Large Fascia Lata Thigh Harvests for Pelvic Organ Prolapse Repair: Are They Safe?

Chaus F1, Funk J1, Twiss C1

Research Type

Clinical

Abstract Category

Pelvic Organ Prolapse

Abstract 26
Live Urogynaecology, Female & Functional Urology - Childbirth and its Consequences
Scientific Podium Session 3
Friday 15th October 2021
08:40 - 08:50
Live Room 1
Anatomy Female Pelvic Organ Prolapse Surgery
1. University of Arizona, Department of Urology
Presenter
C

Christian Twiss

Links

Abstract

Hypothesis / aims of study
Fascia lata is a versatile graft that has applications in various surgical fields.  There is increased interest in the use of autologous fascia lata in pelvic floor reconstruction as an alternative to synthetic mesh given their complications. However, there are also concerns regarding the potential morbidity of harvesting large amount of fascia lata required for pelvic organ prolapse (POP) repair. We report our experience in 71 patients who underwent large fascia lata harvest for POP repair.
Study design, materials and methods
A 4-5-cm x 14-18-cm piece of fascia lata is harvested through a single, minimally invasive 3-4-inch lateral upper thigh incision and used for either autologous transvaginal POP repair or autologous sacrocolpopexy. The landmarks of fascia harvest are 4-5 cm anterior and parallel to the sulcus between the vastus lateralis and the biceps femoris muscles, 15 cm inferior to the anterior superior iliac spine, and 10 cm superior to the lateral femoral condyle. Defect in the fascia lata not closed to prevent compartment syndrome. A Jackson-Pratt drain is placed in the harvest site to prevent seromas, and a compression bandage is applied for four-six weeks post-operatively. An On-Q pain pump is placed in the wound for post-operative pain control. Patients were followed by history, physical exam, and symptoms related to thigh harvest including visual analog pain (VAP) scores, thigh bulges, harvest site seromas/fluid collections, and paresthesia.
Results
Fascia lata harvest was performed on 71 patients with a mean age of 63. Mean follow-up was 9 months (range 1-26 months), with 20 patients having 12 or more months of follow-up. The overwhelming majority of harvest site issues were minor and managed expectantly. Mean VAP score at the harvest site was 0.36 (range 0-6). Seven patients developed non-bothersome thigh bulges, all of which were managed expectantly. Harvest site seromas occurred in 4 patients and all resolved with 2 requiring simple aspiration. Twenty patients reported mild, non-bothersome harvest site paresthesias. No patients had limitations with ambulation / movement post-operatively. No thromboembolic or infectious events occurred.
Interpretation of results
Facia lata harvest site issues were minor and managed expectantly. Large fascia lata harvests are not morbid for these patients.
Concluding message
Our technique of fascia lata harvest produces a robust 4-5-cm x 14-cm graft suitable for POP repair through a single, minimally invasive 3-4-inch incision, offering excellent cosmesis and minimal discomfort. Harvest site morbidity is minor, and most issues resolve with expectant management alone. Continued follow-up of this series is ongoing to determine long-term success.
Disclosures
Funding None Clinical Trial No Subjects Human Ethics Committee University of Arizona - IRB Helsinki Yes Informed Consent Yes
15/07/2024 02:32:46