Autogenous Fascia Lata Research Articles

A Randomized Clinical Trial of Two Methods of Fascia Lata Suspension in Congenital Ptosis

To compare the results of 2 methods of upper eyelid sling placement with autogenous fascia lata in the treatment of congenital ptosis. In a randomized clinical trial, patients with congenital upper eyelid ptosis and poor levator function (<4 mm) were randomly assigned to either of 2 methods of upper eyelid sling placement: group A, bitriangular fascia sling (modified Crawford method), and group B, monotriangular fascia sling (modified Fox method). This study included 30 upper eyelids (15 eyelids in each surgical group) of 19 patients (8 unilateral and 11 bilateral cases) with congenital ptosis. Mean increase in eyelid fissure height was 2.7 +/- 2.3 mm in group A and 3.4 +/- 2.2 mm in group B. Change in eyelid fissure in both groups was significant (p < 0.001, paired t test) but the intergroup difference was not (p = 0.4, independent sample t test). Early complications such as corneal epithelial defects and entropion and late complications such as undercorrection were comparable in the 2 groups. No patient experienced recurrent ptosis requiring reoperation in either group. The monotriangular method of upper eyelid fascia sling placement can be used instead of the more popular bitriangular method. Advantages include less need for fascial tissue, less periocular scar formation, and a shorter period of anesthesia.

Humeral Hemiarthroplasty with Biologic Resurfacing of the Glenoid for Glenohumeral Arthritis

Biologic glenoid resurfacing was developed in 1988 as an alternative to total shoulder arthroplasty in selected (usually younger) patients with primary, posttraumatic, or postreconstructive glenohumeral arthritis. A variety of biologic surfaces, including anterior capsule, autogenous fascia lata, and Achilles tendon allograft, have been combined with a humeral hemiarthroplasty. From November 1988 to November 2003, thirty-four patients (thirty-six shoulders) who were managed with biologic glenoid resurfacing and humeral head replacement either with cement (ten shoulders) or without cement (twenty-six shoulders) were followed prospectively. The study group included thirty men and four women with an average age of fifty-one years. The diagnoses included primary glenohumeral osteoarthritis (eighteen shoulders), postreconstructive arthritis (twelve), posttraumatic arthritis (five), and osteonecrosis (one). Anterior capsule was used for seven shoulders, autogenous fascia lata for eleven, and Achilles tendon allograft for eighteen. All shoulders were assessed clinically and with serial radiographs. The mean American Shoulder and Elbow Surgeons score was 39 points preoperatively and 91 points at the time of the most recent follow-up. According to Neer's criteria, the result was excellent for eighteen shoulders, satisfactory for thirteen, and unsatisfactory for five. Glenoid erosion averaged 7.2 mm and appeared to stabilize at five years. There were no revisions for humeral component loosening. Complications included infection (two patients), instability (three patients), brachial plexitis (one patient), and deep-vein thrombosis (one patient). Factors that appeared to be associated with unsatisfactory results were the use of capsular tissue as the resurfacing material and infection. Biologic resurfacing of the glenoid can provide pain relief similar to total shoulder arthroplasty. It allows selected younger patients to maintain an active lifestyle, including weight-lifting and manual work, without the risk of polyethylene wear. On the basis of this and previous reviews, we currently recommend Achilles tendon allograft as the preferred resurfacing material when this option is chosen. Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Blepharophimosis–ptosis–epicanthus inversus syndrome: objective analysis of surgical outcome in patients from a single unit

