Tensor fascia lata musculocutaneous flap for trochanteric pressure ulcer coverage

The tensor fascia lata (TFL) flap has been successfully used for decades for coverage of hip defects, particularly trochanteric pressure sores. Flap can also be employed to reconstruct defects within the groin, gluteal, ischial, and lower abdominal regions. Flap may be designed as a pedicled or free flap, depending on the region requiring coverage. Flap has a predictable, consistent vascular pedicle based on the transverse branch of the lateral femoral circumflex artery. Several design modifications have been described to avoid dog-ear creation during rotation. These include V-Y advancement and hatchet-shaped flap. In this section, we will describe the tensor fascia lata V-Y musculocutaneous flap for coverage of trochanteric pressure ulcer. Flap is elevated, advanced, and rotated posterior-superior into the defect. Donor site can often be closed primarily. Otherwise, a split thickness graft is used. Favorable outcomes can be achieved with appropriate technique and post-operative care with special attention to wound care, pressure off-loading, and optimization of nutrition and physical rehabilitation.