Tensor Fascia Lata Flap Research Articles

Reconstruction of an infected recurrent ventral hernia after a mesh repair using a pedicled tensor fascia lata flap: Report of two cases

Recently, the use of prosthetic mesh has revolutionized the repair of ventral hernias. However, the occurrence of infection related with the use of this prosthesis remains an important complication, which may result in occurrence of fistula formation of the skin or intestine, sepsis, or reoccurrence of ventral hernia. This report presents two cases where a pedicled musculocutaneous flap using the tensor fascia lata (pedicled TFL flap) was effective as a treatment for an infectious large abdominal hernia, and reviews the previous literature. Two Japanese men aged 61 and 78 years old underwent a ventral hernia repair using Composix Kugel mesh. They both developed a wound infection with methicillin-resistant Staphylococcus aureus. Conservative therapy was not successful and the defect in the abdominal wall of two patients measured 12 x 21 cm and 7 x 10 cm in length, respectively. Reoperations were performed by removing the infectious mesh and then reconstructing the abdominal wall with the bilateral and left-side pedicled TFL flaps, respectively. No recurrence of the ventral hernia has been recognized for 50 months and 7 months after reoperation, respectively. A review of previous studies showed that no patients treated with a pedicled TFL flap experienced a recurrent hernia. Therefore, the pedicled TFL flap was considered to be effective for infectious large abdominal recurrent hernia.

Immediate Repair of Major Abdominal Wall Defect After Extensive Tumor Excision in Patients With Abdominal Wall Neoplasm: A Prospective Review of 27 Cases

The treatment of abdominal wall neoplasm continues to present a challenging problem because it is not easy to repair the giant defect which is resulted from extensive tumor excision. Some techniques and materials have been reported, but most report a certain technique or material for abdominal wall reconstruction. Therefore, we retrospectively reviewed the treatment of such patients in our department and assessed the reconstruction algorithm in such a situation. We studied 27 patients undergoing immediate abdominal wall reconstruction between 1999 and 2008 who sought care for major defects after extensive tumor excision of malignancy. We categorized the defects into three types: type I, defects involving only the loss of skin (15 cases); type II, myofascial defects with intact skin coverage (6 cases); and type III, myofascial defects without skin coverage (6 cases). Different techniques and materials were used. Postoperative morbidities, sign of herniation, and other follow-up data were recorded. The immediate abdominal wall reconstruction was successful in all patients. There was no severe morbidity after the operation. Only one patient developed hernia. Most type I defects can be corrected with primary suture. For type II defects, a prosthetic or biological mesh, or alternatively an autologous fascial substitute, may be used. For type III defects, the resulting full-thickness defect will require a myocutaneous flap, such as the tensor fascia lata flap, with or without a mesh for abdominal wall reconstruction. Human acellular dermal matrix, a biological mesh, is an ideal alternative for synthetic mesh, especially in situations of infection or contamination.

The Vascular Anatomy of the Tensor Fasciae Latae Perforator Flap

The purpose of this study was to differentiate between musculocutaneous and septocutaneous perforators of the tensor fasciae latae perforator flap; to evaluate their number, size, and location; and to provide landmarks to facilitate flap dissection. An additional injection study estimated the skin area of the flap. The anatomical study was performed on 23 fixed and injected cadavers. The perforators of the tensor fasciae latae were identified and classified as septocutaneous or musculocutaneous. Diameter, location, and numbers were measured and the perforators were dissected up to their origin. The injection study was performed on 10 fresh cadavers. On one side, the ascending branch of the lateral circumflex femoral artery was injected with methylene blue; on the other side, the septocutaneous perforators were injected selectively. The size, location, and borders of the stained skin were measured. Forty-five thighs were included in this study. All perforators emerged from the ascending branch of the lateral circumflex artery. The average number of musculocutaneous perforators was 2.3 (range, 0 to 5), the distance from the anterior superior iliac spine was 10.9 cm (range, 4.5 to 16.1 cm), and the diameter was 0.9 mm (range, 0.2 to 2 mm). Four specimens had no musculocutaneous perforator. The average number of septocutaneous perforators was 1.8 (range, 1 to 3), the distance from the anterior superior iliac spine was 10.9 cm (range, 6.2 to 15.7 cm), and the diameter was 1.5 mm (range, 0.5 to 3 mm). Seventy-six percent of the septocutaneous perforators emerged between 8 and 12 cm from the anterior superior iliac spine. The possible pedicle length of a flap based on these vessels is 8.1 cm (range, 6.5 to 10 cm). In the injection study, the average skin area stained with methylene blue was 19.4 x 13.4 cm (range, 10 to 24 cm x 7 to 17 cm) in the ascending branch group. In the perforator group, the average skin area was 19.2 x 13.7 cm (range, 15 to 22 cm x 12 to 16 cm). The authors could show that the number of septocutaneous perforators for the tensor fasciae latae flap is more constant and that their diameter is greater than that of musculocutaneous perforators. The location of these perforators on a line extending from the ilium to the greater trochanter facilitates planning and dissection of a flap.

