In reconstructive surgery, a “flap” is a section of living tissue moved from a donor site to a recipient site to repair a defect. This tissue carries its own blood supply, which allows it to survive in its new location. A versatile option is the Tensor Fasciae Latae (TFL) flap, a segment of tissue taken from the outer thigh. Its reliability makes it a frequent choice for surgeons repairing damage from trauma, cancer removal, or chronic wounds.
Understanding the TFL Flap
The TFL flap originates from the upper, outer thigh, home to the tensor fasciae latae muscle that helps with hip movement. A TFL flap is a composite of several tissue types and can be harvested to include skin, subcutaneous fat, the strong fascia lata connective tissue, and a portion of the TFL muscle. This composition provides substance to fill defects.
The flap has a consistent blood supply, primarily from the ascending branch of the lateral femoral circumflex artery. This vascular network provides blood flow through small perforator vessels to the overlying tissues, ensuring the flap remains healthy and integrates successfully at the recipient site. Because of its reliable anatomy, surgeons can tailor the flap, taking only the necessary components for the reconstruction.
Common Uses in Reconstructive Surgery
The TFL flap is used to address a wide range of soft tissue defects. One of its primary applications is covering trochanteric pressure sores, which are deep wounds over the hip’s bony prominence in bedridden patients. The flap’s bulk and durable nature make it well-suited to protect this high-pressure area after repair.
Its use extends to abdominal wall reconstruction, repairing large hernias or defects left after tumor removal. The strong fascia included in the flap reinforces the weakened abdominal wall. Surgeons also use the TFL flap for complex wounds in the groin and perineal regions, and as a secondary option for breast reconstruction. It can also be used for defects in the head, neck, and lower limbs.
The Surgical Procedure
The process begins with preoperative planning, where the surgeon marks the flap’s dimensions on the patient’s thigh, mapping the underlying muscle and blood vessels. Under general anesthesia, the surgical team makes incisions and dissects the tissue layers to isolate the flap while preserving its artery and vein.
Once freed, the flap is transferred to the recipient site. As a “pedicled” flap, it remains connected to its original blood supply and is rotated to a nearby defect. For distant reconstructions, it is used as a “free flap,” meaning it is detached and requires microsurgery to reconnect its artery and vein to vessels at the new site.
After the flap is secured with sutures, both the recipient and donor sites are closed. The donor site on the thigh is closed directly if the harvested area was narrow, often less than eight centimeters wide. Larger donor sites may require a skin graft to cover the area.
Recovery and Post-Operative Care
Following the procedure, the patient remains in the hospital for monitoring. The medical team checks the health of the flap by regularly assessing its color, warmth, and swelling to ensure the blood supply is functioning properly. Drains are placed at both the flap and donor sites to prevent fluid collections and are removed after several days.
Pain management is administered to keep the patient comfortable. Upon discharge, patients receive specific instructions for wound care for both the reconstructed area and the thigh. Activity restrictions are an important part of recovery, and patients must limit movements that could put tension on either site.
The recovery timeline varies depending on the extent of the surgery. Potential complications can include infection, issues with wound healing, or partial or complete flap failure if blood flow is compromised. At the donor site, patients may experience scarring, numbness on the outer thigh, or asymmetry. Physical therapy may be recommended to help restore function and mobility.