Fascia lata flap to repair perineal hernia in dogs. Temperoparietal fascia flap morbidity frontal branch weakness travels in tpf secondary alopecia damage to hair follicles due to superficial dissection 58. And yet this complex muscle has rarely been mentioned as a potential root cause. Behind sartorius insertion iliotibial tract of fascia lata. Perforator vessels are always present, the anatomy is more constant and it is possible to harvest it through the same surgical access. The anatomy of tfl is more constant than alt flap 36. Flap can also be employed to reconstruct defects within the groin, gluteal, ischial, and lower abdominal regions. A vascularized skinsubcutis fascia lata flap could be raised by dissecting out two to three perforating arteries. The vy tensor fascia lata allows a covering similar to the classical flap, simplifies primary closure and essentially presents the possibility of numerous reutilizations. The latin name for this muscle roughly translates to english as the muscle that stretches the band on the side. Apr 30, 20 this video shows technique of tfl flap elevation and reconstruction of inguinal defect after inguinal block dissection. This was carried out as a single stage procedure in 14 cases. If the tfl flap does not have a sufficient amount of soft tissue, the pressure sore can recur because the covering flap.
The word tensor comes from the latin word tendere which means to tense. The tumor was composed of clear cell adenocarcinoma arising from extrapelvic endometriosis. It belongs to the muscles of the gluteal region, along with the gluteus maximus, gluteus medius and gluteus minimus muscles tensor fasciae latae is found superficial in the anterolateral aspect of the thigh, spanning from the anterior portion of the iliac crest to the superior portion of the tibia, onto. Its likely pain in the tensor fascia latae tfl a common complaint that can be alleviated with the 3 steps outlined in this guide. The tfl muscle takes origin from the anterior iliac crest in an arc and inserts into the iliotibial tract. Split thickness skin graft in place over donor site of tensor fascia lata flap.
The tensor fascia lata is a versatile flap with many uses in. A week doesnt seem to go by without my seeing a new client who says theyve tried everything for hip pain. The tensor fasciae latae tfl muscle flap can be used for reconstruction of decubital ulcers in the trochanteric or ischial region. It was concluded that the pedicled tensor fascia lata flap is a versatile, reliable, easy, and less time consuming. The anterior border of the marked skin flap is incised first, extending it along the inferior border as required. The tensor fasciae latae is a tiny muscle, inferior to the iliotibial band. While conventional treatments like static stretching, massage and trigger point release therapy are useful in the acute stages, they wont provide lasting relief from tensor fasciae latae pain. Start by placing the leg to be stretched behind the other. Indications include trochanteric pressure ulcers, nonhealing, failed hip arthroplasties, and soft tissue defects after.
Cross the bent leg over the left knee and pull with your left hand. The function of involved muscle group is to tense the fascia lata counteracting the backward pull of the gluteus maximus on the iliotibial tract. Latae comes from the latin word lata which means side or lateral. Tensor fasciae latae free grafts are an option for repair of abdominal hernias if abdominal soft tissue is adequate. A radial forearm flap for instance is usually harvested as a fascial flap, taking the antebrachial fascia in continuity with the. Superior gluteal and lateral circumflex femoral artery. The pedicled tensor fascia lata tfl flap has most commonly been utilized for reconstruction of trochanteric pressure sores and lower abdominal wall defects 46. Otherwise, the donor site is closed with a splitthickness skin graft. This study describes the treatment of two patients with recurrent, infected abdominal wall defects using bilateral delayed and tunnelled pedicled tensor fascia lata tfl myofascial flaps. Maximal tensile strength at the sutured region was measured serially. Tensor fasciae latae petmassage training and research.
The tensor fascia lata nap is extremely tensor fascia lata myocutaneous flap 43 versatile and can be made as large as 25 by 40 cm. Clinical uses of the tensor fascia lata myocutaneous flap. Blood supply circumflex iliac, iliolumbar, and iliacofemoral arteries. Proximal femoral resection and tensor fascia lata flap for. The structure of the tensor fasciae latae flap can be musclecutaneous, musclefacial, muscle, and bonemusclecutaneous.