Bone, Tendon, and Soft Tissue Reconstruction in One Stage With the Composite Tensor Fascia Lata Flap

A 46-year-old patient sustained a dia-infracondylar tibial fracture after a ski accident. Open reduction and internal fixation (ORIF) was carried out. After an initially uneventful postoperative course the patient was readmitted because of local and systemic infection signs. Radical surgical debridement was carried out following by Vacuum-Assisted Closure (VAC) therapy. The resulting defect consisted of bone defect of the tibia tuberosity, and complete loss of the patellar tendon and the overlying soft tissue. Reconstruction was carried out with a combined tensor fascia lata (TFL) flap including the TFL muscle with the ilio-tibial tract, vascularized part of the iliac crest and the overlying soft tissue. Bone healing took place without signs of osteomyelitis recurrence, and full weight bearing was possible 4 months after reconstruction. Successful reconstruction of the patellar tendon using the ilio-tibial tract, enables the patient full active knee joint motion. The soft tissue coverage shows stable conditions. The donor site showed inconspicuous healing without pain and normal range of motion of the hip joint. So this composite TFL flap is an interesting flap not only for defects following trauma, but also for combined defects following extensive infections after knee implants.

PR51P THE TENSOR FASCIA LATA FLAP IN ABDOMINAL WALL RECONSTRUCTION

Introduction: The closure of abdominal wall defect after tumour ablation can be a challenging problem. The component that requires reconstruction may only consist of skin or fascia; or it could consist of a combination of these. The pedicled tensor fascia lata flap is a useful option as it could be harvested as either a fascial or fasciocutaneous flap. When the size of the defect is significant, bilateral TFL flaps could be utilised.Methods and Results: To illustrate the flexibility provided by the pedicled TFL flap in abdominal wall reconstruction, two cases are presented in which the nature of abdominal wall defect were different. The first patient had a large fascial defect in the lower abdominal wall and bilateral pedicled TFL fascial flaps were used for reconstruction. The second patient had a full thickness defect and the TFL was harvested as a fasciocutaneous flap for reconstruction. Both defects were repaired satisfactorily without herniation.Conclusion: TFL is a versatile flap and should be the method of choice for lower abdominal wall reconstruction.

