Tensor Fasciae Latae (TFL) Flap
The TFL flap is a Type I musculocutaneous flap (Mathes & Nahai — single dominant vascular pedicle) based on the ascending branch of the lateral circumflex femoral artery (LCFA). It harvests the TFL muscle, overlying fascia lata, and anterolateral-thigh skin as a composite unit. First described by Nahai, Hill & Vasconez (1978), it is one of the 11 recommended procedures in the Höckel algorithm for vulvovaginal reconstruction and is designated first choice when the soft-tissue defect includes the inguinal region.[1][2]
For the broader GU-reconstruction flap menu see Flaps for GU Reconstruction. For related lateral-thigh flap pages see Anterolateral Thigh (LCFA descending branch) and Vastus Lateralis; for the perforator family see SCIP / perforator flap.
Historical Milestones
| Year | Author | Contribution |
|---|---|---|
| 1978 | Hill / Nahai / Vasconez[3] | First TFL myocutaneous free flap (chronic stasis ulcer of the lower leg) |
| 1978 | Nahai / Silverton / Hill / Vasconez[2] | Landmark TFL musculocutaneous-flap description — anatomic / vascular basis; 21 patients; extended safely to within 8 cm of the knee |
| 1979 | Nahai / Hill / Hester[4] | 60-flap series defining arcs of rotation; groin / abdominal wall / free transfers; first osteomyocutaneous sensory TFL flap (heel) |
| 1980 | Withers et al.[5] | Confirmed "exceedingly reliable" pedicle; flap of choice for trochanteric pressure sores |
| 1982 | Temple & Ketcham[6] | Bilateral extended TFLs (10 × 40 cm) rotated posteriorly for a 15 × 30 cm perineal defect post-exenteration |
| 1989 | Paletta et al.[7] | V-Y TFL design — best-vascularized portion advanced; avoids dog-ear |
| 1993 | Medot & Fissette[8] | Transverse TFL flap on the constant posterior transverse branch — 20 × 18 cm |
| 1996 | Safak et al.[9] | Subcutaneous-pedicle TFL — 360° arc of rotation; sensate; reaches pelvic / perineal defects |
| 1998 | Erçöçen et al.[10] | Island V-Y TFL fasciocutaneous flap (dual pedicle: LCFA descending branch + 3rd profunda perforator) |
| 2001 | Koshima et al.[11] | First free TFL perforator flap — no muscle; minimal donor morbidity |
| 2002 | Gosain et al.[12] | Three-zone vascular model — distal skin unreliable 8–10 cm above the knee |
| 2006 | Bulstrode et al.[13] | Largest free TFL series (n = 85) — 93% overall success |
| 2008 | Höckel & Dornhöfer[1] | Listed as one of the 11 vulvovaginal-reconstruction procedures; first choice for inguinal-region defects |
| 2009 | Hubmer et al.[14] | Definitive TFL perforator-flap anatomy — 45 thighs; septocutaneous and musculocutaneous perforator characterization |
| 2018 | Powers et al.[15] | First CTA-based perforator anatomy — 59 thighs; mean 2.5 perforators / TFL |
| 2024 | Gandolfi et al.[16] | Accessory vascularization via SCIA / IGA anastomoses — TFL harvest possible even after LCFA injury |
Muscle Anatomy
| Feature | Detail |
|---|---|
| Origin | Outer lip of the iliac crest between the ASIS and the iliac tubercle; encapsulated within fascia lata, no distal bony attachment[17][18] |
| Insertion | Into the iliotibial band, which inserts distally on Gerdy's tubercle of the lateral tibial condyle[17] |
| Volume | ~1.8 ± 0.8 cm³ (small fusiform muscle vs gluteus medius 27.6 cm³, gluteus minimus 14.1 cm³)[17] |
| Length | ~15 cm (ASIS to musculotendinous junction) |
| Width | ~5–7 cm at widest |
| Innervation | Superior gluteal nerve (L4-S1) — homogeneous (no differential compartments)[17] |
Function
- Hip flexion (anteromedial fibers).[19]
- Hip abduction — minor contribution; induced TFL weakness reduces abduction force by only 15% at 30° hip flexion and has no effect in neutral or extension.[20]
- Hip internal rotation (posterolateral fibers).
- Knee stabilization via tension on the iliotibial band.
- Primary functional role: balancing the body weight and non-weight-bearing leg during walking.[21]
Functional consequence of TFL harvest is minimal in most patients.
