Early and late results of fascia lata transplantation in high myopia.
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Transplantation of a strip of fascia lata to strengthen the posterior sclera in high progressive myopia was performed on 184 eyes of 108 patients with myopia ranging from 7 to 39 D. Three weeks after surgery visual acuity with correction had improved by 0-1 to 0-5 in 151 eyes (82 per cent) and refractive power had decreased by 1 to 8 D in 169 eyes (92 per cent). In 105 eyes (67 patients) that were followed-up for periods of from 1 to 9 years myopia increased in six by 0-5 to 3 D. In 29 patients who had an operation on only one eye and were then followed-up for periods of from 1 to 7 years the degree of myopia in the fellow eye increased by 1-5 to 6 D in 24 (83 per cent), and of the eyes that were operated on myopia increased by 0-5 to 3 D in only 5 (17 per cent). (+info)
One-stage reconstruction of large midline abdominal wall defects using a composite free anterolateral thigh flap with vascularized fascia lata.
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OBJECTIVE: Large midline abdominal wall defects are continuously a challenge for reconstructive surgeons. Adequate skin coverage and fascia repair of the abdominal wall is necessary for achieving acceptable results. The purpose of this paper is to present a new approach to abdominal wall reconstruction using a free vascularized composite anterolateral thigh (ALT) flap with fascia lata. METHODS: Seven patients with large full-thickness abdominal wall defects were successfully reconstructed by means of a composite ALT flap combined with vascularized fascia lata. The size of the skin islands ranged from 20 to 32 cm in length and 10 to 22 cm in width, and the vascularized fascia lata sheath measured 14 to 28 cm and 8 to 18 cm, respectively. Functional outcome of the abdominal wall strength and donor thigh morbidity were investigated by using a Cybex kinetic dynamometer. RESULTS: All flaps survived. No postoperative ventral hernia occurred except for one mild inguinal incision hernia. Subjectively there were no significant donor site problems. Objective assessment was performed in 4 patients 2 years postoperatively. In the reconstructed abdomen, isokinetic concentric and eccentric measurements of extension/flexion ratios of the abdominal wall strength showed no apparent decrease compared with other references. Functional evaluation of quadriceps femoris muscle contraction forces after free ALT composite flap harvest showed an averaged deficit of 30% as compared with the contralateral legs. However, no difficulties in daily ambulating were reported by the patients. CONCLUSION: The free composite ALT myocutaneous flap with vascularized fascia lata provides an alternative option for a stable repair in complex abdominal wall defects. (+info)
The use of tensor fascia lata pedicled flap in reconstructing full thickness abdominal wall defects and groin defects following tumor ablation.
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BACKGROUND: The tensor fascia lata is a versatile flap with many uses in reconstructive plastic surgery. As a pedicled flap its reach to the lower abdomen and groin made it an attractive option for reconstructing soft tissue defects after tumor ablation. However, debate exists on the safe dimension of the flap, as distal tip necrosis is common. Also, the adequacy of the fascia lata as a sole substitute for abdominal wall muscles has been disputable. The aim of the current study is to report our experience and clinical observations with this flap in reconstructing those challenging defects and to discuss the possible options to minimize the latter disputable issues. PATIENTS AND METHODS: From April 2001 to April 2004, 12 pedicled TFL flaps were used to reconstruct 5 central abdominal wall full thickness defects and 6 groin soft tissue defects following tumor resection. In one case, bilateral flaps were used to reconstruct a large central abdominal wall defect. There were 4 males and 7 females. Their age ranged from 19 to 60. From the abdominal wall defects group, all repairs were enforced primarily with a prolene mesh except for one patient who was the first in this study. Patients presenting with groin defects required coverage of exposed vessels following tumor resection. All patients in the current study underwent immediate reconstruction. RESULTS: The resulting soft tissue defects in this study were due to resection of 4 abdominal wall desmoid tumors, a colonic carcinoma infiltrating the abdominal wall, 4 primary groin soft tissue sarcomas, a metastatic SCC of the leg to groin nodes, and a primary SCC of the groin. The size of the flaps used ranged from 20 x 10 cm to 31 x 18 cm. All flaps survived. However, distal flap necrosis occurred in 4 cases. Three of those cases developed in flaps reconstructing abdominal wall defects, and one case developed in a flap used to cover a groin defect. In the former 3 cases, the flap was simply transposed without complete islanding of the flap. In the latter case, a very large flap was harvested beyond the safe limits with its distal edge just above the knee. In addition, wound dehiscence of the flap occurred in 2 other cases from the groin 132 group. Nevertheless, all the wounds healed spontaneously with repeated dressings. Out of the 5 cases that underwent abdominal wall reconstruction, one case developed ventral hernia, in which bilateral TFL flaps were used without mesh enforcement. There was minimal donor site morbidity in the form of partial skin graft loss in 2 cases. The average follow up period in this study ranged from 6 months to 2 years. Only one patient died of distant metastasis of a SCC of the groin skin, 8 months postoperatively and another 2 patients with abdominal desmoid tumors developed local recurrence. CONCLUSION: The tensor fascia lata flap is a reliable and a versatile flap, with minimal donor site morbidity. Problems with the flap's vascularity of its distal part should not be encountered, if the flap is harvested within the safe limits and properly designed and the edges comfortably insetted to the defect. A pedicled flap would be appropriate for lower abdominal wall defects, and is better islanded to achieve extra mobilization and allow a tension free closure, while for groin defects, simple flap transposition should be enough. Nevertheless, reconstruction for full thickness abdominal wall defects by this flap is a static reconstruction. We therefore strongly recommend enforcing the repair with a synthetic mesh primarily to minimize the incidence of ventral hernia. However, further studies with larger number of cases are needed to confirm this observation. (+info)
Assessment of collagen deposits after implant of fascia lata and fat in the vocal folds of rabbits: histomorphometric study.
