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Autologous Fascia Lata

Fascia lata is the deep fascia of the thigh. It receives contributions posteriorly from the gluteal aponeurotic fascia and laterally from the iliotibial band (ITB), its lateral thickening. The ITB runs from the tensor fasciae latae and gluteus maximus proximally to Gerdy's tubercle distally.[1][18] Over the vastus lateralis the ITB is more compliant distally than proximally, and its stiffness changes with hip and knee position.[17]

Autologous fascia lata can supply a sling or a larger reconstructive graft without using synthetic mesh. It is distinct from processed cadaveric fascia lata, which has different preparation, tissue-transmission and durability considerations. See Tutoplast allografts for donor-derived products.

Choosing the Donor Site​

Fascia lata is an alternative to rectus fascia, particularly when the abdominal sheath is scarred, previously harvested, involved in hernia repair or unsuitable for the required dimensions. It offers another donor site and has not been shown to be a superior graft. Commonly cited reasons to choose it:

  • a longer or wider graft is needed;
  • prior abdominal surgery or hernia repair compromises the rectus sheath;
  • rectus exposure is difficult, for example in an obese patient;
  • the operation is vaginal only, without abdominal access.

Mobility, thigh symptoms, prior surgery and the patient's priorities regarding scars and recovery also enter the choice.

The often-cited Lemer study compared autologous rectus fascia with processed cadaveric fascia lata and dermis.[2]

Direct donor-site comparisons are limited. In a retrospective PVS cohort of 21 fascia-lata and 84 rectus-fascia cases, wound complications were 0% versus 14.3% (p = 0.12) and overall complications were 52.4% versus 48.9% (p = 0.81).[26] A 2024 registry included 41,533 sling operations but only 81 fascia-lata and 160 rectus-fascia cases. Its 30-day adverse-event association weakened after excluding UTIs; prior continence surgery, postoperative retention and long-term durability were not captured.[16]

Harvest: Match the Technique to the Graft​

RequirementPlanning considerations
Narrow sling stripDirect harvest through a lateral thigh incision, or a dedicated fascial stripper (Crawford type) through a small incision. In one 19-woman midurethral series, stripper harvest was associated with minimal postoperative morbidity.[4] Mean graft size was 10 × 2 cm for pubovaginal sling and 13 × 4 cm for abdominal sacrocolpopexy/hysteropexy in a 201-woman harvest series.[5] Short grafts suspended on sutures and long self-supporting strips are different configurations; their dimensions and tensioning are not interchangeable.
Broad prolapse graftDirect lateral-thigh exposure permits a wider sheet. Patel's technique used a 4–5 × 15–18 cm graft through a 3–4 inch incision.
Donor-site closureHemostasis, closure and management of the fascial defect are planned for its size and location. Primary closure is an option when the defect can be approximated without undue tension; Johnson's narrow-strip PVS technique left it open because tensioned closure could tear fascia or theoretically cause compartment syndrome.[6]

The PVS procedure covers passage and tensioning. The sacrocolpopexy procedure covers apical suspension and fixation.[3][4]

Donor-Site Morbidity​

Common symptoms and uncommon interventions both belong in counseling. A 2026 series of 201 women reported no intraoperative harvest complication, but one postoperative thigh hematoma required transfusion and drainage, and two patients underwent donor-site hernia repair. At six weeks, 64 women (32%) reported a thigh issue.[5] At a median of 12 months (range 3–67), 28 women reported any thigh issue on direct questioning, including 14 with cosmetic complaints, seven with non-bothersome paresthesia and nine with discomfort.[5] No functional deficit was reported, and complaints decreased over time.[5] An earlier series of 71 patients found immediate complications in 1% hematoma, 3% seroma and 7% cellulitis; among 55 questionnaire responders at a mean of 25 months, 40% reported mild leg symptoms, 5% clinically significant symptoms and 13% dissatisfaction, mostly from cosmesis or leg discomfort.[25]

In Johnson's 2024 survey, only 29/72 eligible patients responded at a mean of 42 months after surgery.[6] Ten (34.5%) reported at least one of weakness, bulge, scar pain, numbness or paresthesia; seven separately reported leg discomfort and three reported weakness.[6] Most respondents liked the cosmetic result, but nonresponse limits generalization. These are patient-reported symptoms rather than a standardized postoperative strength examination.[6] In a separate 2024 series of 108 prolapse patients undergoing 111 large-graft harvests, 59 reported mild peri-incisional paresthesia, 16 had asymptomatic bulges and 16 had seromas (14 resolved); mean follow-up was 19.6 months (range 1–65).[27]

Baseline leg symptoms are recorded, and patients are told that persistent pain, swelling, weakness or a thigh bulge may need evaluation or treatment. Autologous grafting avoids mesh-specific exposure but adds donor-site morbidity and does not eliminate recipient-site wound or voiding complications.