The aim was to objectively assess surgical outcome in blepharophimosis-ptosis-epicanthus inversus syndrome (BPES). Retrospective review of 14 consecutive patients with BPES. Mustardé double z plasty (at about age 4) and autogenous fascia lata Crawford brow suspension (9-12 months later) were used in all. One consultant performed all operations. Patient photographs were scanned and magnified for analysis. Preoperative and postoperative intercanthal distance, vertical palpebral aperture and cosmetic outcome were measured. Values were converted into ratios. Bilateral (mildly asymmetrical) ptosis and symmetrical epicanthic folds were found in all preoperatively. Seventy-one per cent had severe folds. Preoperative intercanthal distance ratio range was 1.26-1.60 (non-BPES=1.0). Median reduction post surgery was 26% (P=0.001, Wilcoxon's signed ranks test). Patients with largest preoperative ratio displayed greatest correction (P=0.029). Mustardé technique completely abolished all epicanthic folds and unmasked prominent caruncles in all. Fifty per cent had mild scarring postoperatively in the medial canthal region. Median change in marginal reflex distance ratio (right)=22.2% (P=0.012), left=18.2% (P=0.008), Wilcoxon's signed ranks tests. Postoperatively all had formed eyelid creases with improved upper lid position symmetry. This is the first known study objectively assessing surgical outcome in BPES. Mustardé double z plasty and Crawford autogenous fascia lata brow suspension are an effective surgical combination in the treatment of this syndrome, with overall cosmetic benefit.

Deltoid flap combined with fascia lata autograft for rotator cuff defects: a histologic study

The purpose of this study was to compare the histological characteristics of an autogenous fascia lata graft alone and a fascia lata graft combined with a deltoid flap in the reconstruction of rotator cuff tears. Ten New Zealand white rabbits were divided into two groups. Infraspinatus tendon defects (1 x 1 cm) were created in each animal. Reconstruction consisted of either a fascia lata graft alone or a fascia lata graft combined with a distally based deltoid flap. At 3 months, tissue harvest and histological analysis was performed. Compared to the fascia lata graft alone, there was significantly increased remodeling activity and neovascularization in the group that included a deltoid flap. Also, there was pronounced interdigitation at the graft/flap interface in the latter group. A mutually beneficial relationship may exist when an autogenous fascial graft is combined with a functional deltoid flap for reconstructing large rotator cuff defects.

Biologic Resurfacing of the Glenoid: Longer Term Results and Newer Innovations

Biologic glenoid resurfacing was developed in 1988 as an alternative to total shoulder arthroplasty in selected younger patients with primary, posttraumatic, or postreconstruction glenohumeral arthritis as a method to improve the results of humeral head replacement. A variety of biologic surfaces have been combined with an uncemented hemiarthroplasty including anterior capsule, autogenous fascia lata, and tendoachilles allograft. This paper presents the senior author’s 5 to 13 year results. From November 1988 to November 1997, 24 patients with 26 shoulders were followed prospectively. There were 22 males and 2 females, with an average age of 52 years (range, 30-75). Fourteen of 26 shoulders had undergone previous surgery. The diagnosis was primary glenohumeral osteoarthritis (9/26), posttraumatic arthritis (4/26), avascular necrosis (1/26), and postreconstructive arthritis (12/26). Anterior capsule was used for seven cases, autogenous fascia lata for 11 cases, and tendoachilles allograft for eight cases. A combination of sutures and anchors were utilized. All patients underwent a cementless humeral head replacement. Neer scores were performed on all patients and serial radiographs reviewed. Results were analyzed using Neer’s criteria: 12/26 excellent (46%), 9/26 satisfactory (35%), and 5/26 unsatisfactory (19%). Glenoid erosion averaged 7.2 mm stabilizing at ∼5 years. Joint space averaged 1.3 mm. There were no revisions for humeral loosening. Complications included infection 2/26, instability 3/26, brachial plexitis 1/26, and DVT 1/26. Factors associated with unsatisfactory results: use of capsule, infection, and early re-injury. Three of five poor results have been revised to TSA, two with excellent results, and one with a poor result. This procedure provides pain relief similar to total shoulder arthroplasty for the diagnostic groups studied. It allows younger patients to maintain an active lifestyle including weight lifting and manual work without the risk of polyethylene wear. Based on this and previous reviews, the senior author recommends either autogenous fascia lata or tendoachilles allograft as the bearing surface.

