Fascia Lata Graft Research Articles

Robotic Sacral Colpopexy Using Autologous Fascia Lata Compared with Mesh.

Objective: The objective is to compare robotic sacral colpopexy (RSC) utilizing autologous fascia lata with RSC with synthetic mesh in the treatment of pelvic organ prolapse (POP). Methods: We performed a prospective nonrandomized case comparison trial at a single institution. We compared RSC utilizing either synthetic mesh or autologous fascia lata in women with symptomatic POP, stages II through IV. The primary outcome was anatomic prolapse recurrence determined by the Pelvic Organ Prolapse Quantification (POP-Q) examination. Secondary outcomes included patient-reported outcomes such as the Urogenital Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7). Complications were also recorded and categorized using the Clavien-Dindo (CD) system. The hypothesis is that autologous fascia lata would provide equivalent anatomic and patient-reported outcomes compared with mesh while eliminating mesh-related complications. Results: Sixty-four women underwent RSC with 19 (29.7%) receiving fascia lata graft. The overall operative time was greater in the fascia lata group with mean fascia lata harvest time of 24.8 ± 7.4 minutes. Intragroup comparisons of the fascia and mesh groups demonstrated significant improvement in pelvic measurements as well as patient-reported outcomes. Intergroup comparison demonstrated equivalent success rates at 12.1 ± 8.7 months follow-up. There was one apical failure in the fascia lata RSC group; however, the difference was not statistically significant (p = 0.30). Significant complications in the fascia lata harvest group included two CD-II and one CD-IIIb. In the mesh group there was one mesh erosion requiring surgical excision (CD-IIIb). Conclusion: This is the first comparison between RSC with autologous fascia lata and mesh. Short-term anatomic outcomes were similar with autologous fascia lata use without the risk of mesh erosion. Morbidity from graft harvest site was not trivial. These results emphasize the need for a randomized controlled trial.

Comparative study between fascia lata and temporalis fascia in myringoplasty

BackgroundRepair of a perforated tympanic membrane (myringoplasty) can facilitate normal middle ear function, resist infection, and help re-establish normal hearing. Autogenous graft materials are the most popular graft materials used in myringoplasty because of their easy acceptability by the body. This study is conducted to compare between temporalis fascia graft and fascia lata graft in myringoplasty for patients with tubo-tympanic dry perforation.ResultsA total of 60 patients with persistent dry tympanic membrane perforation were included in our study during the period from January 2018 to May 2020. Patients underwent myringoplasty with temporalis fascia (30 patients as group A) or fascia lata (30 patients as group B). Patients were scheduled for follow-up visits concerning graft status, ear discharge, and audiograms. The mean postoperative air-bone gap in group A was 17.5 ± 4 after 1 month and 8.6 ± 6.9 after 3 months, while in group B, the mean postoperative air-bone gap was 17.6 ± 4.9 after 1 month and 9.4 ± 7.5 after 3 months. There was 90% success in graft uptake in group A, while there was 80% success in group B.ConclusionUsing temporalis fascia is still the best and most trustworthy technique of myringoplasty compared to fascia lata graft. However, fascia lata can be a good alternative to temporalis fascia especially in cases of revision myringoplasty, ears having large perforation, or near-total perforation where the chances of residual perforation are high because of the limited margin of remnant tympanic membrane overlapping the graft.

A Minimally Invasive Endoscopic Technique for Fascia Lata Graft Acquisition and Fascial Reapproximation.