Female SUI​

Autologous fascia lata and rectus fascia are established PVS materials within the AUA/SUFU surgical options. Counseling covers postoperative retention, catheterization, urgency, recurrent SUI and harvest complications.[7]

  • Latini's retrospective survey. Of 100 contactable women, 63 returned questionnaires at mean 4.4 years; among respondents, 85% reported dry or improved and 77% were satisfied.[8]
  • Brown and Govier. In a single-center comparison of cadaveric (121 women) and autologous fascia lata (46 women) pubovaginal slings, 30 of the 46 autologous-group women (65%) responded to the questionnaire at a mean of 44 months. Among responders, 90% reported cure of stress incontinence and 90% were satisfied; the cadaveric group had shorter follow-up (12 months). Responder-only data from consecutive, nonrandomized cohorts cannot support a comparative claim.[19]
  • Shaw's midurethral series. 19 women, comprising 16 fascia-lata and three rectus-fascia grafts, at median nine months. Four had postoperative voiding dysfunction and three underwent sling loosening.[4]

The 17-year follow-up of a randomized comparison of standard and short (sling-on-string) autologous fascial slings included 107 patients. It found no significant difference between the two methods in IIQ-7, UDI-6, leakage or urgency, improved bladder function from baseline, low reoperation rates and 67.2% satisfaction.[20] The broader randomized comparisons and distinctions between dryness, improvement and satisfaction are summarized on the rectus-fascia page.

Sacrocolpopexy​

Autologous fascia lata is an option for selected patients wishing to avoid synthetic mesh, and long-term comparative durability is uncertain. In Australia, where no approved prolapse mesh was available, fascia lata has been offered as the alternative graft.[10] Material availability varies by product and jurisdiction. Patel's fascia-lata graft was configured as a Y using CV-2 Gore-Tex sutures for sacrocolpopexy.[3] Damiani's series used separate anterior and posterior grafts, with Vicryl at the anterior vaginal cuff and Ethibond at the posterior cuff and sacral ligament.[28]

StudyWhat was observedMain limitation
Patel 202234 open/robotic operations; no symptomatic apical failures at mean 13 months. Thigh bulges, seroma and paresthesia occurred.[3]Small uncontrolled series; symptom-defined failure and variable 2–42 month follow-up.
Bock 2021Prospective nonrandomized comparison: 19 fascia-lata and 45 mesh cases; one apical failure in the fascia group and one mesh exposure requiring excision in the mesh group.[9]Mean follow-up approximately 12 months. Harvest complications included a Clavien IIIb event.
Vereeck 2026101 of 124 included patients had at least six-month follow-up; median 12 months. 86/101 (85.1%) reported much or very much improvement; three underwent repeat prolapse surgery and two underwent thigh reoperation.[10]Single-arm cohort.

These studies support feasibility and informed choice.[3][9][10] A 2025 retrospective robotic series analyzed only 19 of 35 fascia-lata recipients with at least 24 months of follow-up (mean 42.8 months); one had posterior recurrence with apical descent and underwent posterior colporrhaphy with a pubovaginal sling.[29] There was no mesh comparator.[29] A 2024 systematic review reported success of 83–100% for fascia lata (median follow-up 12–52 months) and 87–100% for rectus fascia, and concluded that fascia lata allows a wider graft but has more harvest-site complications.[21] These ranges mix endpoints and follow-up durations. A 2026 scoping review of autologous-tissue sacrocolpopexy (11 studies, 311 women; seven fascia-lata and four rectus-fascia studies; one randomized trial and ten single-arm series) reported success across the mixed graft studies of 75–100% and de novo stress incontinence of 8.3–32.5% where reported.[22] Comparative durability remains uncertain.[22] Bock's prospective 19-versus-45 mesh comparison was nonrandomized with mean 12.1-month follow-up.[9] A 2023 Cochrane review also listed a 30-versus-30 randomized fascia-lata versus polypropylene sacrocolpopexy study in stage III–IV vault prolapse, reported only as a three-year conference abstract.[30]

Penile and Other Reconstruction​

Peyronie grafting. Selection depends on stable disease, deformity, penile length and erectile function. Current EAU guidance does not identify one graft material as superior.[11] A 12-patient autologous fascia-lata series (curvature above 35 degrees) reported straightening and normal erections without complications at a mean of 10 months.[12] The Kalsi series used Tutoplast processed allograft, not the patient's own fascia lata: in 14 patients at a mean of 31 months, the penis was completely straight in 11, 13 were satisfied, one developed de novo erectile dysfunction and four reported shortening of more than 1 cm.[15]

Other penile reconstruction. Burnett described four cases in which autologous fascia lata was used for corporoplasty after multiple failed prosthesis operations, prosthesis fixation after phalloplasty, elongation after partial penile loss from cancer surgery, and tunica albuginea grafting in Peyronie disease. All were successful in that report.[23]

Neurogenic outlet reconstruction. Kakizaki's 13 patients (10 male, 3 female; 11 with neurogenic bladder) ranged from age three to 72; eight received rectus fascia and five fascia lata, and nine also underwent augmentation. Nine were continent at mean 36 months.[13] This is neither a pediatric-only series nor an isolated comparison of graft materials. Safe storage pressures, upper-tract protection and a workable emptying plan are prerequisites for an outlet procedure.[13] In a nonrandomized pediatric comparison without augmentation, all 52 children also underwent simultaneous appendicovesicostomy. No pads were required by 46% of 35 after a 360-degree bladder-neck sling versus 82% of 17 after Leadbetter-Mitchell bladder-neck reconstruction plus sling (p = 0.02); mean follow-up was 28 versus 13 months.[24]

Recurrent urethral fistula. An eight-child post-hypospadias series (2 × 2 cm graft placed between urethra and skin) reported no recurrence at mean 11 months after free fascia-lata interposition. The reported 100% closure reflects a short uncontrolled series without a vascularized-flap comparator.[14]

See also: Rectus fascia, polypropylene mesh, and Tutoplast allografts.

