A minimally invasive endoscopic technique for fascia lata graft acquisition and fascial reapproximation

Jesse Skoch, Mauricio J. Avila, Vernard S. Fennell, Nikolay L. Martirosyan, Ali A. Baaj, Gerald M. Lemole

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Fascia lata remains a popular and robust graft to repair osteodural defects in endoscopic neurosurgery. Classically, this graft is obtained via a large incision in the thigh that is prone to pain and muscle herniation after surgery. OBJECTIVE: To present a novel technique for harvesting fat and fascia lata graft and reapproximating the edges via an endoscopic approach through the thigh using an “outside-in” technique to prevent muscle herniation. METHODS: Initially our technique was performed in cadavers and includes the following: small 2 cm incision in the lateral thigh to accommodate the endoscope, use of blunt dissection and endoscopic tools to obtain the graft, and reapproximation of the fascia via an outside-in technique using conventional sutures with endoscopic visualization to retrieve the sutures beneath the skin and tie them. We then applied the technique to a patient undergoing transsphenoidal tumor resection. RESULTS: This technique was trialed in 3 cadaver specimens (6 limbs) and was used successfully in a patient with excellent cosmetic results seen in follow-up. CONCLUSION: Endoscopic retrieval of fascia lata is feasible via a very small incision. Reapproximation of the cut fascial edges to minimize muscle herniation can quickly and easily be performed with an outside-in technique detailed here. Additional case series may help to solidify the endoscopic retrieval as a preferred technique for fascia lata graft.

Original languageEnglish (US)
Pages (from-to)735-740
Number of pages6
JournalOperative Neurosurgery
Volume19
Issue number6
DOIs
StatePublished - Dec 1 2020

Keywords

  • Endoscopic
  • Fascia lata
  • Fat graft
  • Osteodural
  • Outside-in
  • Skull base
  • Transsphenoidal

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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