Vascular Anatomy
LCFA branching patterns (Palackic 2021, 102 lower limbs)[22]
The LCFA arises from the deep femoral (profunda) artery in most cases (occasionally directly from the femoral artery) and shows highly variable branching — 11 trunk variations identified:
| Group | Branches | Frequency |
|---|---|---|
| A | 3 branches | 49% |
| B | 4 branches | 40% |
| C | 5 branches | 5% |
| D | 2 branches | 6% |
Branches are typically: ascending (supplies TFL), transverse, oblique, and descending (supplies ALT territory).
DSA-based morphology (Yang 2023, n = 113)[23]
LCFA usually routinely sends four main branches (ascending, transverse, oblique, descending). The ascending branch courses ~45° upward and outward from the horizontal axis.
Accessory vascularization (Gandolfi 2024, 7 cadaveric injections)[16]
The TFL has anastomotic perforasome connections with:
- Superficial circumflex iliac artery (SCIA) — confirmed in 6/7 injections.
- Inferior gluteal artery (IGA) — confirmed in 3/7 injections.
These collateral networks enable TFL harvest even when the LCFA is injured.
Perforator anatomy — Hubmer 2009 (definitive cadaveric study, n = 45 thighs)[14]
| Parameter | Musculocutaneous | Septocutaneous |
|---|---|---|
| Average number / TFL | 2.3 (range 0–5) | 1.8 (range 1–3) |
| Distance from ASIS | 10.9 cm (4.5–16.1) | 10.9 cm (6.2–15.7) |
| Diameter | 0.9 mm (0.2–2) | 1.5 mm (0.5–3) |
| Consistency | Absent in 4/45 (9%) | Present in all |
| Concentration | Variable | 76% between 8–12 cm from ASIS |
| Pedicle length | — | 8.1 cm (6.5–10) |
Septocutaneous perforators are more constant, larger, and more reliably located than the musculocutaneous perforators. All perforators arise from the ascending branch of the LCFA.
Skin territory (Hubmer 2009 injection)[14]
- Ascending-branch injection: 19.4 × 13.4 cm (range 10–24 × 7–17 cm).
- Selective perforator injection: 19.2 × 13.7 cm — no significant difference, confirming perforators alone support the full skin territory.
CTA-based anatomy — Powers 2018 (n = 59 thighs)[15]
- Average 2.5 perforators / TFL (all from the ascending branch).
- 66% septocutaneous, 34% musculocutaneous.
- Perforator size on CTA: 3 mm average.
- Pedicle length: 8.3 cm (range 6.0–11.2).
- Perforator location: 10.1 cm inferior, 8.5 cm lateral to the ASIS-to-superolateral-patella line.
Extended-flap three-zone model (Gosain 2002, n = 10 cadavers)[12]
| Zone | Source artery | Reliability |
|---|---|---|
| Proximal | LCFA ascending branch via musculocutaneous perforators | Reliable |
| Middle | Third perforating artery of profunda femoris | Less reliable |
| Distal | Superior lateral genicular artery (popliteal branch) | Unreliable |
Middle and distal zones meet 8–10 cm above the knee — the skin paddle becomes unreliable here without a delay procedure or an additional anastomosis to the superior lateral genicular artery.
Transverse-TFL anatomy (Medot & Fissette 1993, 20 cadavers)[8]
- LCFA divides into 3 terminal branches as it enters the TFL.
- Posterior transverse branch is constant — making the transverse TFL flap highly reliable.
- Descending branch (basis of the longitudinal / extended TFL) absent in 5/20 (25%).
- LCFA also supplies 1–2 ascending iliac-crest periosteal branches — basis for a potential osteomyocutaneous TFL + iliac crest flap.
Sensory innervation
- Lateral femoral cutaneous nerve (L2-3) — overlying anterolateral-thigh skin.
