What are the clinical uses of fascia lata as a graft?

Clinical Uses of Fascia Lata as a Graft

Fascia lata serves as a versatile autograft or allograft for reconstructive procedures across multiple surgical specialties, with established applications in urethral reconstruction, orthopedic ligament repair, ophthalmic surgery, and abdominal wall reconstruction.

Primary Clinical Applications

Urological Reconstruction

For urethral stricture disease, particularly in lichen sclerosus (LS), fascia lata represents a viable nongenital tissue option for staged urethroplasty when buccal mucosa is unavailable or insufficient 1. The guidelines emphasize that nongenital skin or tissue grafts must be used in LS because genital skin grafts have a 90% recurrence rate, while nongenital grafts show minimal failure 1. Fascia lata can be used in:

• Staged urethroplasty for long or multifocal strictures where complete excision of diseased urethral plate is required
• Secondary reconstruction when preferred tissues (buccal mucosa) have been exhausted
• Complex anterior urethral strictures requiring extensive tissue replacement

The key advantage is that fascia lata, as nongenital tissue, resists recurrence of LS disease that would otherwise affect genital skin grafts 1.

Orthopedic Applications

Fascia lata demonstrates strong biomechanical properties for ligament and tendon reconstruction:

• Medial patellofemoral ligament (MPFL) reconstruction: Fascia lata mimics native MPFL biomechanics, avoids hamstring damage, and allows quicker rehabilitation compared to traditional tendon grafts 2
• Chronic elbow instability: Fascia lata allograft shows ultimate load of 234.8 ± 23.1 N with comparable clinical outcomes to triceps autograft, without donor site morbidity 3
• Flexor tendon reconstruction in the hand: When palmaris longus or plantaris are absent, fascia lata provides successful 2-staged reconstruction with good motion recovery 4
• Superior capsule reconstruction: For massive irreparable rotator cuff tears, fascia lata autograft is biomechanically and biologically superior to acellular dermal allograft in thickness and stiffness 5

Ophthalmic Plastic Surgery

Fascia lata has multiple established uses in ophthalmology 6:

• Frontalis brow suspension for congenital ptosis with poor levator function (≤4 mm)
• Patch grafting for ciliary staphyloma coverage
• Orbital implant wrapping following enucleation for intraocular malignancies
• Repair of extruded implants after evisceration
• Fascial sling for recurrent paralytic ectropion
• Globe-threatening defects: Provides sustained tectonic support for scleral staphyloma and reinforcement after tumor resection 7

The minimally invasive harvesting technique leaves minimal scarring and demonstrates excellent biocompatibility 6.

Stress Urinary Incontinence

Autologous fascia lata represents one of the primary surgical options for female stress urinary incontinence 8. Autologous fascia pubovaginal sling (PVS) using fascia lata or rectus fascia shows:

• 85-92% success rates with 3-15 years follow-up
• Superior outcomes to Burch colposuspension (66% vs 49% effectiveness) with lower re-treatment rates 8
• Established role when patients decline synthetic mesh or require concomitant abdominal surgery

Abdominal Wall Reconstruction

In open abdomen management, fascia lata can serve as biological graft material, though guidelines favor other biological prostheses 9. The primary consideration is:

• Non-cross-linked biologic meshes (which could include fascia lata) are preferred in sublay position when linea alba can be reconstructed
• Contaminated fields require biological rather than synthetic materials
• Can be combined with negative pressure wound therapy to facilitate granulation and skin closure 9

Key Properties Supporting Clinical Use

Fascia lata's clinical utility stems from specific characteristics 10:

• Histologically: Composed of parallel, compact collagen fiber bundles with few cells
• Immunologically: Low-antigenic, making it suitable as allograft after processing
• Biomechanically: Sufficient tensile strength (234.8 ± 23.1 N ultimate load) for ligamentous reconstruction 3
• Structural: Fan-shaped configuration mimics certain anatomical structures (e.g., elbow ligamentous complex)

Critical Considerations

Autograft vs. Allograft Selection

• Autologous fascia lata is preferred when available, particularly in urological reconstruction and stress incontinence surgery
• Allogeneic (preserved) fascia lata is acceptable for pediatric patients under 6 years for ptosis correction 6 and when donor site morbidity must be avoided 3
• Processing techniques preserve extracellular matrix scaffold while reducing antigenicity 10

Donor Site Morbidity

Minimally invasive harvesting techniques significantly reduce complications:

• Minimal scarring on thigh with proper technique 6
• Low morbidity compared to traditional tendon harvest sites
• Well-tolerated by patients when modern harvest techniques are employed 5

Contraindications and Limitations

Do not use fascia lata for:

• Urethral reconstruction with genital skin in lichen sclerosus - use only nongenital tissue 1
• Experimental protocols only for non-autologous synthetic materials in urethroplasty 11
• Contaminated fields requiring synthetic mesh - biological materials are mandated 9

The evidence consistently demonstrates that fascia lata functions as a reliable, versatile graft material across multiple surgical disciplines, with the strongest guideline support in urological reconstruction for lichen sclerosus and as autologous fascia pubovaginal sling for stress urinary incontinence 1, 8.