubMedGoogle Scholar
  • 26 Mathes SJ, Steinwald PM, Foster RD, Hoffman WY, Anthony JP. Complex abdominal wall reconstruction: a comparison of flap and mesh closure. Ann Surg 2000; 232 (4) 586-596
    CrossrefPubMedGoogle Scholar
  • 27 Kolker AR, Brown DJ, Redstone JS, Scarpinato VM, Wallack MK. Multilayer reconstruction of abdominal wall defects with acellular dermal allograft (AlloDerm) and component separation. Ann Plast Surg 2005; 55 (1) 36-41 , discussion 41–42
    CrossrefPubMedGoogle Scholar
  • 28 Ninković M, Kronberger P, Harpf C, Rumer A, Anderl H. Free innervated latissimus dorsi muscle flap for reconstruction of full-thickness abdominal wall defects. Plast Reconstr Surg 1998; 101 (4) 971-978
    CrossrefPubMedGoogle Scholar
  • 29 Celik N, Wei FC, Lin CH , et al. Technique and strategy in anterolateral thigh perforator flap surgery, based on an analysis of 15 complete and partial failures in 439 cases. Plast Reconstr Surg 2002; 109 (7) 2211-2216 , discussion 2217–2218
    CrossrefPubMedGoogle Scholar
  • 30 Kuo YR, Kuo MH, Lutz BS , et al. One-stage reconstruction of large midline abdominal wall defects using a composite free anterolateral thigh flap with vascularized fascia lata. Ann Surg 2004; 239 (3) 352-358
    CrossrefPubMedGoogle Scholar
  • 31 Kuo YR, Seng-Feng J, Kuo FM, Liu YT, Lai PW. Versatility of the free anterolateral thigh flap for reconstruction of soft-tissue defects: review of 140 cases. Ann Plast Surg 2002; 48 (2) 161-166
    CrossrefPubMedGoogle Scholar
  • 32 Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 2002; 109 (7) 2219-2226 , discussion 2227–2230
    Google Scholar
  • 33 Koshima I, Nanba Y, Tutsui T, Takahashi Y, Itoh S, Kobayashi R. Dynamic reconstruction of large abdominal defects using a free rectus femoris musculocutaneous flap with normal motor function. Ann Plast Surg 2003; 50 (4) 420-424
    CrossrefPubMedGoogle Scholar
  • 34 Chevray PM, Singh NK. Abdominal wall reconstruction with the free tensor fascia lata musculofasciocutaneous flap using intraperitoneal gastroepiploic recipient vessels. Ann Plast Surg 2003; 51 (1) 97-102
    CrossrefPubMedGoogle Scholar
  • 35 Gosain AK, Yan JG, Aydin MA, Das DK, Sanger JR. The vascular supply of the extended tensor fasciae latae flap: how far can the skin paddle extend?. Plast Reconstr Surg 2002; 110 (7) 1655-1661 , discussion 1662–1663
    CrossrefPubMedGoogle Scholar
  • 36 Zetrenne E, Wirth GA, Evans GRD , et al. Reconstruction of traumatic transposition of the penis and scrotum and associated complex open abdominoperineal pelvic deformity with free innervated tensor fascia latae osteomyocutaneous flap. Ann Plast Surg 2005; 54 (6) 657-661
    CrossrefPubMedGoogle Scholar