- Sensation can be partly retained when the LFCN is integrated into the flap; sensory projection to the donor site may persist for ≥ 2 years.[1]
Flap Variants
| Variant | Pedicle / design | Skin island | Key feature | Indication |
|---|---|---|---|---|
| Standard TFL MC | Pedicled transposition / rotation | Over the TFL muscle (~15 × 8 cm) | Muscle + fascia lata + skin composite | Trochanteric sores, groin, perineum[2] |
| Extended TFL | Pedicled transposition | Extended distally (up to 40 × 10 cm; to within 8 cm of knee) | Distal third unreliable without delay | Large pelvic / perineal defects[2][6] |
| V-Y TFL | V-Y advancement | Over TFL muscle | Advances best-vascularized portion; avoids dog-ear | Trochanteric sores[7] |
| Island V-Y TFL fasciocutaneous | Dual pedicle (LCFA descending + 3rd profunda perforator) | Distal lateral thigh | Avoids muscle sacrifice | Trochanteric sores[10] |
| Subcutaneous-pedicle TFL | Distal skin island on iliotibial tract | Distal lateral thigh | 360° arc of rotation; subcutaneous tunneling; sensate potential | Pelvic / perineal / penile defects[9] |
| Transverse TFL | Constant posterior transverse branch | 20 × 18 cm superolateral thigh | Highly reliable | Various[8] |
| Free TFL perforator | Free; perforator-based | > 15 × 12 cm | No muscle; minimal donor morbidity | Extremity / head & neck[11] |
| Pedicled TFL perforator | Pedicled; septocutaneous perforator | ~14 × 7 cm (4.5–25 × 4.5–19) | Easy planning given perforator constancy | Groin / extremity[24] |
| Free TFL musculofasciocutaneous | Free; muscle + fascia + skin | Variable | Largest free-flap series (Bulstrode n = 85) | Head & neck, abdominal wall, lower limb[13] |
Surgical Technique — Pedicled TFL for Vulvar / Inguinal Reconstruction
Position
- Supine or lithotomy — allows access to both the anterolateral-thigh donor and the vulvar / inguinal defect.
- Ipsilateral lower extremity prepped circumferentially.
Landmarks[2][14][15]
- ASIS — proximal landmark.
- Greater trochanter — lateral landmark.
- Lateral femoral condyle / superolateral patella — distal landmark.
- ASIS-to-superolateral-patella line — the TFL lies along its proximal portion.
- Perforator hot spot: 8–12 cm from the ASIS along the ASIS-to-greater-trochanter line (76% of septocutaneous perforators).
Design
| Design | Skin paddle |
|---|---|
| Standard | ~15 × 8 cm over the TFL muscle |
| Extended | Up to 40 × 10 cm, distally along the iliotibial band to within 8 cm of the knee |
| V-Y / transposition / rotation / island | As required by defect |
Elevation[2][5]
- Distal incision first — elevate distal-to-proximal.
- Subfascial plane — deep to fascia lata; harvest TFL muscle + fascia lata + subcutaneous tissue + skin as composite.
- Identify the pedicle — ascending LCFA enters the deep TFL surface ~8–10 cm below the ASIS.
- Preserve the pedicle as the flap is elevated proximally.
- Motor-nerve choice — superior-gluteal-nerve branch can be preserved or sacrificed depending on flap design.
- Distal extension — fascia lata and overlying skin extended distally; distal skin supplied by terminal musculocutaneous perforators.[2]
Transfer
- Arc of rotation: pivot at the vascular-pedicle entry (~8–10 cm below ASIS). The flap reaches the groin, perineum, lower abdomen, trochanter, ischium, and sacrum.[2][4]
- For vulvar / inguinal defects: rotate anteromedially.
- Subcutaneous-pedicle variant: 360° arc of rotation via subcutaneous tunneling.[9]
Donor closure
- Primary closure for flap widths up to ~8–10 cm.
- Wider flaps require split-thickness skin graft.
- Donor scar on the lateral thigh — visible but concealable by clothing.
Applications
Trochanteric pressure sores
Flap of choice — proximity to the donor, reliable pedicle, fascia-lata padding.[5][7][10]
Groin reconstruction after inguinal / ilioinguinal lymphadenectomy
Nirmal 2011 (n = 25, primary closure vs TFL flap after groin dissection):[25]
| Outcome | Primary closure (28 groins) | TFL flap (20 groins) | p |
|---|---|---|---|
| Wound infection | 14% | 5% | 0.38 |
| Major flap necrosis | 25% | 0% | 0.01 |
| Minor flap necrosis | 25% | 15% | — |
| Necrosis after ilioinguinal dissection | 75% | 17% | 0.001 |
| Seroma | 18% | 15% | 1.0 |
| Hospital stay | 20 ± 14 d | 16 ± 3 d | — |
Conclusion: prophylactic TFL flap reconstruction is advisable following ilioinguinal dissections.
