Tensor Fasciae Latae (TFL) Flap
The tensor fasciae latae (TFL) flap can transfer muscle, fascia lata and overlying lateral-thigh skin together, or be designed as a fascia/skin perforator variant. Its principal pedicle is the ascending branch of the lateral circumflex femoral artery (LCFA). The 1978 descriptions established the musculocutaneous design. Höckel and Dornhöfer later included it in their proposed vulvovaginal-reconstruction scheme, favoring it for selected defects extending into the groin; that is an author's algorithm, not a universal first-choice rule.[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] | Included TFL in their proposed vulvovaginal scheme, favoring it for selected inguinal-involving 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 — in one experimentally induced weakness study, force fell by about 15% at 30° hip flexion, without a detected effect in neutral or extension. This does not measure outcomes after flap harvest.[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]
Donor-site function depends on the amount of muscle/fascia removed, nerve preservation, baseline gait and rehabilitation; the induced-weakness result alone cannot establish minimal postoperative deficit.
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, cadaveric injection study)[16]
The TFL has anastomotic perforasome connections with:
- Superficial circumflex iliac artery (SCIA) — six arteries were injected as part of the anatomy study.
- Inferior gluteal artery (IGA) — three arteries were injected as part of the anatomy study.
These cadaveric connections and one reported clinical reconstruction led the authors to hypothesize alternative TFL perfusion after LCFA interruption. They do not establish that a flap will survive an injured dominant pedicle in an individual patient; confirm actual inflow before relying on a collateral pathway.
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 planning zone: in Hubmer's 45-thigh cadaveric study, 76% of septocutaneous perforators emerged 8–12 cm from the ASIS; locate an individual's perforators rather than treating that interval as guaranteed.
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: the pedicle-entry region is a planning pivot; reported reach includes the groin, perineum, lower abdomen, trochanter, ischium, and sacrum, depending on flap variant, pedicle dissection and patient anatomy.[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
A traditional option because of donor proximity, vascularized tissue and fascia-lata padding; suitability depends on pressure-relief planning and donor-site condition.[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 | — |
This 25-patient retrospective comparison led its authors to suggest prophylactic TFL coverage after selected ilioinguinal dissections. The 75% versus 17% comparison is among groins with ilioinguinal dissection, not all 48 groins or a randomized effect estimate; treatment selection and small subgroup sizes limit generalization.[25]
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] | Listed in the authors' vulvovaginal scheme and favored there for selected defects including the inguinal region; not a universal first-choice standard |
| 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 | 17/20 (85%) without reported flap-skin necrosis; three minor necroses | Small nonrandomized comparison; 75% vs 17% skin necrosis in the ilioinguinal subgroup |
| 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] |
| Function-sparing potential | Induced TFL weakness reduced abduction force in one hip position; postoperative donor function requires separate assessment.[20] |
| Accessory vascular network | SCIA / IGA connections were demonstrated anatomically; reliable harvest after LCFA injury remains an individual perfusion decision.[16] |
| Groin-dissection series | Selected ilioinguinal groins had less skin necrosis with TFL in one small retrospective cohort (75% versus 17%); not a randomized benefit estimate.[25] |
| Inguinal-region vulvar defects | One option in Höckel and Dornhöfer's proposed scheme.[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] | Authors' proposed choice for selected inguinal-involving defects; not universal guidance |
| 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