COVERING LARGE GROIN DEFECTS WITH THE TENSOR FASCIA LATA MUSCULOCUTANEOUS FLAP

By H. LOUIS HILL, M.D., RODERICK HESTER, M.D. and FOAD NAHAI, M.D.

Division of Plastic and Reconstructive Surgery, Emory University, Atlanta, Georgia, USA

DURING the past 2 years we have used the tensor fascia lata muscle with its overlying skin as a musculocutaneous unit to cover ischial and trochanteric defects and as a free flap to cover leg ulcers (Hill et al., 1978). As the following 2 cases illustrate, it is also a useful transposition flap to resurface defects in the groin.

CASE REPORTS

Case I. This 5o-year-old woman had a g x g cm firm mass in her left inner thigh which proved to be a well differentiated leiomyosarcoma, probably of blood vessel origin. It was excised radically with a 5 cm margin of healthy skin, the deep fascia and an in-continuity groin dissection. The femoral vessels were protected by shifting the sartorius muscle over them and the defect closed with a neighbouring tensor fascia lata musculocutaneous flap. The secondary defect was closed directly (Figs. I - 4).

Case 2. A 57-year-old man with a carcinoma of his penis had had the penis amputated and a left groin dissection carried out. The groin wound became infected and burst open I week later when he was referred for plastic surgical repair (Fig. 5). When the wound was clean and the infection subsided, the defect was closed with a tensor fascia lata flap (Figs. 6 and 7).

FIG. I. Case I. A and B. Operative plan. The tumour mass was cleared by 5 cm all round. The tensor fascia lata musculocutaneous flap is outlined.

Address for reprints: H. Louis Hill, Jr., M.D., Emory University Clinic, 1364 Clifton Road, N.E., Atlanta, Georgia 30322, USA.

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COVERING LARGE GROIN DEFECTS ‘3

Frc. 2. Case I. The defect prior to transposition of the flap. The exposed femoral vessels were tiryr covered by the sartorius.

FIG. 3. Case I. The musculocutaneous flap transposed

FIG. 4. Case I. The secondary defect was closed directly.

Frc. 5, Case 2. The skin defect following dehiscence of a block dissection wound.

I4 BRITISH JOURNAL OF PLASTIC SURGERY

FIG. 6. Case 2. The musculocutaneous flap raised and ready for transposition,

FIG. 7. Case 2. Final closure.

COMMENT

From our experience of over 50 cases, there is no doubt that the tensor fascia lata with its overlying skin may be reliably raised on its major pedicle in dimensions of up to 15 x 30 cm. Transposed into nearby groin defects it supplies well vascularised tissue into areas which are notoriously slow to heal. When the femoral vessels are exposed it has the added advantage of providing muscular protection.

Special appreciation to Dr MauriceJ.Jurkiewicz and Dr Luis 0. Vasconez for their continued support and encouragement.

REFERENCE

HILL, H. L., NAHAI, F. and VASCONEZ, L. 0. (1978). The tensor fascia lata myocutaneous free flap. Plastic and Reconstructive Surgery, 61, 517.