Agarwal 2009 (n = 15 inguinal block dissection for malignancy):[26]
- Satisfactory healing in all 15 cases.
- Complications: 2 marginal necroses, 3 lymphedemas, 2 infections, 3 minor STSG losses at donor.
- No regional recurrence.
Saito 2014 (n = 15 oncology patients across multiple defect sites):[27]
- 60% overall complications (distal necrosis 33%, ventral hernia 11% in abdominal-wall recon cases).
- No total flap loss.
Vulvar / perineal reconstruction
| Series | Detail |
|---|---|
| Höckel & Dornhöfer 2008[1] | First-choice flap when the soft-tissue defect includes the inguinal region; one of the 11 vulvovaginal-reconstruction procedures |
| Temple & Ketcham 1982[6] | Bilateral extended TFL (10 × 40 cm each) for a 15 × 30 cm perineal defect post-exenteration; flaps delayed 2 wk preoperatively |
| Withers 1980[5] | 11 TFL musculocutaneous flaps in 9 patients — exceedingly reliable; groin / perineum / abdominal wall / lower chest wall |
| Safak 1996 (subcutaneous-pedicle TFL)[9] | Sensate, thin, durable fascia, extensive reach with 360° rotation arc — pelvic / perineal / penile reconstruction |
Rationale for inguinal-region vulvar defects: simultaneous coverage of (1) vulvar defect, (2) vascularized tissue over femoral vessels in the groin, (3) inguinal dead-space obliteration, (4) well-vascularized tissue into a potentially irradiated field.
Other reconstructive applications
| Application | Detail |
|---|---|
| Head & neck oncologic defects | Hodea 2026 (n = 20) — 95% success; TFL perforator flap as ALT alternative when ALT perforators absent / inadequate[28] |
| Abdominal-wall reconstruction | Bulstrode series; ventral-hernia risk noted (Saito)[13][27] |
| Lower-limb reconstruction | Trochanteric, knee defects, distal-extremity coverage[3][5] |
| Free TFL musculofasciocutaneous | Bulstrode 2006 — n = 85; 93% success, 5% partial loss, 2% total failure[13] |
Outcomes Summary
| Study | n | Indication | Flap | Success | Notable findings |
|---|---|---|---|---|---|
| Nahai 1978[2] | 21 | Various | Pedicled MC | High | First description; reliable pedicle |
| Nahai 1979[4] | 60 | Various | Pedicled + free | High | Expanded experience; rotation arcs defined |
| Withers 1980[5] | 9 pts / 11 flaps | Pressure sores / groin / perineum | Pedicled MC | Exceedingly reliable | Flap of choice for trochanteric sores |
| Temple & Ketcham 1982[6] | 1 | 15 × 30 cm perineal defect | Bilateral extended (10 × 40 cm each) | 100% (with delay) | Largest reported perineal coverage |
| Bulstrode 2006[13] | 85 | H&N / abdo wall / lower limb | Free MFC | 93% | Largest free TFL series; 75% reoperation-salvage |
| Agarwal 2009[26] | 15 | Groin malignancy (inguinal block) | Pedicled | 100% healing | Easy, predictable |
| Nirmal 2011[25] | 11 pts / 20 groins | Post-groin-dissection | Pedicled | 83% no necrosis | TFL superior to primary closure (p = 0.01) |
| Hubmer 2011[24] | 17 | Various | Pedicled perforator | High | Septocutaneous perforator constancy makes planning straightforward |
| Saito 2014[27] | 15 | Oncology, multiple sites | Pedicled | No total loss | 33% distal necrosis; 11% ventral hernia |
| Hodea 2026[28] | 20 | Head & neck | Free perforator | 95% | ALT-alternative when ALT perforators inadequate |
Advantages
| Advantage | Detail |
|---|---|