Autogenous Fascia Lata Grafts: Clinical Applications in Reanimation of the Totally or Partially Paralyzed Face

Although they are traditionally reserved for "aesthetic refinement" in the latter stages of facial reanimation surgery, the author uses a variety of autogenous fascia lata grafts in a very aggressive approach as the primary therapeutic option in static facial rebalancing and/or in conjunction with dynamic muscle transfers to achieve architectural integrity and functional restoration of the totally or partially paralyzed face. Forty-nine autogenous fascia lata grafts, harvested through serial incisions in the lateral thigh, were placed in 35 totally or partially paralyzed faces. The grafts were categorized by anatomical location: I and II, lateral lip in totally paralyzed and partially paralyzed faces, respectively; III, nostril suspension; IV, lower eyelid suspension; V, bimalar lower lip sling; and VI, platysma transfer/autogenous fascia lata extension for lower lip invagination. In all group I and II cases, static balance of facial architecture was restored at 4 to 6 weeks (after swelling resolved). Average lip commissure displacement was corrected to within 0.5 cm of the horizontal axis. Subjective functional improvement in speech, fluid retention, and chewing was immediate in all cases. In group I (n = 10; median age, 10.5 years), a 60 to 100 percent symmetrical smile was achieved with voluntary gracilis contraction of 3 of 5 to 5 of 5. In group II (n = 20; median age, 33 years), with 16 sling only patients, one to two grades of voluntary risorius and lip elevator motion were achieved in most. When accompanied by a temporalis turnover flap, both risorius and lip elevator function improved two to three grades. In group III (n = 5), inspiratory collapse was ameliorated in all cases and nasal flow improved subjectively 80 to 100 percent. In group IV (n = 4), scleral show and keratitis were improved in all cases. In group V (n = 6), improved oral competence was achieved in all patients. In group VI (n = 4), static lip evagination was achieved in all cases; voluntary lip depressor function was two to four grades improved. Early placement of autogenous fascia lata restores static balance of the deeper facial architecture in repose. Functional improvement of chewing, fluid retention, speech articulation, smile symmetry, and ectropion is immediate. The psychological effect is also immediate, with achievement of self-esteem and acceptance by family and peers.

Use of Autogenous Fascia Lata Graft for Perineal Herniorrhaphy in Dogs

To evaluate the effectiveness of a herniorrhaphy technique, using an autogenous fascia lata graft (FLG) for perineal hernia (PH) repair in dogs. Prospective clinical study. Twelve dogs with PH. PHs were repaired with FLG harvested from the dog's ipsilateral thigh and sutured directly into the perineal defect. Correction of associated conditions, and castration were performed. Surgical time, pain, inflammation, pattern of defecation, lameness, hospitalization time, postoperative complications, and owner satisfaction were recorded. Histopathologic examination was performed in 1 dog euthanatized 10 months after repair. Hernia did not recur (mean follow-up, 5.8 months). Lameness was the most frequent minor complication, and was resolved within a few days. Transient rectal prolapse occurred in 2 dogs with bilateral PH. The mean (+/-SD) hospitalization was 1.8+/-0.9 days, and the surgical time was 76.5+/-9.8 minutes. Histopathologic examination in 1 dog revealed perfect integration of FLG into adjacent tissues without substantial tissue reaction. FLG reconstruction of PH is a simple, effective method of treatment. FLG can be used without major complications for primary repair of PH, as an augmentation procedure when the internal obturator muscle is thin or friable, or when herniation has recurred after another repair technique.

Glaucoma Implant Surgery With Autogenous Fascia Lata in Scleromalacia Perforans

A 51-year-old woman with bilateral scleromalacia perforans and advanced glaucoma in the left eye was evaluated. Glaucoma implant surgery with autogenous fascia lata graft for reinforcement of the underlying sclera and a patch graft overlying the tube to prevent tube erosion was planned because of insufficient response to medical glaucoma therapy. Intraocular pressure decreased from 55 to 15 mm Hg and remained under 20 mm Hg throughout the follow-up period of 24 months. No complication was noted. Glaucoma implant surgery using autogenous fascia lata to form a healthy ground and a patch graft to prevent tube erosion seems to be a safe and effective method when normal sclera is lacking, such as in scleromalacia perforans.

