ROLE OF TENSOR FASCIAE LATAE IN ABDOMINAL-WALL RECONSTRUCTION

The role of the tensor fasciae latae as autogenous tissue in reconstru ction of abdominal wall defects is well established. The use of variou s forms of the tensor fasciae latae (free graft versus pedicled flap v ersus free flap) is determined by the characteristics of the defect. A review of abdominal wall reconstructions using tensor fasciae latae w as completed to determine efficacy and establish guidelines for its us e. Abdominal wall reconstructions from 1991 to 1994 using tensor fasci ae latae were reviewed. Demographics, wound characteristics, and compl ications were evaluated. Twenty-seven patients with a mean follow-up o f 23.6 months underwent abdominal wall reconstruction with the tensor fasciae latae: free grafts, 12; pedicled flaps, 9; and free flaps, 6. An average defect size of 14.4 x 13.1 cm was seen. Fourteen (52 percen t) of the reconstructions were completed in contaminated or infected w ounds. One recurrent enteric fistula was seen. Twelve (44 percent) of the patients had flap complications of which 50 percent involved parti al flap necrosis. Donor site complications were seen in five patients (18 percent) and included a hematoma, seroma, and two cases of skin gr aft dehiscence along the edge of the wound. Tensor fasciae latae free grafts are an option for repair of abdominal hernias if abdominal soft tissue is adequate. Pedicled flaps may be used for defects of soft ti ssue and fascia but are limited by the are of rotation and size of the defect. Tensor fasciae latae free flaps are versatile in orientation and may be used for supraumbilical defects. Tip necrosis is significan t in both types of vascularized flaps.