To describe the surgical technique and clinical outcomes associated with autologous fascia lata (AFL) grafting for the management of globe-threatening ophthalmic conditions in dogs. Medical records of five canine patients undergoing ophthalmic surgery with AFL grafting between November 2024 and November 2025 were retrospectively reviewed. Indications included recurrent scleral staphyloma following failure of multi-layer porcine small intestinal submucosa grafting, conjunctival thinning overlying glaucoma drainage device tubing, and reconstruction following deep lamellar keratectomy and sclerectomy for limbal melanocytic tumors. Data collected included signalment, indication for surgery, surgical technique, post-operative management, donor site morbidity, and short- and long-term outcomes. Minimally invasive AFL grafting was successfully used in all five cases to address globe-threatening ophthalmic conditions. In the two dogs treated for recurrent scleral staphyloma, the graft provided sustained tectonic support with no staphyloma recurrence at the last follow-up examinations performed six and 13 months post-operatively. In the case involving conjunctival thinning over a glaucoma drainage device, conjunctival integrity was maintained without recurrence of erosion at the final follow-up at six months. In both cases of limbal melanocytic tumor resection, the graft provided adequate scleral reinforcement with preservation of globe integrity at the last follow-up examination at ten weeks and five months post-operatively. Donor site morbidity was minimal in all cases. AFL grafting provided reliable tectonic support and favorable biocompatibility in dogs undergoing ophthalmic surgery for globe-threatening defects.

Primary repair of full-thickness gluteus medius tears is challenging, particularly in retracted tears with poor tissue quality. Augmentation with autologous fascia lata may enhance repair strength and biologic healing. To establish a gluteus medius tear detachment model in rats and to evaluate whether acute repair augmented with autologous fascia lata results in higher failure load and improved tendon-bone interface organization as compared with primary repair. Controlled laboratory study. Forty adult female Sprague-Dawley rats were randomly assigned to 4 groups: intact control (group C), unrepaired tear (group 1), primary repair (group 2), and augmented repair with autologous fascia lata (group 3) (n = 6 for biomechanical testing, n = 4 for histological analysis per group). In groups 1 to 3, the gluteus medius tendon was detached from the greater trochanter. Group 1 underwent no repair. In groups 2 and 3, repair was performed acutely during the index procedure immediately after tendon detachment, using intraosseous tunnels and 5-0 Prolene sutures; in group 3, an autologous fascia lata graft was incorporated as an onlay augmentation. At 4 weeks, animals were euthanized for biomechanical and histological evaluation. All tendons failed at the tendon-bone interface. Failure load was lower in group 1 (mean ± SD, 15 ± 6 N; P = .01) and group 2 (20 ± 4 N; P = .03) than in group C (29 ± 7 N), while group 3 (30 ± 7 N) did not differ from group C (P = .60). Group 3 had higher strength than groups 2 (P = .01) and 1 (P = .004). Histological scores were lowest in group 1 (3 ± 0.5) as compared with group C (8 ± 1; P = .01), group 2 (12 ± 2; P < .001), and group 3 (11 ± 1; P = .001), with no difference among groups C, 2, and 3 (P > .05). In a rat gluteus medius tendon detachment model, unrepaired detachment resulted in inferior biomechanical strength and histological healing at 4 weeks. Augmentation with autologous fascia lata improved biomechanical strength as compared with primary repair. This rat model may be useful for preclinical evaluation of repair strategies for gluteus medius tears. Autologous fascia lata augmentation may offer biomechanical advantages over primary repair alone.