Fascia lata remains a popular and robust graft to repair osteodural defects in endoscopic neurosurgery. Classically, this graft is obtained via a large incision in the thigh that is prone to pain and muscle herniation after surgery. To present a novel technique for harvesting fat and fascia lata graft and reapproximating the edges via an endoscopic approach through the thigh using an "outside-in" technique to prevent muscle herniation. Initially our technique was performed in cadavers and includes the following: small 2 cm incision in the lateral thigh to accommodate the endoscope, use of blunt dissection and endoscopic tools to obtain the graft, and reapproximation of the fascia via an outside-in technique using conventional sutures with endoscopic visualization to retrieve the sutures beneath the skin and tie them. We then applied the technique to a patient undergoing transsphenoidal tumor resection. This technique was trialed in 3 cadaver specimens (6 limbs) and was used successfully in a patient with excellent cosmetic results seen in follow-up. Endoscopic retrieval of fascia lata is feasible via a very small incision. Reapproximation of the cut fascial edges to minimize muscle herniation can quickly and easily be performed with an outside-in technique detailed here. Additional case series may help to solidify the endoscopic retrieval as a preferred technique for fascia lata graft.

Endoscopic trans nasal intervention in cerebrospinal fluid rhinorrhea: a one and half-year pilot study

<p class="abstract"><strong>Background:</strong> Cerebrospinal rhinorrhea from the anterior and middle skull base was repaired through the inferior intra-nasal corridor under high resolution endoscopic visualization. The sites, tissues utilized and the surgical outcome have been critically analyzed. </p><p class="abstract"><strong>Methods:</strong> 47 subjects of skull base lesions underwent surgical intervention jointly in the Departments of Otolaryngology and Neurosurgery, Dayanand Medical College and Hospital, Ludhiana during a period of 1.5 year. </p><p class="abstract"><strong>Results:</strong> Trans-nasal endoscopic intervention for cerebrospinal fluid rhinorrhea was undertaken in 1 male (14.3%) and 6 female (85.7%) patients. The minimum age in our study was 28 years and maximum 68 years with mean age 49.9 years. 6 (85.7%) patients had a history of spontaneous cerebrospinal fluid leak while 1 (14.3%) had a history of trauma prior to the leak. The body mass index (BMI) of 6 (85.7%) was in the range of 30.0–34.9. Total 6 (85.7%) patients of cerebrospinal fluid leak presented with rhinorrhea or watery nasal discharge as the chief complaint. The cribriform plate, as seen in 5 (71.4%) patients, was the predominant site of cerebrospinal fluid rhinorrhea, followed by the sphenoid, 2 (28.6%) and the fovea ethmoidalis 1 (14.3%). The tissue utilized as graft were fascia lata (7 patients), nasoseptal flap also known as the Hadad-Bassagasteguy flap (5 patients) and middle turbinate mucosa (1 patient). </p><p class="abstract"><strong>Conclusions:</strong> Spontaneous leaks from the cribriform plate outnumbered traumatic leaks male to female ratio was higher 1:6 in the 5th decade. Hadad-Bassagasteguy flap (in isolation or with fascia lata graft) as reconstructive material is used more commonly as compared to fascia lata. </p>

Arthroscopic Superior Capsular Reconstruction With Mesh Augmentation for the Treatment of Irreparable Rotator Cuff Tears: A Comparative Study of Surgical Outcomes