Indications include trochanteric pressure ulcers, nonhealing, failed. Vy tensor fascia lata for trochanteric pressure sore. The word latae is the genitive form of the latin word lata meaning. Dissection proceeds toward the vascular pedicle, which is visualized in the under surface of the. The caudal part of the tensor fasciae latae also acts to flex the hip joint. Tensor fasciae latae definition of tensor fasciae latae by. Microsurgery information for surgeons, health care professionals and patients, with detailed procedure descritpions. Free tensor fasciae latae musculofasciocutaneous flap in.
It lies between the two layers of fascia lata in the proximal third of the thigh and via the iliotibial band inserts onto the lateral tibial condyle gertys tubercle. The tensor fascia lata myocutaneous flap in gynecologic. Tensor fasciae latae perforator flap for reconstruction of. The muscle name describes what the muscle does and where its located.
It becomes very vital for a runner due to this function. The use of tensor fascia lata pedicled flap in reconstructing full. The skin territory of the tensor fascia tata nap has a due. We learned about this technique in i978 prior to publication of their findings and decided to investigate the flap in our patients. If the tfl is consciously kept flexible, it will help in keeping the body injury free as well as being fit. Anatomy of the tensor fascia lata muscle everything you. Rerotation of this flap is not only possible, but also just as reliable as the. It is a small muscle that lies between the gluteus maximus and tensor fascia lata at. Squats are an effective exercise to strengthen the tensor fasciae latae muscle and increase hip flexion and rotation.
Educational video describing the anatomy of the tensor fasciae latae muscle. Rotation flap movement is in the direction of an arc around a fixedpoint and primarily in one plane. Tensor fasciae latae common name tritip, triangle muscle, knuckle cap group pelvic whole sale section round, loin origin tuber coxae of ilium insertion fascia lata fascia covering the quadriceps femoris which inserts on the patella action flexes hip joint. The tensor fasciae latae flap and its use in the closure of. To describe the imaging findings in eight cases of unilateral tensor fascia lata tfl hypertrophy presenting as soft tissue masses. Sep 30, 2003 to describe the imaging findings in eight cases of unilateral tensor fascia lata tfl hypertrophy presenting as soft tissue masses. This article describes an sshaped incision for the open approach of harvesting wide sheets of fascia lata with reference to the important anatomical landmarks. In the second case, parietex composite mesh was positioned underneath the tfl. Jan 29, 20 the best sleeping position for back pain, neck pain, and sciatica tips from a physical therapist duration. Tensor fascia lata musculocutaneous flap for trochanteric. Tensor fascia lata tfl flap and its modifications are commonly used for trochanteric sore coverage. The defect in the abdominal wall was reconstructed with a fascia lata tensor muscle skin flap.
A diaphragmatic defect 2 cm by 5 cm was reconstructed with a patch of autologous fascia lata in the experimental group n 12 and with expanded polytetrafluoroethylene in the control group n 12. A modification of the standard tensor fascia lata myocutaneous flap, namely, the tensor fascia lata vy retroposition flap, is a reliable, durable, efficient, welltolerated, and technically. The fascia lata and the attached tensor fasciae latae muscle are retracted cranially and the biceps caudally. Vy tensor fascia lata for trochanteric pressure sore treatment. Therefore, the ability of the tfl free flap to reconstruct complex abdominal wounds was evaluated. In 70 tfl vy retroposition flap reconstructions performed, the overall postoperative complication rate was 23%, with 4 total flap failures. The advantages of tfl flap are that dissection can be made through the same incision, without impairment of other donor. Reconstruction of radiated gluteal defects following. In order to prevent such occurrence, you need to take care of this type of movements and strengthen the muscle. Flap may be designed as a pedicled or free flap, depending on the region requiring coverage. Tensor fascia lata trigger point in it band and hip pain. Tunnelled tensor fascia lata flap for complex abdominal. It has a very long tendon, called the iliotibial tract or it band, that travels all the way down the outside of the thigh to attach just under the knee joint.