To investigate the effect of amniotic membrane (AM), used alone or in combination with fascia lata (FL), on septal perforation healing in a rabbit model and to assess its potential as a biologically active scaffold for septal reconstruction. Eighteen rabbits were randomized into three groups (FL, AM, and AM+FL). A standardized 5-mm full-thickness perforation was created in the anterior cartilaginous septum. Grafts were placed in a submucoperichondrial plane and secured with sutures. Animals were followed for 4 weeks. Primary outcome was complete perforation closure. Secondary outcomes included percentage reduction in perforation size and histopathologic healing parameters. Residual perforation size was quantified using digital image analysis, and histologic assessment was performed by a blinded histologist. Sixteen rabbits completed follow-up. The AM+FL group demonstrated the greatest mean reduction in perforation size, whereas complete closure was observed in two animals in the AM group and one in the AM+FL group. Closure outcomes differed significantly between the FL and AM+FL groups (p=0.028). Histopathologic analysis showed significantly reduced epithelial and cartilage degeneration, acute inflammation, fibrosis, granulation tissue formation, and collagen deposition in AM-treated groups compared with FL alone (p<0.05). Chronic inflammation and regenerative parameters did not differ significantly. Amniotic membrane, particularly when used as a biologically active scaffold with fascia lata, was associated with improved histopathologic healing parameters in this experimental model. These findings suggest that amniotic membrane may have potential translational relevance as an adjunct in septal perforation repair, although further experimental and clinical studies are required. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The fascia lata plays a central role in force transmission and body mechanics, yet its in vivo mechanical behavior remains poorly characterized. Existing approaches-shear wave elastography and direct force measurements alike-share a fundamental limitation: none simultaneously captures both the elastic and viscous components of fascial mechanics within a single experiment. The primary aim of this study is therefore to develop an experimental and modeling framework that enables the reproducible measurement of the effective viscoelastic properties of the fascia lata in vivo. To this end, we combine controlled ramp-relaxation experiments on the human fascia lata with a constitutive model that integrates fiber recruitment and dual-timescale viscoelastic relaxation. We emphasize that this is an effective model: rather than describing intrinsic local material properties, it characterizes the mechanical response of the fascia lata complex including its coupling to the hip-thigh musculoskeletal system under controlled loading conditions. The model captures both the nonlinear stiffening during elongation and the dual decay of force during relaxation, using a minimal set of physically interpretable parameters. Repeated trials demonstrate good reproducibility, with parameter variability within 10%. Our results support the view that fascia lata behaves as a hierarchical, hydrated composite whose macroscopic mechanical response emerges from the coupled effects of collagen alignment, matrix viscoelasticity, and fluid flow. This work provides a quantitative foundation for future in vivo investigations into how training, rehabilitation, or aging influence the evolution of fascial mechanical properties.

To compare fascia lata allograft (FLA) and subepithelial connective tissue graft (SCTG) for peri-implant mucosal augmentation performed simultaneously with implant placement. This prospective, randomized, examiner-blinded pilot clinical trial enrolled 16 patients requiring single-tooth implant placement with a thin peri-implant soft-tissue phenotype. Participants were randomly allocated (1:1) to SCTG or FLA. The primary outcome was peri-implant mucosal thickness (PMT) measured by using a customized stent-guided transmucosal method at standardized buccal reference points. Secondary outcomes included keratinized mucosal width (KMW), postoperative pain (VAS), and modified wound healing index (MWHI). Follow-up was 24 weeks. Both groups demonstrated significant improvements in PMT and KMW over time. Between-group differences were generally non-significant, except localized PMT differences at the intermediate reference level, favoring SCTG at later visits. FLA showed lower postoperative pain at selected time points. Healing outcomes were comparable. Both SCTG and FLA were effective for peri-implant mucosal augmentation. FLA may represent a viable alternative that avoids donor-site morbidity. Larger long-term trials are required. FLA can be considered a viable alternative for enhancing peri-implant mucosal thickness around simultaneously placed dental implants. ClinicalTrials.gov NCT04679922, registered on December 22, 2020, and retrospectively registered.

Older adults experience a high risk of falls, often due to impaired stepping responses that require rapid and efficient weight transfer. This pilot study examined whether age group and principal component analysis (PCA)-derived profiles of muscle morphology, muscle quality, and strength were associated with weight-transfer performance during voluntary forward and backward stepping. Twenty-three younger and older adults underwent ultrasound imaging of the tensor fasciae latae (TFL), vastus lateralis (VL), and biceps femoris (BF), assessments of knee extensor, knee flexor, and hip abductor strength, and completion of a Choice Reactive Stepping Test (CRST). PCA was applied to nine muscle-related variables to summarize interrelated measures of muscle size, echo intensity, and strength into neuromuscular profiles. The first four principal components (PCs) explained approximately 80.8% of the total variance. PC1 reflected a favorable muscle quality and strength profile, characterized by lower echo intensity and greater hip abduction and knee flexion strength. PC2 suggested a dissociation between TFL thickness and force-generating capacity, whereas PC3 and PC4 reflected muscle-specific structural and strength heterogeneity. PCA-derived PC scores and age group were then entered into a multivariate multiple regression (MMR) model, with weight-transfer onset (WTO) and weight-transfer duration (WTD) during forward and backward stepping as response variables. The MMR model did not provide statistical evidence that age group or any PC was associated with the combined WTO and WTD outcomes. These findings suggest that, in this sample, resting muscle morphology, muscle quality, and maximal strength did not explain weight-transfer performance when modeled as integrated neuromuscular profiles. Weight-transfer performance during stepping may depend on dynamic neuromuscular factors, such as rapid force generation, activation timing, coordination, and task-specific balance strategies, which should be examined in larger studies.