Vascular Supply of the Tensor Fasciae Latae Flap Revised

Sir: The lateral aspect of the thigh is an important donor site for flap harvest due to the high number of type B and C perforators suitable for pedicled and free tissue transfer. The tensor fasciae latae flap, originally described by Hill (in Plastic and Reconstructive Surgery in 1978), represents an important source of soft tissue for composite and functional reconstructions. We read with interest the article entitled “Tensor Fasciae Latae Perforator Flap: Minimizing Donor-Site Morbidity in the Treatment of Trochanteric Pressure Sores,”1 in which the authors recognized the ascending branch of the circumflex femoral artery as the unique source of vascularization of the tensor fasciae latae muscle in 100 percent of the dissected legs. We performed a review of the related literature using plastic surgical journals and PubMed as the main sources of information. Among these articles, we found an important discordance about the identification of the main source of this muscle. Koshima et al.2 described the transverse branch of the lateral circumflex femoral system as the primary vascular supply of the tensor fasciae latae muscle; Kimura,3 in agreement with Ishida et al.,1 recognized the ascending branch of the lateral circumflex femoral artery as the main source of the muscle. Rifaat and Abdel Gawad,4 in accordance with Koshima et al.,2 found the transverse branch of the circumflex femoral artery to be the main source of all of their flaps (n = 12). In an ongoing cadaveric dissection study, we have dissected 31 lower limbs injected with latex. We found the tensor fasciae latae muscle to be supplied in 74 percent from the ascending branch of the lateral circumflex femoral artery and in 13 percent of the sites from the transverse branch of the lateral circumflex femoral artery; in another 13 percent, the artery supplying the tensor fasciae latae was found to arise directly from the common femoral artery or from the deep femoral artery. In four thighs we noticed a secondary arterial supply nourishing the tensor fasciae latae muscle by arising from either the ascending or the descending branch or directly from the femoral artery (Fig. 1).Fig. 1.: Left side of the groin of an injected cadaver in which the source vessels to the tensor fasciae latae have been dissected. F.V., femoral vein; F.A., femoral artery; A.B., ascending branch of the lateral circumflex femoral artery; arrow, secondary source from the femoral artery.The variability about the origin and branching pattern of the lateral circumflex femoral artery has already been reported.5 The aim of this short report about the main source of the tensor fasciae latae flap (as a muscular, musculocutaneous, or perforator flap) is to invite surgeons to exercise caution during the deep dissection of the pedicle, as its vascular supply presents a higher variability than previously reported. Stefano Cotrufo, M.D. Joerg Dabernig, M.D. Canniesburn Plastic Surgery Unit Glasgow Royal Infirmary Glasgow, United Kingdom Integrated Biological and Life Sciences Section for Human Anatomy University of Glasgow Glasgow, United Kingdom Department of Surgical and Perioperative Science Section for Hand and Plastic Surgery University Hospital Umea, Sweden Department of Integrative Medical Biology Section for Anatomy Umea University Umea, Sweden ACKNOWLEDGMENT This research was sustained by the Steven Forrest Charitable Trust.

Alternative reconstructive choices for anterolateral thigh flap dissection in cases in which no sizable skin perforator is available

Alternative choices were proposed to facilitate a successful reconstruction when no sizable skin perforator is encountered in anterolateral thigh (ALT) flap dissection. Alternative choices such as harvest of a tensor fascia latae (TFL) flap, elevation of an anteromedial thigh (AMT) flap, use of a free muscle component with full-thickness skin graft coverage, and use of another donor flap were performed. Between August 1995 and December 2006, 10 of 923 patients underwent ALT flap elevation with no sizable perforators. Of them, each of the 4 patients received reconstruction with a free TFL flap, 3 with an AMT flap, 2 with a free muscle flap, and 1 with a radial forearm flap. There was 1 TFL flap failure due to postoperative venous thrombosis, and the defect was repaired by an AMT flap. When no sizable perforator is encountered, successful reconstruction could still be achieved by the proposed alternative choices.

The use of argon beam coagulation in pressure sore reconstruction

Pressure sores are a significant source of physical and financial burden for debilitated patients. When conservative measures fail, surgical reconstruction with myocutaneous flaps may be the last hope for cure and/or improved quality of life in these patients. Adequate haemostasis is an integral component of these reconstructive procedures, as bleeding and haematoma formation can lead to increased morbidity. This study was designed to investigate the use of argon beam coagulation in patients undergoing bony debridement and subsequent pressure sore reconstruction with myocutaneous flaps. The clinical records of 34 patients undergoing pressure sore reconstruction with the use of argon beam coagulation from 2004 to 2006 at an academic institution were reviewed and outcomes were assessed. Reconstruction was performed by a single surgeon on 34 patients (31 men, three women; mean age 41+/-15 years), with a total of 41 pressure sores. Thirteen (32.5%) patients had evidence of osteomyelitis preoperatively and five (12.5%) had previous coccygectomies secondary to infection. Twenty-six (65%) of the pressure sores were treated with hamstring V-Y musculocutaneous flaps, 10 (25%) with gluteal flaps, and four (10%) with tensor fascia lata flaps. Overall, suture line dehiscence occurred in six (15%) cases, flap failure and pressure sore recurrence occurred in six (15%) cases, an abscess developed in one (2.5%) case, and a sinus tract with a superficial wound developed in one (2.5%) case. There were no complications related to haemostasis, including excessive bleeding or haematoma formation. Argon beam coagulation is an efficacious tool for achieving adequate haemostasis during pressure sore reconstruction, particularly when significant bony debridement is involved. The use of argon beam coagulation does not result in an increased complication or recurrence rate when compared with conventional electrocautery methods.

