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Minimally Invasive Fascia Lata Harvest: A New

Method
Sir:
F ascia lata (FL) is a material that is abundant and

safe to harvest and has multiple uses as a graft
material.1–3 Its advantage in augmentation rhinoplas-
ty is in creating a smooth, natural looking dorsum.2
Many techniques have been described for FL
harvest, which require endoscopes, strippers, or
fasciotomes.4 Other small incision techniques have
been described, but the graft segment harvested in
those series is narrow5 and not suitable for our pur-
poses. Fig. 1. The landmarks and boundaries for fascia lata harvest
We describe a simple technique that uses a small are shown. The yellow shaded area delineates the fascia lata
superior 2 cm transverse incision and an inferior stab for harvesting.
incision to harvest a long and wide graft segment,
without the use of specialized equipment. As the
graft harvested is abundant, it can be used for many
indications; the authors’ main use of the graft is in
rhinoplasty.
The harvest limits are as follows: laterally—4 cm
anterior to the lateral intermuscular septum—this
is to preserve a 4 cm strip of the iliotibial band;
inferiorly—10 cm superior to the lateral femoral
condyle joint—this is to preserve the FL condensa-
tion around the knee; and superiorly—up to 15 cm
from the level of anterior superior iliac spine—this Fig. 2. Intraoperative photograph demonstrating the long
is to avoid harvesting FL on the superior surface of and wide graft delivered via a small incision.
the tensor fascia lata muscle.
Figure 1 shows the delineated donor site (yellow Two parallel cuts are made with long scissors
shaded area) that will be harvested. This is the fas- along the length of the FL, its free edge grasped with
cia anterior to the iliotibial band, 10 cm superior to a Roberts artery forceps, and then pushed inferiorly
the lateral condyle, and up to 15 cm from the level until no further extension is possible. The artery tip
of anterior superior iliac spine. The authors have is tented against the skin, and the inferior stab inci-
now refined the technique to a superior 2 cm incision is made, delivering the graft via this incision.
sion and inferior stab incision. A sheet of FL up to 20 cm × 4 cm can be har-
After hydrodissection with saline, a 2 cm superior vested using this technique (Fig. 2) and folded for
incision is made and deepened to the plane of the augmentation.
FL. A Boies elevator is used to tunnel under the skin Compression dressings are worn for 24 hours,
flap. The FL is incised with a blade, and the eleva- thereafter, compression stockings for 6 weeks. The
tor is used to mobilize the fascia off the underlying patient is advised against vigorous activities in the
muscles. immediate postoperative period.
In rhinoplasty, similar outcomes can be achieved
Presented at the 15th Asian Research Symposium in with an FL graft compared to materials such as acellular
Rhinology, May 24–26, 2012, Singapore. dermis. Contour lines are smooth, and irregularities are
Copyright © 2013 American Society of Plastic Surgeons. effectively camouflaged. The distinct advantage of FL is
Unauthorized reproduction of this article is prohibited. that there seems to be minimal resorption.2 The disad-
This is an open-access article distributed under the terms vantages include difficult handling, potential donor site
of the Creative Commons Attribution-NonCommercial- morbidity such as hematoma, and 2 additional scars.
NoDerivatives 3.0 License, where it is permissible to download However, the superior incision is usually quite high up
and share the work provided it is properly cited. The work in the thigh and is covered even by shorts.
cannot be changed in any way or used commercially. In conclusion, this described technique enables a
PRS GO 2013;1:e7; doi:10.1097/GOX.0b013e31828c4406; simple and safe harvest without special equipment,
Published online 5 April 2013. with acceptable risks and morbidities.
www.PRSgo.com 1
Copyright © 2013 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
PRS GO • 2013
Valerie Su-Lin Tay, MBBS, MMed devices, or drugs mentioned in this article. The Article Pro-
Kar Su Tan, MBBS, MMed cessing Charge was paid for by the authors.
Ian Chi Yuan Loh, MBBS, MMed
REFERENCES
Department of Otolaryngology, Head and Neck Surgery 1. Baroody M, Holds JB, Vick VL. Advances in the diagnosis
Changi General Hospital and treatment of ptosis. Curr Opin Ophthalmol. 2005;16:351–
Singapore 355.
2. Jang YJ, Wang JH, Sinha V, et al. Tutoplast-processed fascia
Correspondence to Dr. Loh lata for dorsal augmentation in rhinoplasty. Otolaryngol Head
Department of Otolaryngology, Head and Neck Surgery Neck Surg. 2007;137:88–92.
3. Chan DB, Temple HT, Latta LL, et al. A biomechanical com-
Changi General Hospital
parison of fan-folded, single-looped fascia lata with other
2 Simei Street 3 graft tissues as a suitable substitute for anterior cruciate liga-
Singapore 529889 ment reconstruction. Arthroscopy 2010;26:1641–1647.
ian_loh@cgh.com.sg 4. Bhatti AF, Soueid A, Baden JM, et al. Fascia lata harvesting:
minimal access for maximum harvest. A new technique. Plast
Reconstr Surg. 2010;126:277e–278e.
DISCLOSURE 5. Kashkouli MB. A novel technique for small-incision fascia
The authors have no financial interest to declare in rela- lata harvesting without a fasciatome for the frontalis suspen-
tion to the content of this article and also to the products, sion procedure. Orbit 2007;26:203–206.
2
Copyright © 2013 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.

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Minimally Invasive Fascia Lata Harvest: A New

F ascia lata (FL) is a material that is abundant and

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