Use of tensor fascia lata flap for reconstruction of the defect created following inguinal block dissection in a case of carcinoma penis: a case report and brief review of literature

Abstract

Tensor fascia lata (TFL) flap is a versatile myofasciocutaneous flap. It has varied usages as both free and pedicled flap. As a pedicled flap, it is a good option for reconstructing soft tissue defects after tumor ablation. The TFL perforator flap is a good alternative for anterolateral thigh (ALT) flap. The advantages of TFL flap are that dissection can be made through the same incision, without impairment of other donor sites. The reconstructive plan remains same as that of ALT flap. TFL flap offers a good volume of skin and can be made thin removing variable portions of muscle. The present case is a 63-year-old patient with a carcinoma penis who underwent left ilioinguinal block dissection resulting in a defect of 8 cm × 8 cm in the left inguinal region. TFL flap was raised with U-shaped incision and used for closure of the defect with good result.

Tensor Fascia Lata Flap for Large Inguinal Defects After Block Dissection for Carcinoma Penis

“…of cases with flap necrosis-(>5mm) 00 Seroma formation-(>50 ml) 02 Average hospital stay (in days) 15 Avg PO day from which RT started 28 Post-operative lymphoedema 04 Radionecrosis of flap 3 wks after RT 00` Table 1: Post-Operative Evaluation DISCUSSION: Carcinoma penis in its advanced form is still a common occurrence in developing countries probably due to lack of screening methods and ignorance. 4,1 They have to be treated only by surgery for fear of infiltration of femoral vessels and ineffectiveness of RT if they are fungating. 1,3 Block dissection for these lymph nodes leaves large raw areas which heal very slowly.…”

“…4,1 They have to be treated only by surgery for fear of infiltration of femoral vessels and ineffectiveness of RT if they are fungating. 1,3 Block dissection for these lymph nodes leaves large raw areas which heal very slowly. Primary coverage in such wounds is mandatory as post-operative Radiotherapy is needed to prevent recurrence.…”

“…Carcinoma penis with fungating inguinal secondaries is still seen in India and third world countries. 1,2,3 Surgery in the form of emasculation and inguinal block dissection is the primary treatment which has to be followed by irradiation. The main problem of inguinal block dissection in this scenario is large inguinal defect and difficulty in covering it .skin grafting has the disadvantage of radionecrosis and longer time for wound healing.…”

“…Flap closure has the advantage of giving good protection to femoral vessels, bringing well vascularised tissue to the region, lesser hospital stay and early referral to RT. 1,3 The options available are TRAM flap, ALT flap and rectus femoris flap, but each has got its own disadvantages apart from needing surgical expertise.…”

“…In this setting pedicled Tensor fascia lata flap is a versatile, simple, reliable and less time consuming flap with added advantage of inconsequential muscle weakness. 4,1,3 More over the donor site is in an inconspicuous area which is esthetically better. 4 Tensor fascia lata flap is first used by Wangensteen in 1934 and was latter popularized by Nahai et al 3 It is well vascularized and doesn't need much microsurgical expertise.…”