Graft bridging (GB) and long head of the biceps tendon (LHBT)-based reconstructive techniques have been used to manage massive rotator cuff tears (MRCTs); however, their clinical outcomes remain variable. In this study, we explored a combined strategy of autogenous fascia lata graft bridging with LHBT transposition. The aim was to compare the effectiveness of this combined approach with partial repair in the treatment of MRCTs. This retrospective comparative study evaluated two surgical treatments for MRCTs (> 5cm or ≥ 2 tendons involved, Hamada grade 1-3): partial repair (the partial repair group) versus autogenous fascia lata graft bridging combined with LHBT transposition (the combined surgery group). Patients were enrolled between January 2016 and June 2023. The clinical outcomes included active range of motion (forward flexion, external rotation, internal rotation) and the American Shoulder and Elbow Surgeons (ASES) score and the Constant Murley Score (CMS) assessed before surgery and at the final follow-up (≥ 2 years). Radiographic assessments were used to determine the acromiohumeral interval (AHI) and graft integrity before surgery and at the final follow-up. The study enrolled 53 patients with MRCTs, of whom 24 underwent partial repair and 29 received autogenous fascia lata graft bridging with LHBT transposition. Both groups demonstrated significantly improved ASES and CMS scores at the final follow-up (≥ 2 years), with superior outcomes in the combined surgery group (ASES: 88.6 vs. 84.0, P = 0.014; CMS: 83.4 vs. 77.4, P < 0.001). While both groups showed comparable improvements in the range of motion (both P < 0.001), the combined surgery group exhibited significantly greater restoration of AHI (7.4mm vs. 5.4mm, P < 0.001). MRI assessment revealed significantly lower retear rates (6.9% vs. 37.5%, P = 0.015) in the combined surgery group. This study suggests that an augmented reconstruction strategy combining autogenous fascia lata graft bridging and LHBT transposition provided better ASES and CMS scores, increased acromiohumeral distance, and lower retear rates compared with partial repair alone at two-year follow-up.

Despite the high prevalence of knee osteoarthritis, the anatomical factors that characterize distinct deformity patterns remain unclear. This study aimed to compare the three-dimensional (3D) lower-limb musculature between varus and valgus knee osteoarthritis (OA) using an artificial intelligence (AI)-based computed tomography (CT) segmentation, evaluating whole-muscle volume, fatty degeneration, and morphological differences to inform targeted prevention, treatment, and rehabilitation strategies. This retrospective study included 75 patients who underwent CT imaging before total knee arthroplasty for end-stage knee OA. Patients were categorized into valgus (femorotibial angle [FTA] ≤ 176°) and varus (FTA > 176°) groups. A validated Bayesian U-Net-based AI segmentation model was used to reconstruct 3D musculature and quantify muscle volume and Hounsfield unit (HU) values. Twenty-three muscle compartments were analyzed. For the vastus medialis and tensor fasciae latae (TFL), intramuscular fat volume was additionally quantified using Mimics to calculate fat percentage. Between-group comparisons were performed using the Mann-Whitney U test, and false discovery rate correction was applied for multiple comparisons. The valgus group (n = 16) demonstrated significantly smaller muscle volumes in the biceps femoris, TFL, and superficial posterior compartment than the varus group (n = 59) after false discovery rate correction. The HU value of the TFL was significantly lower in the valgus group. The vastus medialis showed a lower HU value before correction; however, this difference did not remain significant after false discovery rate correction. Mimics-based fat quantification revealed no significant difference in the fat percentage of the vastus medialis, whereas the TFL showed significantly higher fat infiltration in valgus knees. Correlation analyses using FTA as a continuous variable showed that greater valgus alignment was associated with lower TFL muscle volume, lower TFL HU values, and greater TFL fat infiltration. AI-assisted CT-based 3D analysis revealed distinct muscle morphologies and fatty degeneration patterns in varus and valgus knees of patients with OA. Valgus knees exhibited characteristic reductions in the posterior and lateral muscle groups and increased fatty infiltration of the TFL. These deformity-specific muscular alterations may inform personalized rehabilitation strategies and help elucidate the factors contributing to the progression of OA. Not applicable.

