Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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262 Surgery and Healing in the Developing World
6. Deep absorbable sutures joining the flap to the surrounding vaginal wall
must all be preplaced. When they have all been are tied, the flap will
gently overlie the vesicovaginal fistula repair or widen and extend the
vagina.
7. Twice a day perineal care is given. The patients usually have a catheter
draining for 2 weeks before being ready to go home.
Tensor Fascia Lata Myocutaneus Flap (Figs. 39A,B)
This flap is located on the lateral aspect of the thigh. Its length can extend from
the greater trochanter to three-fourths the distance to the knee joint. The vessel
supplying this muscle comes in anteriorly about 4 cm below the greater trochanter
and 10 cm below the inguinal ligament.
It is very helpful in relieving burn scar contractures located in the inguinal region
as well as replacing sections of the lower abdominal wall.
1. The flap is elevated starting distally and inferiorly. It includes the tensor
fascia lata with the skin and subcutaneous tissues.
2. The plane of dissection is very easily developed immediately beneath the
tensor fascia lata and includes its muscle belly.
3. The donor site can be closed primarily with interrupted nonabsorbable
mattress sutures.
Figure 39A. Elevated left tensor fascia lata myocutaneus flap. Donor area will be closed
primarily.
Figure 39B. Reconstruction using a right rectus
femoris and left tensor fascia lata myocutaneus
flap.