Morbidity Associated with Autologous Fascia Lata Harvesting for Pelvic Floor Surgery.

Abstract

<h4>Introduction and hypothesis</h4>Fascia lata (FL) is an alternative to mesh for pubovaginal sling (PVS) or abdominal sacrocolpopexy/hysteropexy (ASC). Literature on perioperative complications is sparse. We aim to evaluate the morbidity associated with the FL harvest for treatment of female pelvic floor dysfunction.<h4>Methods</h4>Women undergoing FL harvest Feb 2021-May 2025 at a surgeon's private practice and tertiary public hospital. The same harvest technique was used, with graft size depending on the indication (mean size ASC; 13 × 4 cm; PVS 10 × 2 cm). Thigh issues were ascertained by direct questioning and serial follow-up.<h4>Results</h4>Two hundred and one women had FL harvesting, with median follow-up of 12 months (range 3-67). Median age 66 years (range 35-81) and mean BMI 27.7 kg/m² (SD 4.4). There were no intra-operative complications of the harvesting. Immediate postoperative complications included one thigh haematoma (ASC) requiring blood transfusion and drainage. At 6 weeks, 64 women (32%) reported 'any' thigh issue, with pain/discomfort the most common (n = 33, 17%). Intervention was rare; two with seroma had aspiration attempted but nothing drained, and five required occasional simple analgesia. At median follow-up of 12 months (range 3-67), 28 (17%) reported 'any' thigh issue on direct questioning. The majority were cosmetic (n = 14, 8%) followed by non-bothersome paresthesia (n = 7, 4%) and discomfort (n = 9, 5%). Two underwent hernia repair with a biological graft. Prospective follow-up of ASC harvest saw thigh issues decline over time. Cosmetic defect was the most common remaining complaint on questioning at 12 months (n = 18, 24%).<h4>Conclusions</h4>Most concerns were minor and required no intervention. No functional deficits were reported and complaints decreased over time.