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Several materials have been injected or introduced in the vocal folds in attempt of solving the glottic insufficiency. However, few studies have evaluated the cicatricial process due to the implantation of these materials. AIM: The objective of this research was to evaluate the concentration of collagen after microsurgery graft of muscular fascia and fat in the vocal folds of rabbit. STUDY DESIGN: experimental. MATERIAL AND METHOD: Nineteen rabbits were submitted to the graft insert in the right vocal fold, being nine of fascia and ten of fat. The left vocal fold was submitted to the same process, except for the insertion of fat or fascial graft. The rabbits were sacrificed after 90 and 180 days. The collagen was analyzed through the method of the Picrosirius-polarization using the Image Pro Plus software. RESULTS: There was prevalence of the collagen in all grafted groups when compared with the group control. The concentration of the collagen found in the rabbits submitted to fat graft was significantly larger when compared to the concentration of the rabbits submitted to graft of muscular fascia, either with 90 as with 180 days. CONCLUSION: The fat and muscular fascia implantation in the vocal folds of rabbit promoted production of collagen, being more intense with fat. (+info)
Reconstruction with fascia lata allograft of the posterior vertebra elements after resection for aneurysmal bone cyst in a child.
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We report a case of ABC in a child where, after resection of the posterior spinal column of L1, we did a biological reconstruction using a posterior tension band with a segment of fascia lata allograft in tension between T12 and L2. After the long term follow up, X-ray and MRI controls showed a satisfactory alignment of the spine and no local recurrence. The patient now has no sign of spinal instability or deviation, with no kind of discomfort or pain, and has a normal life. In our experience this biological tension band interferes minimally with the growth of the spine, and has a less number of complications in comparison with other more aggressive methods and so is a good option for restoring the stability in young patients with benign spinal tumors that arises on the posterior column without having any kind of potential deviations. (+info)
Three-dimensional mathematical model for deformation of human fasciae in manual therapy.
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CONTEXT: Although mathematical models have been developed for the bony movement occurring during chiropractic manipulation, such models are not available for soft tissue motion. OBJECTIVE: To develop a three-dimensional mathematical model for exploring the relationship between mechanical forces and deformation of human fasciae in manual therapy using a finite deformation theory. METHODS: The predicted stresses required to produce plastic deformation were evaluated for a volunteer subject's fascia lata, plantar fascia, and superficial nasal fascia. These stresses were then compared with previous experimental findings for plastic deformation in dense connective tissues. Using the three-dimensional mathematical model, the authors determined the changing amounts of compression and shear produced in fascial tissue during 20 seconds of manual therapy. RESULTS: The three-dimensional model's equations revealed that very large forces, outside the normal physiologic range, are required to produce even 1% compression and 1% shear in fascia lata and plantar fascia. Such large forces are not required to produce substantial compression and shear in superficial nasal fascia, however. CONCLUSION: The palpable sensations of tissue release that are often reported by osteopathic physicians and other manual therapists cannot be due to deformations produced in the firm tissues of plantar fascia and fascia lata. However, palpable tissue release could result from deformation in softer tissues, such as superficial nasal fascia. (+info)
Distal fascia lata lengthening: an alternative surgical technique for recalcitrant trochanteric bursitis.
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Tensor fascia lata flap reconstruction in groin malignancy.
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INTRODUCTION: Block dissection of inguinal lymph nodes is done in cases of malignant inguinal lymphadenopathy, which requires the removal of skin where it is involved, or elevation of the flaps which have precarious blood supply leading to necrosis. Thus, wound closure presents a big challenge. It can be done either by primary closure which is frequently complicated by necrosis, or by split thickness skin graft which is complicated by rejection on radiotherapy. Another option is to cover the wound by a vascularised pedicled graft. This prospective study was conducted after obtaining clearance from the ethical committee. The results were compared with the accepted complication rates of the operation. METHODS: We presented our experience of coverage of wounds after block dissection of inguinal lymph nodes for malignant deposits in 15 patients (with median age of 46 years) by pedicled tensor fascia lata thigh flap. RESULTS: The results following the surgery were good. Healing was satisfactory in all 15 cases. There were two cases of marginal flap necrosis, and three cases developed lymphoedema which was managed by stockings. There were two cases of infection which were settled by antibiotics. There were three cases of loss of a small area of skin graft at the donor site. There was no reported case of recurrence in the inguinal region. CONCLUSION: This technique of coverage of the defect after inguinal block dissection is easy with predictable good results. (+info)