The it band syndrome and hip pain culprit october 11, 2015 by dr. A portion of external table of iliac crest can be harvested with the. Helps stabilize and steady the hip and knee joints by putting tension on the iliotibial band of fascia innervation. In its superior aspect, tensor fasciae latae is found between the sartorius and gluteus medius muscle, where it overlays the gluteus minimus muscle. Tfl flap has a small volume of muscle on its proximal portion but is just a thin fasciocutaneous flap on its distal portion. Tensor fascia lata i a major cause of unexplained hip pain. Anatomy, surgical technique, applications, and limitations revisited. Tfl flaps were elevated and delayed for 4 weeks in both cases. Motor innervation comes from the lateral branch of the superior gluteal nerve, while sensitive innervations are enabled by the lateral femoral cutaneous nerve 2,3,4.
Anterior superior iliac spine, outer lip of anterior iliac crest and fascia lata insertion. Many types of squats are available, including a full, front, hack or box squat, depending on preference. It was concluded that the pedicled tensor fascia lata flap is a versatile, reliable, easy, and less time consuming procedure for the coverage of defects around trochanter, groin, lower anterior abdomen, perineum, and ischial region. It is positioned lateral to the hip joint, immediately beneath the skin. Reconstruction of trochanteric pressure sores using. Role of tensor fasciae latae in abdominal wall reconstructio. The purpose of this study was to differentiate between musculocutaneous and septocutaneous perforators of the tensor fasciae latae perforator flap. Frequently, the size and location of the defect produce this option. Innervation superior gluteal t12 and lateral femoral cutaneous. The word tensor comes from the latin verb meaning to stretch. Tensor fascia lata was incised with electrocautery, and a breiskynavratil retractor was used to elevate the fatty tissue from on top of the fascia as well as from underneath. The more the flap is rotated, the shorter the flapbecomes. The flap can be harvested without a skin paddle, using only the muscle and fascia.
Can be reinforced by drilling holes into cut edge of iliac bone approximate external obliques and aponeurosis to tensor fascia lata and gluteus muscles keep inferior oblique inferior and anterior to asis skin loss. We investigated whether fascia lata is an appropriate material for reconstruction of the diaphragm. The imaging studies included five radiographs, five computed tomography ct and six magnetic resonance imaging mri examinations. As we mentioned above, the most common cause of the tensor fasciae latae is a muscle strain. Compression neuropathy and tensor fasciae latae syndrome. Micro vascular free flaps used in head and neck reconstruction certified fixed orthodontic courses by indian dental academy. It is, therefore, most important to know its vascular stalk characteristics before its use in the reconstruction of defects 6,7,8,9. Tensor fasciae latae muscle an overview sciencedirect topics.
B fascia lata flap flp was created through two parallels incisions cranial and caudal and a perpendicular incision at the distal limit. The only disadvantage is the necessity of a femoral incision for harvest. Patients and methods dissection is chosen as the method that is most fre. Tensor fasciae latae is a fusiform muscle located in the lateral aspect of the thigh.
It is thicker in the upper and lateral part of the thigh, where it receives a fibrous expansion from the gluteus maximus, and where the tensor fasciae latae is inserted between its layers. After hydrodissection with saline, a 2 cm superior incision is made and deepened to the plane of the fl. Wangensteen first reported the tensor fascia lata flap for abdominal wall reconstruction. Reconstruction of diaphragm using autologous fascia lata is safe, easy, and inexpensive, and provides smooth wound healing. Laura perry the tensor fascia latae also spelled tensor fasciae latae or tensor fascia lata, but commonly referred to as the tfl is a small muscle that lies just in front of the hip joint. The fascia lata is an investment for the whole of the thigh, but varies in thickness in different parts. Ppt muscle flaps powerpoint presentation free to view. The fascia lata stripper is engaged and, with the stripper held as close to the leg as possible, it is pushed superiorly while gentle tension is held on the silk suture pulling the.
May 11, 2020 the tensor fasciae latae muscle is the most superficial muscle of the anterolateral aspect of the thigh. Can i bill for harvest of of left tensor fascia lata graft. To our knowledge, the tfl flap has not been previously described for use in the reconstruction of extensive oncologic gluteal defects. The tensor fasciae latae is a muscle, which helps in flexing and abducting the thigh. Start by lying down on the back, and bend your right knee. Defektdeckung mit musculustensorfasciaelataelappen. The fascia lata is a fibrous sheath that encircles the thigh like a subcutaneous stocking and tightly binds its muscles. The anatomy and operative technique for raising the free tensor fasciae latae flap are well described. The tumor including a part of the abdominal rectus muscle and rectus sheath, subcutaneous fat, skin, and the right inguinal ligament was resected en bloc. Recently i have begun to think of the tensor fascia lata muscle tfl as the undiscovered country of hip pain. On the lateral surface, it combines with the tendons of the gluteus maximus and tensor fasciae latae to form the iliotibial tract, which extends from the iliac crest to the lateral condyle of the tibia.