Flap reconstruction following gynaecological tumour resection for advanced and recurrent disease – A 12 year experience

We have reviewed all the cases of flap reconstruction following resection of a gynaecological malignancy at the Royal Marsden Hospital over 12 years from 1993 until 2005. Forty-six patients were identified who required 53 flaps. The predominant site of the primary tumour was vulva, accounting for 83% of the cases, with cervix, ovary, vagina and endometrium making up the remainder. Squamous cell carcinoma was the most common histological type, accounting for 71% of cases, with adenocarcinoma, Paget disease, leiomyosarcoma, melanoma and basosquamous carcinoma making up the remainder. Most patients (73%) had recurrent disease at the time of reconstruction and most patients (80%) had been treated with radiotherapy either before and/or after surgery. Local flaps accounted for 49% of the reconstructions performed, with 16 rhomboid flaps, five lotus petal flaps and five advancement flaps. Of the pedicled myocutaneous flaps, there were 21 rectus abdominis flaps, four gracilis flaps and one tensor fascia lata flap. There was one free flap. The complication rate was 53%, with wound breakdown predominating. The 5 year survival was 14%, with 67% of patients surviving 1 year. This group of patients often have advanced disease and a limited life span. The complications associated with performing a major reconstructive procedure need to be balanced against the potential wound problems associated with leaving these advanced tumours untreated surgically.

Simultaneous Island-pedicled Anterolateral Thigh Flap and Pedicled Tensor Fasciae Latae Flap for the Reconstruction of Abdominal Fascia Defect after Radical Ablation of a Recurrent Desmoid Tumor: A Ca

Aggressive fibromatosis, also known as desmoid tumor, was an uncommon, locally aggressive benign monoclonal fibroblastic proliferation arising in musculoaponeurotic structures. One 28 year-old female patient suffered from a recurrent desmoid tumor over lower abdominal wall. There was a 15×20 cm^2 abdominal fascia defect after radical ablation surgery. Combined island-pedicled anterolateral thigh (ALT) fasciocutaneous flap and pedicled tensor fasciae latae (TFL) flap were utilized to replace abdominal fascia and soft tissue defect. The whole course was smooth without any complication. The TFL flap is the prime choice of flap for middle and lower abdominal fascia defect reconstruction. The combination with the ALT flap might be the lifeboat for soft tissue and fascia insufficiency, and rendered limited donor site deformity. The obscure scar which may mimic that one in abdominoplasty is also the advantage by this design for radical excision of desmoid tumor. Simultaneous island-pedicled ALT flap and pedicled TFL flap have restored the abdominal wall both functionally and esthetically.

Utility and Anatomical Examination of the DIEP Flap’s Three-Dimensional Image with Multidetector Computed Tomography

Sir: Modern reconstructive surgery has increased the importance of perforator flaps. However, there are many variations in the position of perforators, and it is difficult to perform effective surgical planning. Thermography, Doppler ultrasound, and supersonic color Doppler imaging have been used for preoperative detection of perforators; these methods have both merits and disadvantages but ultimately do not always provide definitive results. In contrast, enhanced multidetector computed tomography allows accurate detection of perforators before surgery case by case, and is a very useful tool in preoperative planning for surgery using perforator flaps. The three-dimensional image supplies the exact location of perforators (Fig. 1), and we compose a three-dimensional image using computed tomographic data (Fig. 2).Fig. 1.: Computed tomographic image of the abdominal wall. P1, right-side main perforator; P2, left-side main perforator.Fig. 2.: Sagittal section. View from the umbilicus. P1, right-side main perforator; U, umbilicus; SEV, superficial epigastric vein.The deep inferior epigastric perforator (DIEP) flap was developed by Koshima et al. in 19891–3 and is particularly useful because it retains the function of the rectus abdominis muscle and uses surplus adipose tissue. For this reason, it has been used for reconstructive mammaplasty by Allen and Blondeel; subsequently, anterolateral thigh, gluteal artery perforator, thoracodorsal artery perforator, and tensor fasciae latae flaps have been developed for use over much of the body.4 However, it is often difficult to predict the positions of perforators before surgery because of the variation in these positions. In this communication, we show that multidetector computed tomography can be used to plan an operation in detail; in this sense, multidetector computed tomography can perhaps be understood to illuminate reconstructive surgery in a manner analogous to Edison’s development of the light bulb in 1879. Many anatomical reconstructions are performed using perforator flaps as standard medical practice. In 1987, Taylor and Minabe5 reported a detailed examination of the angiosome in the context of nourishment perforators of the abdominal wall based on obduction data. Determination of accurate positions for perforators is difficult; for example, in blood vessel anatomy performed in cadavers, correspondence of individual build differences and vascular variation cannot be achieved based on the mean anatomical position of each blood vessel relative to the previous vessel. The number of perforators depends on sex and the thickness of the abdominal wall: the physical features of women require more perforators, and patients with a thick abdominal wall panniculus adiposus also tend to have more perforators. One further characteristic of the examination is that the microvasculature is not easily recognized in a thin panniculus adiposus. DIEP flaps are used for reconstructive mammaplasty in patients with breast cancer, and presurgical planning with knowledge of the position of perforators is useful in this procedure. Both preoperative and postoperative multidetector computed tomography is particularly appropriate in breast cancer patients, who also require this procedure for diagnostic purposes, and simultaneous scanning from the thoracic region to the abdominal region is possible. Multidetector computed tomography is particularly useful in breast cancer patients because it is also used for preoperative and follow-up cancer diagnostic testing and therefore serves two simultaneous purposes in these patients. Makoto Mihara, M.D. Misa Nakanishi, M.D. Miho Nakashima, M.D. Mitunaga Narushima, M.D. Isao Koshima, Ph.D. Department of Plastic and Reconstructive Surgery Tokyo University Tokyo, Japan DISCLOSURE The authors have no financial or other commercial interest in the work described in the communication.