Background: Arthroscopic superior capsular reconstruction (ASCR) is an alternative to open surgery for irreparable chronic rotator cuff tears (RCTs). This approach can provide static restraint while avoiding upward migration of the humeral head. However, graft tears and their effect on clinical outcomes after ASCR remain a debated topic. Purpose: To evaluate the clinical outcomes of ASCR with mesh augmentation for the treatment of irreparable RCTs. Study Design: Cohort study; Level of evidence, 3. Methods: The data of 72 patients with irreparable RCTs who underwent ASCR between 2013 and 2018 were retrospectively evaluated. Among them, 64 patients who met the inclusion and exclusion criteria were enrolled in this study. Fascia lata grafts augmented with a polypropylene mesh were used for 30 patients (mesh group), and grafts without mesh augmentation were used for 34 patients (control group). Clinical outcomes were evaluated using range of motion, the American Shoulder and Elbow Surgeons (ASES) questionnaire, and visual analog scale for pain. Radiological outcomes were evaluated according to acromiohumeral distance and stage of rotator cuff arthropathy. The status of fatty infiltration and graft integrity was evaluated using magnetic resonance imaging. Outcomes were assessed preoperatively and at the final follow-up. Results: Both groups showed improvement in clinical and radiological outcomes at the final follow-up. The mesh group demonstrated a larger improvement in ASES score (mean ± SD, 29.1 ± 15.8) than the control group (18.1 ± 15.9) (P = .006). The mean improvement in active forward flexion was significantly higher in mesh group (40°± 26°) than in control group (28°± 23°) (P = .003). The mean improvement in active external rotation was also significantly higher in the mesh group (11°± 5°) than in the control group (6°± 3°) (P = .004). Graft healing rate was significantly higher in the mesh group (83.3%) than in the control group (58.8%) (P = .039), and acromiohumeral distance was significantly greater in the mesh group (9.1 ± 2.4 mm) than in the control group (6.3 ± 1.8 mm) at the final follow-up (P = .001). Subgroup analysis revealed that patients with graft failure generally showed progression of fatty infiltration without improvement in the stage of rotator cuff arthropathy. Patients with intact grafts demonstrated a more substantial improvement in functional outcomes (ASES score and forward flexion motion). Conclusion: ASCR with mesh augmentation reduced graft failure rate to restore superior shoulder joint stability.

Endoscopic Repair of Nasal Septal Perforations With Fascia Lata.

Nasal septal perforation (NSP) consists of defects of mucosa, cartilage, and bone. Nasal septal surgery is by far the most common cause of NSP. Many surgical approaches have been described for NSP repair. In this study, the authors describe a novel technique for repairing all sizes of NSP using an only fascia lata graft. The authors implemented a retrospective study design. Seventeen patients who underwent NSP repair between January 2016 and January 2019 were included to the study. Entire nasal surgical steps were performed under endoscopic view, harvested fascia lata graft is placed in tympanoplasty fashion after all edges of perforation is elevated and implantation bed is prepared. The mean size of the septal peforations were 18.52 ± 4.17 mm horizontally, 11.52 ± 3.42 mm vertically. The mean follow up period was 14.47 ± 9.5 months (range: 2-36). In 15 of the 17 patients, total NSP closure was achieved (88,23%). Endoscopic close technique using fascia lata for nasal septal perforation closure is a safe and reliable technique with high success rate and it should be considered in patients with nasal septal perforation.

Facial Reanimation by Modified Intraoral Temporalis Tendon Transfer With Ancillary Procedures.

Facial nerve palsy is an exceedingly debilitating condition, incapacitating functional and aesthetic facets of the face. Orthodromic transfer of temporalis muscle is an easy and predictable technique which offers early animation of oral commissure and lower face. A retrospective chart review of 6 patients of facial palsy treated with orthodromic temporalis tendon transfer for facial reanimation is presented. The technique consisted of intra-oral coronoidectomy followed by attachment of fascia lata grafts from the coronoid to the commissure, the upper and lower lips via small cutaneous incisions. Contraction of the temporalis, pulls the fascia lata extensions thereby reanimating the lower face. 4 male and 2 female patients with an age range of 25 to 49 years were treated. Simultaneous fat grafting (2 patients), depressor labi inferioris muscle resection (2 patients) and wedge excision of nasolabial fold (2 patients) was done as ancillary procedures. Post-operative smile evaluation was carried out using the Terzis and Noah facial grading system. Patients were asked to smile with and without biting, and photographs and video were taken. The results were graded from 1 to 5 based on a 5-point scale (ie, poor, fair, moderate, good, and excellent) by an independent observer. The results were excellent in 1 patient (Terzis grading 5/5) and good in the remaining 5 patients (Terzis grading 4/5). Excursion of the oral commissure ranged from 6 to 10 mm. Our experience indicates that temporalis tendon transfer for facial reanimation has a short learning curve and provides early predictable outcome without significant complications. This single-stage, day-care procedure can be easily incorporated by maxillofacial surgeons to expand their surgical spectrum.