Tensor fascia lata vy retroposition myocutaneous flap. The tfl muscle originates from the outer lip of the anterior iliac crest between the. Mar 25, 2015 the tensor fasciae latae is a tiny muscle, inferior to the iliotibial band. The skin island of the flap can be very large and can be thinned removing a large part of the muscle allowing its use for almost. A boies elevator is used to tunnel under the skin flap. Reconstruction of diaphragm using autologous fascia lata. 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. Blunt dissection and separation along the neck of the femur with the fingertip allows visualization of a triangle bounded dorsally by the middle and deep gluteal muscles, laterally by the vastus lateralis muscle, and medially by the. The authors performed reconstructions in five patients with large defects of the achilles tendon and overlying skin by using a perforator flap derived from the tensor fasciae latae flap. Turk j vet anim sci in the pelvic diaphragm without the placement of sutures. The tensor fasciae latae pain can be caused by muscle strain, which is the most common cause. Tensor fascia lata type i applications coverage of lower abdominal wall, perineum, ischium and sacrum. Tensor fascia latae pain accelerate physical therapy, p. One has merely to look at the long and unsuccessful history of attempts to avoid the inevitable slough after radical vulvectomy to further appreciate this fact 4.
This band, also called the it band, is an elongated strip of fascia a type of connective tissue located in the. Tensor fasciae latae medical definition merriamwebster. In the second case, parietex composite mesh was positioned underneath the tfl flap and allowed to incorporate. Tensor fasciae latae free flaps are versatile in orientation and may be used for supraumbilical defects. Reconstruction was performed using pedicled tensor fascia lata flaps. This muscles flap has a developed practice in plastic and reconstructive surgery.
Chapter 7 the tensor fasciae latae muscle flap thieme connect. Tensor fascia lata tfl flap is a versatile myofasciocutaneous flap. A modification of the standard tensor fascia lata myocutaneous flap, namely, the tensor fascia lata vy retroposition flap, is a reliable, durable, efficient, welltolerated, and technically straightforward procedure. See more ideas about tensor fasciae latae, massage therapy and hip pain. Use of tensor fascia lata flap for reconstruction of the defect created. The pedicled tensor fascia lata flap tfl flap is a method of choice for abdominalwall reconstruction. We would classify a skin flap as containing skin and subcutaneous fat, while a fascial flap will contain fascia and may or may not contain skin as well. The defect was covered with a tensor fascia lata tfl flap. Microsurgical transfer may overcome these disadvantages. The tensor fascia latae also spelled tensor fasciae latae or tensor fascia lata, but commonly referred to as the tfl is a small muscle that lies just in front of the hip joint. Dec 31, 2016 the tensor fascia lata tfl flap has been successfully used for decades for coverage of hip defects, particularly trochanteric pressure sores. The tensor fasciae latae perforator is a reliable anatomical landmark to clearly identify the hueter interval when using the minimallyinvasive direct anterior approach to. Sixtythree percent of complications were treated with local wound care, thus avoiding repeat surgery. The flap is safe with a good blood supply, the muscle is expendable, and when used for the present purpose, the donor defect can usually be closed directly.
Tensor fascia lata flap reconstruction in groin malignancy. The deep fascia overlying the deltoid muscle is sharply cut and the flap is elevated in a plane underneath the fascia. Applications coverage of lower abdominal wall, perineum, ischium and sacrum. This exercise stretches the gluteus medius, gluteus minimus and tensor fascia latae muscles. Transposition flap the rectangular flap is rotated on a pivot point. Tunnelled tensor fascia lata flap for complex abdominal wall reconstruction. In the exstrophy case, as the flap was used to cover the anterior abdominal wall defect, the flap was released after six weeks, thus making it a two staged procedure. Its origin is the anterior border of the ilium with insertion on the middle third of thigh along the iliotibial tract.