Long-term results of frontalis suspension using autogenous fascia lata for congenital ptosis in children under 3 years of age

Purpose To evaluate the outcome of frontalis suspension surgery for congenital ptosis using autogenous fascia lata for children under 3 years of age. Design Retrospective nonrandomized interventional case series. Methods This study included nine children (14 eyelids) with severe congenital ptosis aged less than 3 years. All patients underwent frontalis suspension surgery using autogenous fascia lata. Postoperative lid level results, ptosis recurrence, and cosmetic appearance of leg scars were evaluated after the operation. Results The mean age of the patients was 15.3 months (range, 6 months to 2.5 years) with a mean follow-up period of 41.6 months (range, 18 to 96 months). All children achieved satisfactory cosmetic and functional results, with no postoperative complications such as wound infection, corneal exposure, eyelid contour abnormalities, or ptosis overcorrection. No recurrence of ptosis was encountered. Harvesting was not difficult, and a sufficient amount of material was achieved. There was one patient (11.1%) with a hypertrophied leg scar. Conclusions Frontalis suspension using autogenous fascia is proposed as a possible procedure for correcting congenital ptosis in children younger than 3 years of age. It appears to be an effective and feasible treatment for children with poor levator muscle function in this age group.

Results of medial patellofemoral ligament reconstruction in the treatment of patellar dislocation

Purpose: The purpose of this study is to describe the technique of medial patellofemoral ligament reconstruction using autogenous hamstrings or autogenous fascia lata and report the results at a minimum 2-year follow-up. Type of Study: This study represents a case series. Patients with patellofemoral instability following patellar dislocation were restrospectively reviewed after being treated with medial patellofemoral ligament reconstruction. No concurrent control group was used. Methods: Nineteen consecutive patients underwent medial patellofemoral repair or reconstruction in the treatment of patellar instability after patellar dislocation. The reconstructions were performed using autogenous gracilis and/or semitendinosus tendons or a strip of autogenous fascia lata. Fifteen patients were available for interview, examination, and radiographic evaluation, with a mean follow-up of 31.5 months. Results: Subjectively, 10 knees had excellent results, 3 knees obtained good results, 1 knee had a fair result, and 1 knee had a poor result, for a total of 93% improvement overall. Using Fulkerson’s functional knee score, 93% had good or excellent results. The average postoperative result on Kujala’s score for anterior knee symptoms was 88 (range, 80-100). The Tegner activity level averaged 6.8 preinjury and 6.7 postoperatively. Radiographic evaluation showed significant improvements in the congruence angle by an average of 20° (P =.0006), and in the lateral patellofemoral angle by an average of 10° (P =.0003). Conclusions: Surgical reconstruction or repair of the medial patellofemoral ligament provides favorable results for the treatment of recurrent patellofemoral dislocations with regard to radiographic findings, patient satisfaction, and functional outcome.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 3 (March), 2001: pp 298–306

Scapulothoracic stabilisation for winging of the scapula using strips of autogenous fascia lata.

We have used a modified technique in five patients to correct winging of the scapula caused by injury to the brachial plexus or the long thoracic nerve during transaxillary resection of the first rib. The procedure stabilises the scapulothoracic articulation by using strips of autogenous fascia lata wrapped around the 4th, 6th and 7th ribs at least two, and preferably three, times. The mean age of the patients at the time of operation was 38 years (26 to 47) and the mean follow-up six years and four months (three years and three months to 11 years). Satisfactory stability was achieved in all patients with considerable improvement in shoulder function. There were no complications.

Scapulothoracic stabilisation for winging of the scapula using strips of autogenous fascia lata

We have used a modified technique in five patients to correct winging of the scapula caused by injury to the brachial plexus or the long thoracic nerve during transaxillary resection of the first rib. The procedure stabilises the scapulothoracic articulation by using strips of autogenous fascia lata wrapped around the 4th, 6th and 7th ribs at least two, and preferably three, times. The mean age of the patients at the time of operation was 38 years (26 to 47) and the mean follow-up six years and four months (three years and three months to 11 years). Satisfactory stability was achieved in all patients with considerable improvement in shoulder function. There were no complications.