Surgical management of a lateral luxation of the tendon of the superficial digital flexor muscle using an autologous fascia lata graft

SUMMARYAn 18‐month‐old, 23‐kg, neutered male Staffordshire bull terrier was presented with acute left pelvic limb lameness. There was marked swelling at the level of the tuber calcanei, and lateral luxation of the tendon of the superficial digital flexor muscle (TSDFM) was palpable. Surgical correction included replacement of the TSDFM before apposition of the retinacular tissues. An autologous fascia lata graft was harvested from the ipsilateral limb and sutured over the primary suture line as augmentation. A modified Robert‐Jones bandage with caudally positioned splint was placed for 12 days, and 5‐minute lead exercise was started after 6 weeks. At 10 and 14 weeks postoperatively, the dog was exercising without evidence of lameness or clinical signs. Subjective grading by the attending veterinary surgeon (European College of Veterinary Surgeons boarded surgeon) revealed no lameness at either time point (Visual Analogue Scale score of 0/10). A clinical metrology questionnaire revealed normal mobility (Liverpool Osteoarthritis in Dogs Questionnaire score of 3).

Use of autologous fascia lata graft to repair a complex corneal ulcer in a mare

BackgroundApplication of an autogenous fascia lata graft in the treatment of keratomalacia in the horse has not been reported. The present case describes the use of an autologous fascia lata graft to surgically treat a complicated corneal ulcer in a horse.Case presentationA 12-year-old Arabian mare was admitted to Sharjah Equine Hospital with a history of right eye ulcerative keratitis of unknown duration. Following a week of aggressive medical treatment, the condition deteriorated and a keratectomy and pedicle conjunctival graft were performed. A week later, the conjunctival graft partially dehisced and the ulcer continued to degrade.In attempting to preserve the integrity of the globe a second grafting procedure was performed when a segment of fascia lata harvested from the ipsilateral hind leg was grafted onto the corneal lesion.Response to surgery was positive and the mare was discharged from the hospital on Day 31 post diagnosis (17 days after the second surgery) with a comfortable eye.Follow-up12 months later revealed a comfortable but only partially visual eye due to corneal scarring.ConclusionAlthough the graft actually failed from the point of view of tissue integration, fascia lata appears to be a readily available, effective and affordable autografting material and we believe this technique has potential for short term physical and structural support of severe malacic or other complex corneal ulcers.

Outcome of Endoscopic Endonasal Repair of CSF Rhinorhea Using Fascia Lata Graft

Cerebrospinal fluid rhinorrhea occur when there is communication between skull base and the nasal cavity. Nowadays endoscopic endonasal repair of CSF rhinorrhea become the preferred surgical intervention. Setting: ENT department at Ghazi AL Hariri Hospital for specialised surgeries, Medical City, Baghdad, Iraq. Aim: To assess the effectiveness of fascia lata as sealing graft in the endoscopic endonasal repair of CSF rhinorrhea. Patients and Method: Fifteen patients present to our department with possible clinical diagnosis of CSF rhinorrhea. The patients submitted to full history, examination including nasal endoscopy, radiological investigation (CT and MRI) of the nose and paranasal sinuses and skull base and CSF analysis. Operative technique was endoscopic endonasal repair using fascia lata graft .With monthly follow-up. Results: Successful rate noted in 93% of the patients .No recurrence of meningitis attacks among those who reported meningitis on their presenting illness. Conclusion: Endoscopic endonasal repair of CSF rhinorrhea has less operative and postoperative complication. Fascia lata graft offers a good choice for the repair.

"Parachute" Technique for Reconstruction of Small Skull Base Defects of the Ventral Skull Base.

"Parachute" Technique for Reconstruction of Small Skull Base Defects of the Ventral Skull Base.

Trapezius Transfer to Restore Shoulder Function in Traumatic Brachial Plexus Injury: Revisited and Modified.

