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Autologous Fascia Lata

Autologous fascia lata — the deep fascia of the thigh — is a robust native-tissue graft with broad reconstructive-urology applications: pubovaginal sling, sacrocolpopexy, Peyronie's grafting, corporal reconstruction, pediatric bladder-neck slings, and urethral fistula repair. It is the primary alternative to autologous rectus fascia, often preferred when a longer or wider graft is needed.[1][5]

Anatomy & Biomechanics​

The fascia lata is the deep thigh fascia, with contributions from the gluteal aponeurotic fascia posteriorly and the iliotibial band (ITB) laterally — the ITB is the lateral thickening, with proximal origin at TFL / gluteus maximus and distal insertion at Gerdy's tubercle.[1][2]

  • High tensile strength and stiffness; site-dependent elasticity — stiffer proximally, more compliant distally.[3]
  • Tensile testing: comparable maximum load to failure and stiffness to autologous rectus fascia.[4]

Harvest Technique​

  • Open harvest — 3–4 inch lateral upper-thigh incision; direct harvest. Graft size varies by indication: 10 × 2 cm for PVS; 13–18 × 4–5 cm for sacrocolpopexy.[5][6]
  • Fascial stripper (Crawford stripper) — small incision + specialized stripper to harvest a long, narrow strip. Used for sling procedures with minimal postoperative morbidity.[7]
  • Close the fascial defect primarily where feasible; skin closure with compression dressing.

Why Fascia Lata Over Rectus​

  • Longer / wider strips available (up to 18 × 5 cm).
  • Prior abdominal surgery or hernia repair that compromises the rectus.
  • Obese patient where rectus exposure is difficult.
  • Concurrent pelvic procedure without abdominal access (e.g., vaginal-only sling case).
  • Pediatric patients where rectus harvest in small anatomy is challenging.

Pubovaginal Sling for Female SUI​

Established alternative to rectus fascia. Long fascial strip (typically 24–28 × 2 cm) harvested and passed retropubically beneath the bladder neck or midurethra.[8]

StudynFollow-upOutcome
Latini 20041004.4 yr mean85% dry or improved; 77% satisfied; 83% would repeat.[9]
Brown / Govier 20004644 mo mean90% cure of SUI; 90% overall satisfaction.[10]
Wu NEJM 2021 review——Fascia lata acceptable alternative to rectus fascia with similar cure rates.[11]
Nair 17-yr RCT (short vs standard autologous fascial slings)—17 yrDurable improvement in bladder function; 67.2% patient satisfaction; low reoperation.[12]
Shaw 2022 midurethral fascia lata sling16ShortSignificant ISI and UDI-6 improvement; leg pain bothersome in 1 patient beyond 6 wk.[7]

Sacrocolpopexy for POP​

Fascia lata has emerged as a key autologous alternative to synthetic mesh, particularly in Australia where no approved POP mesh is currently available.[14]

Technique: a 4–5 × 15–18 cm piece is harvested and configured into a traditional Y-graft using nonabsorbable sutures for attachment to vaginal cuff and sacral promontory.[5]

StudynFollow-upOutcome
Patel 20223413 mo meanPOP symptoms resolved in all; no treatment failures; harvest-site VAS 0.4/10.[5]
Vereeck 2026 prospective cohort101≥ 6 mo85.1% PGI-I "very much better" / "much better"; significant POP-Q and APFQ improvement; Clavien-Dindo grade 3 in 5.0%.[14]
Bock 2021 robotic—Short-termRobotic SCP with fascia lata vs mesh — equivalent short-term anatomic outcomes; +~25 min for harvest; 1 mesh erosion required excision in the mesh arm.[15]

Fascia lata vs rectus fascia for POP (Matak SR): success fascia lata 83–100% vs rectus 87–100% — fascia lata allows a wider graft but has more harvest-site complications.[16]

Alao 2026 scoping review (11 studies, 311 women) across all autologous sacrocolpopexy: 75–100% success, but the literature is limited to small mostly single-arm studies without direct comparative trials against mesh.[17]

Peyronie's Disease & Penile Reconstruction​

Used as a tunical substitute graft after plaque incision. AUA Peyronie's guideline: plaque incision / excision with grafting may be offered to patients with adequate rigidity and curvature > 60°; curvature improvement generally > 80%.[18]

StudynMaterialOutcome
Kargi 200412Autologous fascia lataCurvature correction in all; normal erections; no complications at 10 mo mean.[19]
Kalsi 200614Tutoplast (processed fascia lata allograft)Complete straightening 11/14 (79%); 13/14 satisfied; 1 de novo ED.[20]
Burnett 1997 seminalCase seriesAutologous fascia lataSuccessful corporoplasty, penile prosthesis fixation, and penile elongation after ablative cancer surgery.[21]

