In the lateral aspect of the thigh the fascia lata is markedly thickened to form the iliotibial tract, receiving into its upper part the insertions of glu-teus maximus behind and tensor fasciae latae further forward. As the tract passes distally it overlies vastus lateralis but there is no attach-ment between the two structures.
Although the fascia lata encircles the thigh the thickening which constitutes the iliotibial tract virtually ceases along a line dropped vertically from the anterior superior iliac spine. The tensor fasciae latae muscle is perfused in its lowest part from the ascending branches of the lateral femoral circumflex vessels which reach it about the level of the pubic tubercle. This supply appears to extend into the upper two-thirds of the iliotibial tract.
The tensor fasciae latae myocutaneous flap is
designed on the lateral aspect of the thigh with its base superior, and makes use of the iliotibial tract as its ‘muscular’ element. Its anterior bor-der runs vertically along a line brought just lateral to the anterior superior iliac spine in order to avoid the lateral cutaneous nerve of thigh. Its posterior border approximates to the line running down from the greater trochanter.
The length of the flap is determined by the geometry of the transfer but it can safely extend to the junc-tion between the upper two-thirds and the lower third of the thigh. The flap is technically easy to raise because the plane between the tract and vastus lateralis is so well defined and avascular. It can be raised proximally to the level of the pubic tubercle.
Its usual use is as a transposed flap, moved posteriorly to cover a defect of
trochanter and/or ischium. The secondary defect is split skin grafted as a rule.