Grafts and Nonvascularized Repair Materials for Anterior Skull Base Defects.

Autologous tissue sacrocolpopexy for apical pelvic organ prolapse: a scoping review of the extent, nature, and characteristics of the evidence.

While standard treatments for mandibular osteoradionecrosis (MORN) exist for mild/superficial and severe/full thickness disease, there is no consensus on treatment for advanced, partial thickness disease. In this niche, the anterolateral thigh fascia lata (ALTFL) "rescue" flap has managed MORN successfully. This study aimed to compare ALTFL with fibula free flap (FFF) reconstruction to determine differences in outcomes, complications, and postoperative logistics. A retrospective chart review of patients undergoing ALTFL or FFF for MORN between 2008 and 2024 was carried out. Fifty-one patients with Grade III (n = 26) or IV (n = 25) MORN underwent FFF (n = 22) or ALTFL (n = 29). ALTFL patients were older but did not differ in preoperative MORN treatment or risk factors compared to FFF. Median operative time for ALTFL was significantly less than FFF in both Grade III (298 min vs. 516 min) and IV (298 min vs. 599 min), without differences in subsites of mandible involved. Hospitalization for ALTFL was significantly shorter than FFF for both Grade III (2 days vs. 7 days) and IV (4.5 days vs. 7 days) without differences in peri-operative complications, flap failure or MORN resolution. Tracheotomy was performed more often for patients undergoing FFF for Grade III MORN. Patients who underwent ALTFL were more likely to return to a diet beyond soft within the follow-up period. The ALTFL rescue flap offers reduced morbidity and improved resource allocation compared to FFF for the treatment of advanced, partial thickness MORN with similar outcomes.

Multimodal Management and Predictors of CSF Leak Following Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas.

Salvage of composite soft tissue and extensor mechanism defects of the knee using free anterolateral thigh flaps with vascularized fascia lata.

Soft tissue sarcomas (STS) of the foot are rare, accounting for 2-5% of musculoskeletal sarcomas, and are often associated with higher amputation rates due to limited soft tissue coverage, complex anatomy, and the functional demands of weight-bearing. We report the case of a 70-year-old woman with a myxoinflammatory fibroblastic sarcoma involving the 2nd-4th metatarsals. Limb salvage surgery was performed, consisting of en bloc resection with preservation of the metatarso-phalangeal joints, skeletal fixation with titanium plates, tendon reconstruction using tensor fascia lata, and soft-tissue coverage with an anterolateral thigh free flap. Intraoperative, interstitial brachytherapy catheters were placed, enabling 36Gy/9 fractions safely without wound or flap complications. At 6months, the patient was disease-free and ambulatory without disability. This case demonstrates that with multidisciplinary planning, complex reconstruction and adjuvant brachytherapy can achieve durable local control and preserve function in selected patients with foot sarcoma.

To describe the use, indications, and outcomes of a limited transoral approach for segmental mandibulectomy reconstruction with minimal access vessel isolation and anastomoses in patients with mandibular osteoradionecrosis. Retrospective review of patients who have undergone FFF reconstruction of segmental mandibulectomy via transoral plating and inset at our institution from 2022 to 2024. Nine patients (median age of 66, 100% male) with mandibular ORN underwent FFF reconstruction via transoral approach with minimal access vessels isolation. The majority of patients failed conservative management of ORN, with eight patients receiving prior antibiotic therapy and seven undergoing hyperbaric oxygen therapy. Preoperative fracture/nonunion and fistula were noted in seven and four patients, respectively. The median length of hospitalization following this procedure was 6 days (range: 4-9). One patient developed nonunion in the postoperative period and required revision with anterolateral thigh fascia lata free flap and iliac crest bone grafting. An additional patient required takeback for hematoma and successful vascular salvage; however, complications were otherwise minimal, with no other patients experiencing operating room takeback, readmission within 30 days, hematoma, fistulas, or flap compromise. All patients demonstrated clinical and radiographic arrest of ORN at most recent follow-up. Median follow-up length was 13.9 months (range 7.7-34). Mandibular reconstruction using a transoral approach with FFF provides a promising alternative to the traditional transcervical approach for patients with osteoradionecrosis, potentially reducing morbidity and improving outcomes.