Pediatric Bladder Neck Slings​

Used interchangeably with rectus fascia for neurogenic sphincteric incontinence:

  • Kakizaki 1995 (n = 13; 5 fascia lata): 9 continent and 3 significantly improved at 36 mo mean.[22]
  • Snodgrass 2010: Leadbetter-Mitchell bladder neck procedure + fascial sling achieved continence without pads in 82%.[23]

Urethral Fistula Repair​

Kargi 2003 pediatric series — 8 patients (mean age 8 yr) with recurrent fistulae after hypospadias repair; 2 × 2 cm fascia lata graft placed between urethra and skin → no recurrence at 11 mo mean.[24]

Donor-Site Morbidity​

The largest series specifically evaluating fascia lata harvest morbidity for pelvic floor surgery (Buckley 2026, n = 201):[6]

  • No intraoperative complications.
  • 6 wk: 32% reported "any" thigh issue (pain / discomfort most common at 17%).
  • 12 mo: 17% any thigh issue — mostly cosmetic (8%), non-bothersome paresthesia (4%), mild discomfort (5%).
  • No functional deficits; complaints decreased over time.
  • 2 (1%) required hernia repair at the harvest site.

Earlier series (Walter 2001): 40% mild symptoms, 5% clinically significant, 13% dissatisfaction (mostly cosmetic) at 25 mo mean.[25]

Johnson 2024 cosmetic / functional impact study: harvest-site bother is largely mild and decreases over time.[13]

Fascia Lata vs Rectus Fascia​

FeatureFascia LataRectus Fascia
Graft sizeLarger (up to 18 × 5 cm)Smaller (typically 12 × 2 cm)
Tensile strengthComparableComparable
Harvest siteLateral thighLower abdomen
Harvest morbidityCosmetic defect, paresthesia, thigh painHernia risk, abdominal pain
Functional deficitNone reportedRare
Avoids abdominal incisionYesNo
POP success83–100%87–100%
SUI cure85–90%75–94%

Summary​

ApplicationGraft sizeOutcome
Pubovaginal sling (SUI)10–28 × 2 cm85–90% cure; durable at 17 yr
Sacrocolpopexy (POP)13–18 × 4–5 cm85–100% success; equivalent to mesh short-term
Peyronie's graftingVariable79–100% curvature correction
Corporal reconstruction / penile lengtheningVariableSuccessful per Burnett case series
Pediatric bladder neck slingVariable69–82% continence
Urethral fistula repair2 × 2 cm100% in small series
Donor-site morbidity—17% any issue at 12 mo; no functional deficits

See also: Rectus Fascia, Polypropylene Mesh, Porcine Acellular Collagen Matrix, Raz-Pereyra Trocar.

References​

1. Hutchinson LA, Lichtwark GA, Willy RW, Kelly LA. The Iliotibial Band: A Complex Structure With Versatile Functions. Sports Medicine. 2022;52(5):995-1008. doi:10.1007/s40279-021-01634-3

2. Huang BK, Campos JC, Michael Peschka PG, et al. Injury of the Gluteal Aponeurotic Fascia and Proximal Iliotibial Band: Anatomy, Pathologic Conditions, and MR Imaging. Radiographics. 2013;33(5):1437-1452. doi:10.1148/rg.335125171

3. Otsuka S, Shan X, Yoshida K, et al. Site Dependent Elastic Property of Human Iliotibial Band and the Effect of Hip and Knee Joint Angle Configuration. Journal of Biomechanics. 2020;109:109919. doi:10.1016/j.jbiomech.2020.109919

4. Lemer ML, Chaikin DC, Blaivas JG. Tissue Strength Analysis of Autologous and Cadaveric Allografts for the Pubovaginal Sling. Neurourology and Urodynamics. 1999;18(5):497-503.

5. Patel S, Chaus FM, Funk JT, Twiss CO. Total Autologous Fascia Lata Sacrocolpopexy for Treatment of Pelvic Organ Prolapse: Experience in Thirty-Four Patients. Urology. 2022;170:73-77. doi:10.1016/j.urology.2022.08.038

6. Buckley VA, Vereeck S, Karjalainen PK, Rosamilia A. Morbidity Associated With Autologous Fascia Lata Harvesting for Pelvic Floor Surgery. International Urogynecology Journal. 2026;37(4):1049-1054. doi:10.1007/s00192-025-06421-6

7. Shaw JS, Gerjevic KA, Pollack C, Strohbehn K. Minimally Invasive Autologous Fascia Sling at the Midurethra: A Case Series. Journal of Minimally Invasive Gynecology. 2022;29(10):1165-1169. doi:10.1016/j.jmig.2022.07.001

8. Govier FE, Gibbons RP, Correa RJ, et al. Pubovaginal Slings Using Fascia Lata for the Treatment of Intrinsic Sphincter Deficiency. The Journal of Urology. 1997;157(1):117-121.