Background: Trapezius transfer has shown promise to restore shoulder movements and has stood through the passage of time. We here in describe a modification of trapezius transfer technique and review the current literature available. Methods: The modified trapezius transfer in which the trapezius muscle is extended with folded tensor fascia lata graft and attached as distally possible to the deltoid insertion was done in twelve patients at tertiary health care centre in India. Post-operative splinting and staged physiotherapy were given. Results: Results were described in the form of improvement in degree of shoulder abduction and Disabilities of the Arm, Shoulder and Hand (DASH) score. Six months post-surgery there were improvement in shoulder abduction and DASH score with mean 116 degrees (10-180 degree) and 38 (23-58) respectively. One patient showed poor results due to poor compliance in post-operative period. There were no major complications observed. Conclusions: The modified technique of trapezius transfer described here is a feasible option with good biomechanical outcomes. The technique is simple and can be adopted easily by emerging brachial plexus surgeon as a technique for secondary reconstruction of shoulder joint.

Morbidity in the postoperative follow-up of endoscopic anterior skull base surgery

IntroductionEndoscopic access to the sellar region by videoendoscopy shows a low rate of surgical complications, with findings that indicate risk factors for reducing morbidities during and after the postoperative period. ObjectiveTo evaluate, over a nine-year period, the acquisition of skills by the anterior skull base surgical team, according to the time of elimination of nasal crusts and/or the presence of morbidities in the postoperative follow-up of individuals treated in a tertiary public hospital. MethodsAfter confirming the diagnosis of skull base pathologies, the individuals in this study underwent endoscopic surgery according to the rostrocaudal or coronal axis. For the skull base reconstruction, the nasoseptal flap (associated or not with fascia lata with thigh fat) or free graft was used; clinical follow-up of individuals occurred for a minimum period of 12 months. To assess the impact of the surgical approach on patient clinical evolution, qualitative data related to smoking, post-nasal discharge, nasal flow, smell, taste, clinical symptoms of headache, cranial paresthesia, comorbidities and postoperative morbidities were obtained. ResultsThe most frequent diagnosis was pituitary macroadenoma (84.14%). The mean absence of crusts in this cohort was 124.45 days (confidence interval 95%=119.50–129.39). There was a low cerebrospinal fluid fistula rate (3%). Reconstruction with the nasoseptal flap with a fat graft was an independent variable that recorded the highest mean time for the elimination of nasal crusts (=145 days, confidence interval 95%=127.32–162.68). Allergic rhinitis and smoking were shown to be the most important and independent variables that increased the mean time to eliminate nasal crusts. ConclusionThe mean time to eliminate nasal crusts did not change over the years during which the procedures were performed, demonstrating the adequate training of the surgical team. Debridement and nasal irrigation with saline solutions should be performed more frequently and effectively in patients with allergic rhinitis, smokers and those who received the nasoseptal flap and fascia lata graft with autologous fat.

Revision of anterior cruciate ligament reconstruction with a pedicled quadruple hamstring autograft.

Results of iterative ACL reconstructions are lower than after primary reconstructions. Our aim was to report the results of a retrospective series of revision using pedicled quadruple hamstring autograft. The hypothesis was that the results were satisfactory and comparable to the literature. The study period was from January 2012 to December 2014. Fourteen patients (average age 26) were included. A fascia lata graft was used 12 times for primary reconstruction. Trauma was the cause of failure 12 times. The time interval between primary reconstruction and revision was 6.2years. Preoperative scores used were LYSHOLM, TEGNER and IKDC. Sagittal stability was measured using the KT-1000 device. X-rays and MRI were performed to confirm the diagnosis, look for preoperative osteoarthritis and evaluate the position of the bony tunnels (Bernard and Hertel). Bone tunnels were in a proper position 14 times. At 45-month follow-up, improvement of objective IKDC score was significant (85.7% A/B, p < 0.0002) as well as subjective IKDC score (85.5, p < 0.0004). A significant improvement was established for the LYSHOLM score (91.8, p = 0.001) using the Wilcoxon test. The average LYSHOLM score was 92% (p > 0.5), and the average TEGNER score was 5.5 (p = 0.003). The Lachman test found a hard stop in all patients. The pivot shift test was negative for 78.5% of the cases. The laxity measurement found 12 cases with less than 3mm. One persistent distal hypoesthesia at 2-year follow-up was observed. The hypothesis was confirmed. This series differs by the cause of failure, which was essentially traumatic, and the initial predominance of a fascia lata graft. These results remain to be confirmed. Retrospective case series, level IV.

