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

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.