title: Direct fascia lata reconstruction to reduce donor site morbidity in endoscopic endonasal extended surgery: a pilot study.
abstract: OBJECTIVE
  Fascia lata is a validated source of autologous grafts, adopted by many surgical figures throughout different types of reconstructive procedures. Postoperative pain and muscle prolapse are frequent complications after harvesting fascia lata; donor site morbidity causes delayed mobilization and increased lenght of hospital stay. In our department fascia lata is used as autologous graft in reconstruction of skull base after extended endoscopic transsphenoidal surgery (EETS) and the thigh defect is usually repaired with allograft to restore tissue continuity and avoid muscle prolapse. Our aim was to evaluate the post-operative pain and muscle prolapse in a group of patients who underwent EETS with fascia lata reconstruction with allograft.
  
  
  METHODS
  We retrospectively analyzed clinical data of 11 patients who underwent harvesting and reconstruction of fascia lata during EETS, collected in our department of Neurosurgery between January 2012 and September 2015. "Pain on rest" and "pain on walking" data were collected daily according to the Numerical Rating Scale (NRS) system, during hospital stay until sutures removal and 1 month after surgery. Furthermore, the degree of muscle prolapse was analyzed at the time of sutures removal and 1 month following surgery.
  
  
  RESULTS
  11 patients were studied between January 2012 and September 2015: 4 men and 7 women (1:1.75). Mean age 53.6±11.1years. During the post-operative stay, "pain on rest" and "pain on walking" values of all patients did not exceed grade 4 of NRS. While removing sutures, "pain on rest" resulted grade 1 of NRS in 27.3% (3/11) patients, while "pain on walking" was grade 1 of NRS in 18.2% (2/11) and grade 2 in 9.1% (1/11). After a month of surgery "pain on rest" reduced to NRS grade 1 in 9.1% (1/11), while patients NRS results for "pain on walking" were the same as the previous evaluation. Mean duration of hospital stay was 5.7±2.28 days. 10 patients were discharged home, only 1 patient was transferred to a rehabilitation ward. No visible nor palpable muscle prolapse was found in our group of patients during the entire assessment.
  
  
  CONCLUSIONS
  Findings show how fascia lata reconstruction with allograft reduced post-operative discomfort and muscle prolapse in our serie; it also permitted their early mobilization and discharge. These are promising results. However further studies are needed to see this technique approved.
authors.affiliation: Surgical Department, Neurosurgical Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Via Venezia 16, 15121 Alessandria, Italy. Electronic address: mat.vitali@virgilio.it.
authors.forename: Matteo
authors.initials: M
authors.lastname: Vitali
authors.affiliation: Department of Otorhinolaryngology, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Via Venezia 16, 15121 Alessandria, Italy.
authors.forename: Frank Rikki
authors.initials: FR
authors.lastname: Canevari
authors.affiliation: Surgical Department, Neurosurgical Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Via Venezia 16, 15121 Alessandria, Italy; Department of Clinical Surgical, Diagnostic and Pediatric Sciences, Neurosurgery, Università degli Studi di Pavia, Viale Golgi 19, 27100 Pavia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cattalani
authors.affiliation: Surgical Department, Neurosurgical Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Via Venezia 16, 15121 Alessandria, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Grasso
authors.affiliation: Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery-Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Somma
authors.affiliation: Surgical Department, Neurosurgical Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Via Venezia 16, 15121 Alessandria, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Barbanera
mesh_terms: D000328:Adult; D005206:Fascia Lata / Q000637:transplantation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D010865:Pilot Projects; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D060053:Transplant Donor Site / Q000473:pathology
keywords: CSF leak; Donor site morbidity; Extended endoscopic endonasal approach; Fascia lata graft; Postoperative pain; Skull base reconstruction