Which is Better for Management of Tympanic Membrane Perforation Temporalis Fascia or Fascia Lata Graft?

A good graft material is the one which is easily available and harvestable, tough and is easy to be handling and survival is good. Both temporalis fascia and fascia lata graft satisfy all these criteria. Keeping all these factors in mind, the comparative study of temporalis fascia and fascia lata graft in tympanoplasty is undertaken. All the patient reporting to ENT OPD with tympanic membrane perforation who are fit for surgery were advised tympanoplasty or tympanoplasty with mastoidectomy were included in the study. Our observation and data analysis have shown that fascia lata is definitely better than temporalis fascia in terms of intactness of graft (95.1% in fascia lata and 90.24% in temporalis fascia) and PTA average improvement is higher in fascia lata graft (11.56 ± 5.005) as compared to temporalis fascia graft (10.32 ± 4.634) and ABG improvement is higher in fascia lata graft (2.7317 ± 1.118) as compared to temporalis fascia graft (2.634 ± 1.089). Fascia lata has better dimensional stability, easy handling and thickness of the graft and it provides more resistant to negative middle ear pressure. Hence, fascia lata is one of the good choices in otologist's armentorium for tympanoplasty graft material.

Acellular dermal matrix as an alternative to autologous fascia lata for skull base repair following extended endoscopic endonasal approaches.

Skull base reconstruction after extended endoscopic endonasal approaches (EEAs) can be challenging. In addition to the nasoseptal flap, which has been adopted by most centers, autologous fascia lata is also often utilized. Harvesting of fascia lata requires a separate thigh incision, may prolong recovery, and results in a visible scar. In principal, the use of non-autologous materials would be preferable to avoid a second incision and maintain the minimally invasive nature of the approach, assuming the CSF leak rate is not compromised. To assess the efficacy of acellular dermal matrix (ADM) as a non-autologous alternative to autologous fascia lata graft for watertight closure of the cranial base following EEAs. A retrospective chart review of extended EEAs performed before and after the transition from fascia lata to ADM was performed. Cases were frequency matched for approach, pathology, BMI, use of lumbar drainage, and tumor volume. Power analysis was performed to estimate the sample size needed to demonstrate non-inferiority. ADM was used for watertight closure of the cranial base in 19 consecutive extended endoscopic endonasal approaches (16 gasket-seals and 3 buttons) with 1 postoperative CSF leak at the last follow-up (median 5.3, range 1.0-12.6months). All patients had high-flow intraoperative leaks. The cohort included 8 meningiomas, 8 craniopharyngiomas, 2 chordomas, and 1 pituicytoma ranging in size from 0.2 to 37.2cm3 (median 5.5, IQR 2.8-13.3cm3). In 19 historical controls who received fascia lata, there were 2 postoperative CSF leaks. Preliminary results suggest that ADM provides a non-inferior non-autologous alternative to fascia lata for watertight gasket-seal and button closures following extended EEAs, potentially reducing or eliminating the need to harvest autologous tissue.

Patellar ligament rupture in a cat treated with autologous fascia lata graft augmentation

A five-year-old male domestic shorthair cat has been referred with a two-week history of lameness affecting the right hind limb. Gait assessment revealed an involuntary flexion of the stifle during...