9. Latini JM, Lux MM, Kreder KJ. Efficacy and Morbidity of Autologous Fascia Lata Sling Cystourethropexy. The Journal of Urology. 2004;171(3):1180-1184. doi:10.1097/01.ju.0000111807.67599.8d

10. Brown SL, Govier FE. Cadaveric Versus Autologous Fascia Lata for the Pubovaginal Sling: Surgical Outcome and Patient Satisfaction. The Journal of Urology. 2000;164(5):1633-1637.

11. Wu JM. Stress Incontinence in Women. The New England Journal of Medicine. 2021;384(25):2428-2436. doi:10.1056/NEJMcp1914037

12. Nair DB, Khan Z, Mishra T, et al. Autologous Fascial Slings for Stress Urinary Incontinence: A 17-Year Follow-Up of a Randomised Controlled Study. International Urogynecology Journal. 2024;35(3):649-659. doi:10.1007/s00192-023-05702-2

13. Johnson C, Vollstedt A, Nakatsuka H, Orzel J, Takacs EB. Cosmetic and Functional Impact of Fascia Lata Harvest for Use in Surgery for Stress Urinary Incontinence. Neurourology and Urodynamics. 2024;43(5):1185-1191. doi:10.1002/nau.25462

14. Vereeck S, Buckley V, Rosamilia A. Short-Term Outcomes of Single-Arm Sacrocolpopexy With Autologous Fascia Lata. International Urogynecology Journal. 2026;37(4):1011-1017. doi:10.1007/s00192-025-06424-3

15. Bock ME, Nagle R, Soyster M, et al. Robotic Sacral Colpopexy Using Autologous Fascia Lata Compared With Mesh. Journal of Endourology. 2021;35(6):801-807. doi:10.1089/end.2020.0537

16. Matak L, Baekelandt J, Šimičević M, et al. Comparison Between Fascia Lata and Rectus Fascia in Treatment of Pelvic Organ Prolapse: A Systematic Review. Archives of Gynecology and Obstetrics. 2024;309(6):2395-2400. doi:10.1007/s00404-024-07531-0

17. Alao AI, Olanrewaju BO, Purwar B, Vij M. Autologous Tissue Sacrocolpopexy for Apical Pelvic Organ Prolapse: A Scoping Review. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2026;322:115130. doi:10.1016/j.ejogrb.2026.115130

18. Nehra A, Alterowitz R, Culkin DJ, et al. Peyronie's Disease: AUA Guideline. The Journal of Urology. 2015;194(3):745-753. doi:10.1016/j.juro.2015.05.098

19. Kargi E, Yeşilli C, Hoşnuter M, et al. Relaxation Incision and Fascia Lata Grafting in the Surgical Correction of Penile Curvature in Peyronie's Disease. Plastic and Reconstructive Surgery. 2004;113(1):254-259. doi:10.1097/01.PRS.0000095951.04305.38

20. Kalsi JS, Christopher N, Ralph DJ, Minhas S. Plaque Incision and Fascia Lata Grafting in the Surgical Management of Peyronie's Disease. BJU International. 2006;98(1):110-114. doi:10.1111/j.1464-410X.2006.06251.x

21. Burnett AL. Fascia Lata in Penile Reconstructive Surgery: A Reappraisal of the Fascia Lata Graft. Plastic and Reconstructive Surgery. 1997;99(4):1061-1067. doi:10.1097/00006534-199704000-00021

22. Kakizaki H, Shibata T, Shinno Y, et al. Fascial Sling for the Management of Urinary Incontinence Due to Sphincter Incompetence. The Journal of Urology. 1995;153(3 Pt 1):644-647. doi:10.1097/00005392-199503000-00025

23. Snodgrass W, Barber T. Comparison of Bladder Outlet Procedures Without Augmentation in Children With Neurogenic Incontinence. The Journal of Urology. 2010;184(4 Suppl):1775-1780. doi:10.1016/j.juro.2010.04.017

24. Kargi E, Yeşilli C, Akduman B, et al. Fascia Lata Grafts for Closure of Secondary Urethral Fistulas. Urology. 2003;62(5):928-931. doi:10.1016/j.urology.2003.07.012

25. Walter AJ, Hentz JG, Magrina JF, Cornella JL. Harvesting Autologous Fascia Lata for Pelvic Reconstructive Surgery: Techniques and Morbidity. American Journal of Obstetrics and Gynecology. 2001;185(6):1354-1358. doi:10.1067/mob.2001.119074