Compartment syndrome: A rare complication of tensor fascia lata flap reconstruction following ilio-inguinal block dissection

Compartment syndrome: A rare complication of tensor fascia lata flap reconstruction following ilio-inguinal block dissection

Reconstruction of a pelvic floor defect using a pedicled tensor fascia lata flap: a new technique to prevent radiation injury for pediatric patients with advanced pelvic tumors

BackgroundIn the treatment of pelvic tumors, pelvic floor defects owing to a wide excision tend to increase the occurrence of such morbidities as radiation injury. The reconstruction of these defects would minimize the risk of such morbidities. Authors introduce a new technique for repairing a pelvic floor defect using a tensor fascia lata flap. MethodsTwo boys, 4 years old and 10 months old, presenting with pelvic rhabdomyosarcoma underwent a tumor extirpation associated with a wide excision of the pelvic organs. After the removal of the tumor, a tensor fascia lata flap was designed on the right thigh. The pedicled rotation flap was subcutaneously elevated, guided to the intraperitoneal cavity, and was fixed to cover the superior aperture of the lesser pelvis. ResultsThe flaps functioned well, and postoperative radiation therapies consisting of 45 and 41.4 Gy to the lesser pelvic cavity were carried out without any complications. As a result, the necessary postoperative protocol combination therapies could be successfully performed in a timely manner. ConclusionThe pedicled tensor fascia lata flap is considered to be an alternative option for the stable repair of pelvic floor defects to prevent radiation injury.

Compartment syndrome: A rare complication of tensor fascia lata flap reconstruction following ilio-inguinal block dissection

Compartment syndrome: A rare complication of tensor fascia lata flap reconstruction following ilio-inguinal block dissection

A Five- to Twenty-Year Follow-Up of Reconstruction of Heel and Plantar Surfaces

It is obvious that the soft tissue losses of the plantar surface and heel are different from other sites, so reconstruction of such tissues requires special consideration. Different procedures have been proposed and described by expert authors. The objective of this study was to compare these different procedures and the outcome of free flap transfer to these areas. All patients who had soft tissue losses of the plantar surface and heel were entered into the study. They were treated in Hazrat Fateme and Akhtar University hospitals by a team of 2 reconstructive surgeons, 2 general surgeons, and 2 nurses between 1982 and 2005. Patient ages were between 5 and 50 years. The initial injury was caused by mine explosions in almost 90% of patients. Flaps were raised conventionally and transferred to the recipient sites; microvascular procedures were performed for vessel anastomosis and some for nerve coaptation. Recovery of sensation was evaluated by light touch. The total number of free flap transfer was 108: 9 cases of mid-sole, 38 cases of forearm, 18 cases of sensory tensor fasciae latae flaps, and 43 cases of scapular and latissimus dorsi free flap transfer. All were followed up for at least 5 years.