| Reliable axial pedicle | Ascending LCFA branch with septocutaneous perforators present in 100% of dissections[14] |
| Large skin paddle | Up to 19 × 13 cm standard; extendable to 40 × 10 cm (with delay) |
| Versatile design | Standard MC / extended / V-Y / island / transverse / subcutaneous-pedicle / perforator (pedicled or free) |
| 360° arc of rotation | With subcutaneous-pedicle variant[9] |
| Composite tissue | Muscle + fascia lata + skin in a single elevation |
| Fascia lata structural component | Useful for abdominal-wall or pelvic-floor reconstruction |
| Sensate potential | LFCN can be incorporated[1] |
| Minimal functional deficit | TFL contributes only ~15% to hip abduction at 30° flexion[20] |
| Accessory vascularization | SCIA / IGA collaterals enable harvest even after LCFA injury[16] |
| Demonstrated efficacy after ilioinguinal LND | Prophylactic TFL flap reduces flap necrosis (75% → 17%; p = 0.001)[25] |
| First-choice for inguinal-region vulvar defects | Per Höckel algorithm[1] |
Limitations
| Limitation | Detail |
|---|---|
| Distal-skin unreliability | Skin paddle unreliable 8–10 cm above the knee without delay or additional anastomosis[12] |
| Donor-site contour | Visible lateral-thigh scar; STSG required when width > 8–10 cm |
| Variable LCFA branching | 11 trunk variations; descending branch absent in 25% (transverse-TFL anatomy)[8][22] |
| Donor-site complications | Distal necrosis 33% in mixed-site oncology series (Saito); ventral hernia 11% in abdominal-wall recon[27] |
| Sensory projection to donor | LFCN-included flap may have persistent sensory projection to donor for ≥ 2 y[1] |
| Not ideal for hairless / mucosal subunits | Hair-bearing anterolateral-thigh skin |
| Cannot reach midline above umbilicus | Pedicled arc of rotation limits anterior abdominal-wall extension |
Position in Vulvar Reconstructive Algorithms
| Algorithm | Position |
|---|---|
| Höckel 2008[1] | First-choice flap when defect includes the inguinal region; one of the 11 vulvovaginal-reconstruction procedures |
| Salgarello 2005 | Reserved for very large / extended defects when V-Y / lotus / pudendal-thigh are inadequate |
| Toulouse 2025 | Perforator flaps first-line; TFL perforator variant could serve when an ALT alternative is needed |
See Also
- Anterolateral Thigh (ALT) Flap — LCFA descending-branch sibling
- Vastus Lateralis Flap — adjacent LCFA-based muscle flap
- SCIP / perforator flap — broader perforator-flap framework
- Vulvar Reconstruction Atlas
- Flaps for GU Reconstruction
References
1. Höckel M, Dornhöfer N. Vulvovaginal reconstruction for neoplastic disease. Lancet Oncol. 2008;9(6):559–568. doi:10.1016/S1470-2045(08)70147-5
2. Nahai F, Silverton JS, Hill HL, Vasconez LO. The tensor fascia lata musculocutaneous flap. Ann Plast Surg. 1978;1(4):372–379. doi:10.1097/00000637-197807000-00003
3. Hill HL, Nahai F, Vasconez LO. The tensor fascia lata myocutaneous free flap. Plast Reconstr Surg. 1978;61(4):517–522. doi:10.1097/00006534-197804000-00004
4. Nahai F, Hill L, Hester TR. Experiences with the tensor fascia lata flap. Plast Reconstr Surg. 1979;63(6):788–799.
5. Withers EH, Franklin JD, Madden JJ, Lynch JB. Further experience with the tensor fascia lata musculocutaneous flap. Ann Plast Surg. 1980;4(1):31–36.
