Endoscopic Harvest of Fascia Lata Free Flap in a Cadaveric Model

Advances in technology and surgical technique have expanded the breadth of pathology amenable to endonasal resection. The avoidance of cerebrospinal fluid (CSF) leaks and adequate repair of skull base defects are critical to the ultimate success of any endoscopic procedure. Traditionally, the fascia lata free flap is harvested during the endonasal procedure through a 10-cm incision. The fascia lata closure has demonstrated a high success rate; however, the harvest may result in a painful and cosmetically unappealing surgical site. As a result, we have developed a minimally invasive endoscopic suprafascial technique for fascia lata harvest in a cadaveric model.

A 2-cm incision was made in the lateral thigh of a cadaver approximately one third of the distance between the femoral greater trochanter and lateral epicondyle. An endoscopic port (endoport) was advanced over a 7-mm high-definition endoscope, and CO₂ insufflation was used to improve visualization in the suprafascial plane. Blunt dissection was performed under direct visualization through the endoport. An endoscopic bipolar scissor was used to make two 1-cm incisions in the fascia lata at the proximal and distal margins of the flap. Taking care to preserve the integrity of the underlying muscle, the scissor was used to connect the incisions, thereby creating a 10 × 4-cm elliptical graft. The graft was removed with standard toothed forceps, and the incision was closed with absorbable suture.

We report our experience with endoscopic fascia lata harvest in a cadaveric model. Our results show that a large graft suitable for the vast majority of dural repairs can be harvested endoscopically through a small incision. Furthermore, the procedure appears to be less traumatic to the surrounding tissue and results in a more cosmetically suitable final appearance. Future investigation is necessary to establish the feasibility of the procedure in live models where active bleeding may complicate the harvest. Long-term follow-up of the cosmetic results and postoperative pain are also needed.