Morbidity Associated with Autologous Fascia Lata Harvesting for Pelvic Floor Surgery

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.

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.

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%).

Most concerns were minor and required no intervention. No functional deficits were reported and complaints decreased over time.