Hydrogel Exoplant Fragmentation 10 Years After Scleral Buckling Surgery

Materials used for scleral buckling procedures in retinal detachment repair have evolved from absorbable tissues, including autogenous fascia lata and cadaveric sclera or dura mater, to nonabsorbable synthetic agents such as polyethylene tubing, solid silicone rubber, silicone sponges, and hydrogels. Hydrogels are hydrophilic materials formed from 3-dimensional polymer networks. The most widely used hydrogel is co-poly(methylacrylate-2-hydroxyethyl acrylate), or MIRAgel (MIRA, Waltham, Mass). The forerunner of MIRAgel, MAI, has the same chemical composition. Hydrogels are permeable to water and low-molecular-weight hydrophilic substances. Their ability to absorb and then slowly release water-soluble antibiotics offers an advantage over silicone. Ho et al 1 reported that the MAI implant was as effective a buckling element as either solid silicone rubber or silicone sponge. He noted that the degree of swelling of the exoplant could be altered by varying its state of hydration, its softness and elasticity were protective against erosion, and it was less prone

Split Pectoralis Major Transfer for Serratus Anterior Palsy

The results of split pectoralis major tendon transfer (sternal head) for symptomatic scapular winging because of palsy of the serratus anterior muscle were reviewed. Eleven consecutive patients, whose average age was 34 years, had a duration of preoperative symptoms ranging from 12 to 60 months. Ten patients had electromyograms documenting a long thoracic nerve injury. Using an inferior axillary incision, the tendon of the sternal head of the pectoralis major is mobilized and transferred to the inferior angle of the scapula. The tendon transfer is reinforced with autogenous fascia lata. After surgery, a scapulothoracic orthosis is worn for 6 weeks, and restriction of vigorous activities is recommended for 6 months. At an average followup of 41 months, 10 of 11 (91%) patients had satisfactory results with significant improvement in function and reduction of pain. Each of these 10 patients had improved scapular tracking with no scapular winging or mild, dynamic winging at latest followup. One patient had an unsatisfactory result with a full recurrence of scapular winging secondary to noncompliance with the postoperative physical therapy regimen. The split pectoralis major tendon transfer provides a reasonable substitute for a paralyzed serratus anterior muscle in scapular stabilization. Strict adherence to technical principles and postoperative rehabilitation reliably leads to satisfactory clinical results.

Autogenous Tensor Fascia Lata Graft Replacement of the Patellar Ligament in a Dog

SummaryThis report documents a complicated trauma case in a dog that was successfully managed by substitution of a missing patellar ligament with an autogenous tensor fascia lata free graft. Important to the success of the case was the use of a careful postoperative regime of progressive controlled mobilization with the aid of the hinged transarticular external skeletal fixator. Because of the advantages provided by use of the autogenous tensor fascia lata graft and the hinged transarticular external skeletal fixator, patient morbidity was low and the end result was good.An autogenous tensor fascia lata free graft was successfully used to completely substitute for a missing patellar ligament in a dog. Postoperative rehabilitation was facilitated by the use of the hinged transarticular external skeletal fixator. The technique is described along with the results. Complete substitution of the patellar ligament with a graft has not been reported in the dog.

Arthroscopic management of trapeziometacarpal joint arthritis of the thumb

Open partial trapeziectomy and interpositional arthroplasty have proven to be effective in ameliorating the symptoms of carpometacarpal joint arthritis of the thumb. Surgical technique of arthroscopic partial resection of the trapezium and interpositional arthroplasty is described. Thirty-three interpositional arthroplasties were carried out arthroscopically. Autogenous tendon graft. Gortex (WL Gore & Associates, Inc. Flagstaff, AZ) and fascia lata allograft were used as interpositional material; 87.8% of patients got relief from pain. Average postoperative pinch strength was 11 lbs. No ligament reconstruction was required because the capsule was left intact. The procedures were done on an outpatient basis and all patients were discharged the same day. There were no complications associated with radial sensory nerve.

Bilateral Fascia Lata Patch Grafts in a Patient With Progressive Scleromalacia Perforans

This study was performed to evaluate the use of autogenous fascia lata patch grafts with systemic immunosuppression in the treatment of progressive bilateral scleromalacia perforans. Autogenous fascia lata was compared with donor bank sclera and was demonstrated to be more suitable for this condition.