6. Temple WJ, Ketcham AS. The closure of large pelvic defects by extended compound tensor fascia lata and inferior gluteal myocutaneous flaps. Am J Clin Oncol. 1982;5(6):573–577. doi:10.1097/00000421-198212000-00003
7. Paletta CE, Freedman B, Shehadi SI. The VY tensor fasciae latae musculocutaneous flap. Plast Reconstr Surg. 1989;83(5):852–857. doi:10.1097/00006534-198905000-00012
8. Medot M, Fissette J. The cutaneous territory of the transverse tensor fascia lata flap: further anatomical considerations. Surg Radiol Anat. 1993;15(4):255–258. doi:10.1007/BF01627874
9. Safak T, Klebuc MJ, Keçik A, Shenaq SM. The subcutaneous pedicle tensor fascia lata flap. Plast Reconstr Surg. 1996;97(4):765–774. doi:10.1097/00006534-199604000-00012
10. Erçöçen AR, Apaydin I, Emiroğlu M, et al. Island V-Y tensor fasciae latae fasciocutaneous flap for coverage of trochanteric pressure sores. Plast Reconstr Surg. 1998;102(5):1524–1531. doi:10.1097/00006534-199810000-00027
11. Koshima I, Urushibara K, Inagawa K, Moriguchi T. Free tensor fasciae latae perforator flap for the reconstruction of defects in the extremities. Plast Reconstr Surg. 2001;107(7):1759–1765. doi:10.1097/00006534-200106000-00018
12. Gosain AK, Yan JG, Aydin MA, Das DK, Sanger JR. The vascular supply of the extended tensor fasciae latae flap: how far can the skin paddle extend? Plast Reconstr Surg. 2002;110(7):1655–1661. doi:10.1097/01.PRS.0000033023.09635.B4
13. Bulstrode NW, Kotronakis I, Baldwin MA. Free tensor fasciae latae musculofasciocutaneous flap in reconstructive surgery: a series of 85 cases. J Plast Reconstr Aesthet Surg. 2006;59(2):130–136. doi:10.1016/j.bjps.2005.04.038
14. Hubmer MG, Schwaiger N, Windisch G, et al. The vascular anatomy of the tensor fasciae latae perforator flap. Plast Reconstr Surg. 2009;124(1):181–189. doi:10.1097/PRS.0b013e3181ab114c
15. Powers JM, Martinez M, Zhang S, Kale SS. A description of the vascular anatomy of the tensor fascia lata perforator flap using computed tomography angiography. Ann Plast Surg. 2018;80(6S Suppl 6):S421–S425. doi:10.1097/SAP.0000000000001424
16. Gandolfi S, Chaput B, Berkane Y, Lupon E, Karra A. The accessory vascularization of the tensor fasciae latae muscle: towards a new classification? Surg Radiol Anat. 2024;46(6):725–731. doi:10.1007/s00276-024-03343-8
17. Flack NA, Nicholson HD, Woodley SJ. The anatomy of the hip abductor muscles. Clin Anat. 2014;27(2):241–253. doi:10.1002/ca.22248
18. Flack NA, Nicholson HD, Woodley SJ. A review of the anatomy of the hip abductor muscles, gluteus medius, gluteus minimus, and tensor fascia lata. Clin Anat. 2012;25(6):697–708. doi:10.1002/ca.22004
19. Paré EB, Stern JT, Schwartz JM. Functional differentiation within the tensor fasciae latae. A telemetered electromyographic analysis of its locomotor roles. J Bone Joint Surg Am. 1981;63(9):1457–1471.
20. Hoch A, Dimitriou D, Wolf-Wettstein J, et al. Tensor fasciae latae and gluteus maximus muscles: do they contribute to hip abduction? J Orthop Res. 2025;43(4):828–833. doi:10.1002/jor.26036
21. Gottschalk F, Kourosh S, Leveau B. The functional anatomy of tensor fasciae latae and gluteus medius and minimus. J Anat. 1989;166:179–189.
22. Palackic A, Skias C, Winter R, et al. Terminology of the branches of the lateral circumflex femoral artery: who is who? J Anat. 2021;239(6):1465–1472. doi:10.1111/joa.13507
23. Yang L, Cheng J, Liu Z, et al. Morphological study of branches of lateral femoral circumflex artery based on digital subtraction angiography. J Plast Reconstr Aesthet Surg. 2023;80:18–24. doi:10.1016/j.bjps.2022.08.075
24. Hubmer MG, Justich I, Haas FM, et al. Clinical experience with a tensor fasciae latae perforator flap based on septocutaneous perforators. J Plast Reconstr Aesthet Surg. 2011;64(6):782–789. doi:10.1016/j.bjps.2010.11.002
25. Nirmal TJ, Gupta AK, Kumar S, et al. Tensor fascia lata flap reconstruction following groin dissection: is it worthwhile? World J Urol. 2011;29(4):555–559. doi:10.1007/s00345-011-0706-z
26. Agarwal AK, Gupta S, Bhattacharya N, Guha G, Agarwal A. Tensor fascia lata flap reconstruction in groin malignancy. Singapore Med J. 2009;50(8):781–784.
27. Saito A, Minakawa H, Saito N, et al. Clinical experience using a tensor fascia lata flap in oncology patients. Surg Today. 2014;44(8):1438–1442. doi:10.1007/s00595-013-0733-z
28. Hodea FV, Chen WY, Huang CH, et al. Free tensor fascia lata perforator flap: an alternative lateral thigh-based option for head and neck oncologic defect reconstruction. Microsurgery. 2026;46(3):e70208. doi:10.1002/micr.70208