Outcome of Endoscopic Endonasal Repair of CSF Rhinorhea using Fascia Lata Graft

Cerebrospinal fluid rhinorrhea occur when there is communication between skull base and the nasal cavity. Nowadays endoscopic endonasal repair of CSF rhinorrhea become the preferred surgical intervention.Setting:ENT department at Ghazi AL Hariri Hospital for specialised surgeries, Medical City, Baghdad, Iraq.Aim: To assess the effectiveness of fascia lata as sealing graft in the endoscopic endonasal repair of CSF rhinorrhea.Patients and Method: Fifteen patients present to our department with possible clinical diagnosis of CSF rhinorrhea. The patients submitted to full history, examination including nasal endoscopy, radiological investigation (CT and MRI) of the nose and paranasal sinuses and skull base and CSF analysis. Operative technique was endoscopic endonasal repair using fascia lata graft .With monthly follow-up.Results: Successful rate noted in 93% of the patients .No recurrence of meningitis attacks among those who reported meningitis on their presenting illness.Conclusion: Endoscopic endonasal repair of CSF rhinorrhea has less operative and postoperative complication. Fascia lata graft offers a good choice for the repair.

Skull Base Reconstruction with Multilayered Fascia Lata: A Single-Center 17 Years Experience.

Objective Reconstruction after open surgery of anterior skull base lesions is challenging. The fascia lata graft is our workhorse for achieving dural sealing and preventing cerebrospinal fluid leak and meningitis. This study seeks to analyze the donor and recipient site complication rates after fascia lata reconstruction. Methods This is a retrospective review of all open anterior skull base operations in which a double-layer fascia lata graft was used for the reconstruction of the defect from 2000 to 2016 at the Tel-Aviv Sourasky Medical Center, a tertiary referral center in Israel. Results Of the 369 patients operated for skull base lesions, 119 underwent open anterior skull base surgery and were reconstructed with a fascia lata graft. The patients' mean age was 47.1 years, and 68 (57.1%) were males. The overall postoperative early and late donor site complication rates were 6.7% ( n = 8) and 5.9% ( n = 7), respectively. Multivariate analysis found minor comorbidities and persistent/recurrent disease as being predictors for early-term complications. The overall postoperative early central nervous system (CNS) complication rate was 21.8% ( n = 26), while 12.6% ( n = 15) of the patients had late postoperative CNS complications. Conclusion Reconstruction of open anterior skull base lesions with fascia lata grafting is a safe procedure with acceptable complication and donor site morbidity rates.

Functional Outcomes of Decompressive Hemicraniectomy for Treatment of Malignant Infarctions of the Middle Cerebral Artery

Introduction: Malignant middle cerebral artery (MCA) infarction is a devastating entity that is associated with up to 80% mortality. Decompressive Hemicraniectomy has been utilized to treat brain swelling and mass effect secondary to these infarctions in an attempt to improve functional outcome. Aim: To evaluate the functional outcome of decompressive hemicraniectomy in management of malignant MCA infarctions. Methods: The study included 30 patients with malignant MCA infarctions operated upon by decompressive hemicraniectomy and duroplasty with pericranium or fascia lata graft in the period from June 2016 to January 2019. Pre-operative neurological condition, associated morbidity, location and extent of the infarction were assessed. Surgery was performed within 48 hours of the onset of stroke or 12 hours within deterioration of conscious level. Pre-operative CT scan as well as sequential post-operative CT was done. Functional outcome was assessed by the modified Rankin Scale (mRS) at the time of discharge and 3 months following surgery. Results: The study included 18 males and 12 females with a mean age of 54.7 years. The pre-operative GCS was <8 (5 - 7) in 11 patients and 8 or higher (8 - 13) in 19 patients. Good functional outcome (mRS 0 - 3) was achieved in 13 (43.3%) cases while poor outcome (mRS 4 - 5) occurred in 8 (26.7%) cases and mortality (mRS 6) occurred in 9 (30%) cases. Conclusion: Decompressive hemicraniectomy improves functional outcome in cases of malignant MCA infarction. Pre-operative GCS, age, volume of infarction, degree of midline shift, timing of surgery and associated morbidity are the most important factors affecting the outcome.