Ptosis surgery using Mersilene mesh suspensory material.

Frontalis suspension procedure using a Mersilene mesh sling was performed on 23 ptotic eyelids of 22 patients (age range 3 to 35 years) with poor or absent levator function. The surgical technique used was a modified Fox's method. The mean palpebral fissure height was 3.1 mm preoperatively and increased to 8.0 mm after the operation. No serious complication was seen postoperatively and during an average follow-up of 25 months. In one case with a cosmetically inadequate result, the upper third of the initially implanted Mersilene mesh was removed during reoperation and histological examination of the specimen revealed fibrovascular tissue invasion through the mesh fibres. Mersilene mesh appears to be an effective and safe alternative sling material for brow suspension surgery, giving good permanent results for cases in which autogenous fascia lata was inappropriate.

Biologic resurfacing of the glenoid with hemiarthroplasty of the shoulder

A porous-coated humeral head replacement with biologic resurfacing of the glenoid was performed in 14 patients between 1989 and 1992. Six of the 14 patients had greater than 2 years of follow-up and form the basis of this report. The patients ranged in age from 33 to 54 years. Diagnoses were osteoarthritis in one, postreconstruction arthritis in four, and posttraumatic arthritis in one. The biologic resurfacing was done with either autogenous fascia lata or anterior shoulder capsule. All patients were relieved of pain. Average postoperative positions were elevation 138 degrees, external rotation 50 degrees, and internal rotation to the T12 spinous process. These results represent average increases of 57 degrees, 45 degrees, and six spinal segments, respectively. No donor site complications occurred. With Neer's rating scale there were five excellent results and one satisfactory result. We conclude that biologic resurfacing of the glenoid appears to improve the results of hemiarthroplasty and may well be the procedure of choice for young patients with end-stage glenohumeral arthritis.

A Prospective Study Comparing Two Fascial Reconstruction Techniques to Stabilise the Cranial Cruciate Deficient Stifle in the Dog

SummaryThe standard intra-articular “underand-over” (U &amp; O) cranial cruciate ligament substitute technique, using autogenous fascia lata, was compared with a combined intra- and extracapsular U &amp; O fascial reconstruction procedure. Medium, large and giant dog breeds (body weights ≥ 15 kg), presented with unilateral rupture of the cranial cruciate ligament, were included in the study. Functional usage of the operated limb was evaluated according to a clinical grading system within the first six weeks and again at 12 and 26 weeks after the operation.Dogs treated with the standard intraarticular U &amp; O procedure were partly weight-bearing on the operated limb within three to five weeks postoperatively. Return to full use of the limb with no or only mild, occasional lameness was recorded in 20 of 24 dogs (83.3%) after 26 weeks. Those treated with the combined intra- and extracapsular U &amp; O procedure, returned to partial weight-bearing within four to seven weeks after the operation. These dogs exhibited slightly more cranial drawer motion (± 1.0 - 2.0 mm) at the six- and 12-week follow-up examinations, when compared to the first group, but stifle stability improved between 12 and 26 weeks. The results obtained from 45 of 55 dogs (81.9%) treated with the combined intra- and extracapsular U &amp; O technique were comparable with the standard intra-articular U &amp; O procedure with return to full use of the limb after 26 weeks. Radiological evidence of peri-articular osteophyte formation showed no remarkable difference between the two techniques after 26 weeks. Results obtained from the standard intra-articular U &amp; O technique indicated that it was an effective method for use in large dogs with body weights greater than 30 kg. This is in agreement with findings in other studies. The combined intra- and extracapsular U &amp;O fascial reconstruction was a reliable alternative for use in the medium to large dog breeds with body weights ranging between 15 and 26 kg.The standard intra-articular “under-and-over” (U &amp; O) replacement technique was effective for use in dogs with body weights (BW) &gt;30 kg. Dogs treated with the combined intra- and extracapsular U &amp; O method had slightly more cranial drawer motion at the six-week and 12-week examinations, but stifle stability improved between 12 and 26 weeks, especially in medium-sized to larger dogs with BW ranging between 15 and 26 kg.