Incidence and clinical impact of cystic changes in interpositional grafts following arthroscopy-assisted lower trapezius tendon transfer: A retrospective comparative clinical study.

To compare the iliotibial band autograft biologically augmented with gracilis (ITBAG) technique with a hamstring tendon autograft combined with extra-articular lateral tenodesis using fascia lata (HT-LET), in terms of (1) return-to-sport rates, (2) patient-reported functional outcomes and (3) complication rates. This matched retrospective two-group study included patients from the FAST Cohort (French Prospective ACL Study). Patients who underwent revision for graft re-rupture were excluded from the comparative analyses of functional outcomes and return to sport. Return-to-sport status and level, subjective functional scores (International Knee Documentation Committee Subjective Knee Form, Knee Injury and Osteoarthritis Outcome Score, Lysholm, Tegner, Anterior Cruciate Ligament-Return to Sport after Injury) and complications requiring reoperation were assessed after a minimum follow-up of 2 years. A total of 628 patients (314 in each group) were analysed. At a mean follow-up of 4.2 years, 65.3% (203/311) of ITBAG patients and 66.9% (204/305) of HT-LET patients had returned to sport (p = 0.73), with a mean time to return of 8.4 months and 8.9 months, respectively (p = 0.25). The ITBAG group demonstrated significantly better patient-reported outcomes in selected functional scores, including Lysholm (96.5 vs. 95) and ACL-RSI (87.5 vs. 79.2), while other functional measures were similar between groups. Re-rupture rates were low in both groups, occurring in 1% of patients in the ITBAG group and 2.9% in the HT-LET group (p = 0.14). However, the HT-LET group showed a higher incidence of other complications (p < 0.01), mainly due to postoperative cyclops syndrome. Although return-to-sport rates were comparable between techniques, ACL reconstruction using an iliotibial band graft augmented with gracilis resulted in superior functional scores and a lower rate of postoperative stiffness compared with hamstring autograft reconstruction with extra-articular lateral tenodesis. Level III, cohort study.

Two sequential saphenofemoral junctions of a single great saphenous vein separately perforating the cribriform fascia lata.

Editorial Commentary: When it Comes to Graft Thickness for Superior Capsular Reconstruction, Go Thick or Go Back to the Original.

Background/Objectives: Lower eyelid malposition is a recognized complication following eyelid tumor excision, trauma, or degenerative changes, and is frequently associated with laxity or disruption of the canthal ligaments. Conventional reconstruction techniques using autologous grafts such as fascia lata or auricular cartilage are effective but are associated with donor-site morbidity and increased surgical complexity. This study aimed to evaluate the feasibility and early outcomes of a novel technique for reconstruction and reinforcement of the lower eyelid canthal ligaments using a barbed suture system. Methods: A single-institution retrospective case series was conducted, including consecutive patients who required lower eyelid canthal ligament reconstruction or horizontal support reinforcement from April 2025 to November 2025. Margin reflex distance 2 (MRD-2) was measured from standardized photographs preoperatively and at final follow-up. Munk scale scores, surgically induced astigmatism (SIA), and postoperative complications were recorded. Results: Seven patients (median age 72 years; range 38–86) underwent the procedure. Indications included post-oncological eyelid reconstruction (n = 2), cicatricial ectropion (n = 2), paralytic ectropion (n = 1), involutional ectropion (n = 1), and cicatricial entropion (n = 1). The median follow-up was 189 days (range 105–280). MRD-2 at final follow-up was 5.4 mm in Case 1 (preoperative: 5.7 mm) and 4.1 mm in Case 2 (preoperative: 4.2 mm), indicating maintained eyelid position. Munk scale scores improved in four of five evaluated patients. No recurrence of ectropion or entropion was observed during follow-up. Transient linear skin indentation along the suture pathway was observed in all cases and resolved spontaneously in all patients by 3 months postoperatively. One patient experienced transient postoperative diplopia that resolved with conservative management. Conclusions: This study demonstrates the feasibility of lower eyelid canthal ligament reconstruction using a barbed suture system in a heterogeneous cohort of seven patients. Short-term results are encouraging, with maintained eyelid position and no recurrence of malposition observed during the follow-up period. These preliminary findings warrant further evaluation in larger, prospective, controlled studies with longer follow-up.