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. Lemer ML, Chaikin DC, Blaivas JG. Tissue strength analysis of autologous and cadaveric allografts for the pubovaginal sling. Neurourol Urodyn. 1999;18:497–503. PubMed. doi:10.1002/(sici)1520-6777(1999)18:5<497::aid-nau12>3.0.co;2-k

3. 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

4. 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

5. 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

6. 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

7. American Urological Association/SUFU. Surgical Treatment of Female Stress Urinary Incontinence. 2023 amendment. Statements 12, 16–18 and autologous fascia PVS discussion. Guideline.

8. 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

9. 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

10. 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

11. European Association of Urology. Guidelines on Sexual and Reproductive Health, Limited Update March 2026, section 8.2.3.b (surgical treatment of Peyronie's disease and graft materials). Guideline chapter.

12. 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

13. 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

14. 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

15. Kalsi JS, Christopher N, Ralph DJ, Minhas S. Plaque incision and fascia lata grafting in the surgical management of Peyronie's disease. BJU Int. 2006;98:110–114. doi:10.1111/j.1464-410X.2006.06251.x.

16. Hong CX, Son Y, Patel VJ, Lince K, Gupta P. Comparison of perioperative adverse events following suburethral sling placement using synthetic mesh, autologous rectus fascia, and autologous fascia lata in a national surgical registry. Neurourol Urodyn. 2024;43(4):925-934. doi:10.1002/nau.25434.

17. 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. J Biomech. 2020;109:109919. doi:10.1016/j.jbiomech.2020.109919

18. 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

19. Brown SL, Govier FE. Cadaveric versus autologous fascia lata for the pubovaginal sling: surgical outcome and patient satisfaction. J Urol. 2000;164(5):1633-1637. PubMed. doi:10.1016/s0022-5347(05)67046-2

20. 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. Int Urogynecol J. 2024;35(3):649-659. doi:10.1007/s00192-023-05702-2

21. Matak L, Baekelandt J, Šimičević M, et al. Comparison between fascia lata and rectus fascia in treatment of pelvic organ prolapse: a systematic review. Arch Gynecol Obstet. 2024;309(6):2395-2400. doi:10.1007/s00404-024-07531-0

22. Alao AI, Olanrewaju BO, Purwar B, et al. Autologous tissue sacrocolpopexy for apical pelvic organ prolapse: a scoping review of the extent, nature, and characteristics of the evidence. Eur J Obstet Gynecol Reprod Biol. 2026;322:115130. doi:10.1016/j.ejogrb.2026.115130

23. Burnett AL. Fascia lata in penile reconstructive surgery: a reappraisal of the fascia lata graft. Plast Reconstr Surg. 1997;99(4):1061-1067. doi:10.1097/00006534-199704000-00021

24. Snodgrass W, Barber T. Comparison of bladder outlet procedures without augmentation in children with neurogenic incontinence. J Urol. 2010;184(4 Suppl):1775-1780. doi:10.1016/j.juro.2010.04.017

25. Walter AJ, Hentz JG, Magrina JF, Cornella JL. Harvesting autologous fascia lata for pelvic reconstructive surgery: techniques and morbidity. Am J Obstet Gynecol. 2001;185(6):1354-1358. doi:10.1067/mob.2001.119074

26. Peng MY, Sussman RD, Escobar C, et al. "Rectus fascia versus fascia lata for autologous fascial pubovaginal sling: a single-center comparison of perioperative and functional outcomes." Female Pelvic Med Reconstr Surg. 2020;26(8):493-497. doi:10.1097/SPV.0000000000000761

27. Delu AA, Terrani KF, Funk JT, Twiss CO. "Harvest of large fascia lata autograft: outcomes in 108 patients." Neurourol Urodyn. 2024;43(5):1179-1184. doi:10.1002/nau.25464

28. Damiani GR, Villa M, Falcicchio G, et al. "Robotic sacrocolpopexy with autologous fascia lata: a case series." Gynecol Minim Invasive Ther. 2023;12(1):10-14. doi:10.4103/gmit.gmit_7_22

29. Burns RT, Black M, Jeng G, Powell CR. "Medium term outcomes for robotic sacral colpopexy with autologous fascia lata." Neurourol Urodyn. 2025;44(6):1339-1343. doi:10.1002/nau.70094

30. Maher C, Yeung E, Haya N, et al. "Surgery for women with apical vaginal prolapse." Cochrane Database Syst Rev. 2023;7(7):CD012376. doi:10.1002/14651858.CD012376.pub2