Reconstruction of abdominal wall by whole thigh flap

Closure of extensive abdominal wall defects can be a very challenging task as there are no known large local or free vascularized flaps available that could cover the entire abdomen. Tensor fascia latae (TFL) has been widely used for abdominal wall reconstruction [Hill HL, Nahai F, Vasocnez LO. The tensor fascia lata myocutaneous free flap. Plast Reconstr Surg 1978;61:517-22]. However, the dimensions of the standard TFL flap limit its use in cases of large full thickness abdominal wall defects. Therefore, we have used an ingenious technique of raising the entire thigh skin as a fasciocutaneous flap (whole thigh flap) based on the concept of fusion of angiosomal territories, to reconstruct such a defect following excision of a large abdominal wall tumour.

Functional reconstruction of Achilles tendon defects combined with overlaying skin defects using a free tensor fasciae latae flap

We present our experience in functional reconstruction of the Achilles tendon with large tissue defects following after trauma and infection. To cover the skin defect and to reconstruct the Achilles tendon we used the free tensor fasciae latae (TFL) flap. From 1997 to 2003 six males, ranging from 22 to 71 (average 38.6) years, underwent this reconstructive procedure. All of them had sustained a trauma with following loss of the tendon and of the overlying tissue. After initial debridements the reconstruction with a tensor fascia latae free flap was performed. To achieve a strong distal fascia lata attachment to the calcaneal bone, we developed a special method of fixation. After vertical osteotomy in the calcaneus the distal part of the fascia flap was introduced between the bone segments, which were fixed together with a spongiosa screw. For functional outcome, it was important to fix the foot in a 90 degrees position with tension on the vascularised fascia lata. The range of motion of the ankle of the reconstructed foot showed 93.7% in comparison to the normal foot. No flap failure occurred in any of the six patients. Simultaneous soft-tissue and function restoration of the foot with TFL free flap is in our opinion an optimal one-stage reconstructive procedure.

Modified tensor fascia lata musculofasciocutaneous flap for the coverage of trochanteric pressure sores

The method most frequently used for the coverage of trochanteric pressure sores is the tensor fascia lata (TFL) flap. The authors introduce a new, hatchet-shaped incision strategy for the TFL flap, which preserves the safe blood supply of the flap and keeps the flap mobile enough. The part of the flap including the muscle is adapted to the greater trochanter. This provides a good aesthetic result without dog-ear formation at the rotation point of the flap. The donor site is closed in a V-Y fashion, and the closure does not require any skin grafting or designing a local flap. The TFL hatchet flap was used nine times on eight patients to cover trochanteric pressure sores. With one exception all patients healed. No recurrence was observed during the follow-up period, and no contour difference developed on the lateral aspect of the thigh.

The ???Duck??? Modification of the Tensor Fascia Lata Flap

Various common locations of pressure sores require specific considerations. The most commonly used flap for the treatment of trochanteric ulcers is the tensor fascia lata (TFL) flap. According to our experience with the original flap, excessive tension and eventual suture separation at the confluence of the donor site flaps and the TFL flap is the most common problem. The purpose of this article is to present a new design for the TFL flap for the coverage of trochanteric pressure sores. An anterior triangular extension is designed exactly at a point where the flaps that will cover the donor site unite after transposition. The desepithelialized proximal part of the flap is folded into the pouch and sutured. The duck flap was applied to 31 trochanteric pressure sores in 27 patients with no major complications. This modification has many advantages: (1) the flap is reliable and easily designed, (2) formation of dead space and cone-shaped dog-ear deformity due to rotation is prevented, (3) better esthetic results are achieved, (4) suture separation is prevented via a tension-free closure, (5) the desepithelialized part produces tight attachment of the flap to the recipient bed, (6) as no muscle tissue is included, the flap is more resistant to pressure.

A single tensor fasciae latae musculocutaneous and fascia flap for composite reconstruction of urogenital and groin defect

The tensor fasciae latae flap is a well known musculocutaneous flap used for many indications in the field of plastic surgery. The flap has some modifications to fit different reconstructive requirements of the defects. Osseous-muscle flap, osseous musculocutaneous flap, muscle flap, muscle-fascial flap and musculocutaneous-fasciocutaneous flap are some known alternatives. We used a modification of this well-known flap as musculocutaneous and fascia flap for a composite reconstruction of groin and urogenital defect. We reconstructed the groin defect with musculocutaneous part of the flap, and the defect over neourethra with the fascial extension and grafting. The aim of this modification was to reconstruct a genital defect with a thin and more pliable tissue to overcome the problem of distortion, kinking and thickness of the flap.