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Crawford Fascial Stripper

Fascia-lata strip-harvesting instrument used through a limited thigh incision, originally described in ophthalmic frontalis-sling surgery. A fascia-lata pubovaginal sling (PVS) may use a stripper, but graft shape, harvest site and instrument choice depend on the operation; a large sheet graft may require an open harvest instead. The Crawford name comes from the ophthalmic fascia-lata harvest tradition, not from the vascular surgeon associated with aortic aneurysm classification.[18][19]

Design​

  • The Bausch + Lomb STORZ N4298 catalog lists a 355-mm (14-in) Crawford fascia stripper. Its instructions describe finger rings, an off-center release disk, an operating channel, a movable cutting blade, pivot posts and a ring clip; they do not establish a universal distal circumferential blade or a fixed graft width for every Crawford-pattern device.[20][21]
  • The N4298 instrument and blade are individually matched: the stamped letters must agree; blades are not interchangeable even with another device bearing the same part number. Release the blade by turning the off-center disk one-half turn, and reassemble according to the manufacturer's directions.[21]
  • For this reusable model, follow its disassembly, cleaning, inspection and steam-sterilization instructions and local processing validation. The manufacturer specifies wrapped steam at 132°C for 4 minutes or 121°C for 30 minutes, with sterilization after cleaning in the disassembled state; immediate-use steam is for emergency reprocessing, not routine storage. These settings are not interchangeable instructions for other models.[21]

The principle is to mobilize a suitable narrow strip through a limited incision without opening the thigh along its entire length. Width, length, orientation, incision and number of passes are procedure- and patient-specific: an ophthalmic series harvested approximately 1-cm-wide, 7–9-cm strips, whereas an AUGS PVS technique summary describes a 1 × 12-cm strip and a PVS case series sometimes required more than one incision.[7][19][22]

Reconstructive-Urology and Urogyn Uses​

Pubovaginal sling (PVS) — the core RU/urogyn indication​

Autologous fascia-lata PVS is an established non-mesh option for selected stress urinary incontinence (SUI), including recurrent SUI and some complex sphincter-deficiency cases. A fascial stripper is one harvest option and is not a required or proven superior PVS method. A 25-woman retrospective PVS series used a fascial stripper but did not identify every device as a Crawford model; 15 of 25 patients required two or three small incisions rather than one.[19]

  • Primary autologous fascia-lata PVS for SUI with ISD, recurrent SUI after failed TVT / TOT, or mesh-avoidant patients.
  • Salvage fascia-lata sling after mesh erosion / explant.
  • Selected pediatric or adolescent autologous slings according to the underlying continence indication and graft requirements; do not infer a specific stripper choice from the graft material alone.
  • Selected bladder-neck procedures may use autologous fascia; the specific wrap and harvest technique require indication-specific confirmation.

Donor-site studies of SUI or PVS and large POP grafts assess different harvests and populations; their results do not establish the morbidity of the Crawford instrument itself.[9][10]

Fascia-lata interposition for fistula repair​

  • Selected complex fistula repairs have used a free fascia-lata graft, including reported rectovaginal fistula repairs. A free graft is not itself vascularized and does not substitute for the perfused omental, peritoneal or muscle flap often considered for recurrent or scarred repairs; whether fascia, a flap or both are appropriate depends on the fistula and local tissue.[23][24]
  • Recurrent vesicovaginal or rectourethral fistula: any planned interposition needs an indication- and defect-specific reconstructive approach; ophthalmic or PVS strip dimensions are not a general fistula graft specification.

Other RU/urogyn graft applications​

  • Bladder-neck reconstruction and urethroplasty buttress. Potential graft applications with operation-specific shapes and fixation; PVS and ophthalmic-harvest studies do not establish the outcomes of these distinct reconstructions.
  • Pelvic-organ-prolapse repair. Autologous fascia-lata grafts were used in a 108-patient/111-harvest series of large grafts for transvaginal and sacrocolpopexy repair; this is not a PVS donor-site series and does not establish the Crawford stripper as the harvest method.[10]

Cross-disciplinary fascia-lata uses (relevant context)​

Fascia lata is used across specialties, but these examples do not all document the Crawford device or a graft that could be harvested as a narrow strip; donor-site findings cannot simply be transferred across graft sizes and procedures:[8][11][12][13]

  • Neurosurgery. Dural substitute for watertight closure.
  • Orthopedic surgery. ACL reconstruction, arthroscopic superior capsular reconstruction.
  • Otolaryngology. Tympanoplasty graft (better dimensional stability than temporalis fascia for large perforations).
  • Orbital surgery. Wrapping hydroxyapatite orbital implants after enucleation (two patients in one series).[5]

Harvest Technique​

  1. Incision placement:
    • Distal lateral approach: a strip-harvest protocol places an approximately 4-cm incision about 8 cm above the knee; exact placement varies with required graft length and available fascia.[18]
    • High approach: between the greater trochanter and anterior iliac crest was described in a 23-patient ophthalmic series as an alternative with a more concealed scar; this does not prove a lower herniation rate than distal harvest.[5]
  2. Dissect to fascia lata. The dense fascial envelope of the thigh musculature (iliotibial band laterally).
  3. Prepare the strip origin: the Iowa long-strip technique makes a short transverse fascial incision and holds the proximal fascial edge with a traction suture. This differs from outlining a broad sheet graft for open excision.[18]
  4. Feed the fascial edge into the stripper and advance proximally along the iliotibial band with maintained traction, following the chosen instrument's operating instructions. Avoid disrupting the band along its entire longitudinal axis.[18][21]
  5. Actuate the blade to divide the far end after attaining adequate length, then withdraw and inspect the strip. Do not assume a single pass or incision will meet the dimensions of every PVS or large interposition graft.[18][19]
  6. Inspect the donor defect and obtain hemostasis; decide on further harvest only after checking graft dimensions and residual band integrity.
  7. Compression and drainage when indicated by graft extent and local protocol; a large-graft POP series used a drain and prolonged compression, which should not be imposed on every narrow-strip harvest.[10][18]
  8. Close the incision according to the approach and donor-site findings.

Donor-Site Outcomes​

A 30-patient pediatric long-term study (mean age 7 yr) reported:[7]

  • 50% had neither visible nor palpable muscle prolapse at the harvest site.
  • 26.7% obviously visible bulging (muscle prolapse).
  • Mean scar width 7.5 mm; mean scar length 3.6 cm.
  • 90% no functional leg discomfort; 6.7% occasional discomfort; 3.3% frequent discomfort during exercise only.

These are 30 children's ptosis-harvest observations, not adult PVS outcome estimates. The series was retrospective and nonrandomized, with mean follow-up of 27 months.[7]

For SUI or PVS, Johnson 2024 had 29 questionnaire respondents of 72 eligible women: 7/29 reported leg discomfort, 3/29 weakness or bulge and 5/29 scar pain, despite 21/29 rating the scar good or excellent. Response bias and unreported device choice limit inference. For larger POP grafts, Delu 2024 reported 16 asymptomatic bulges, 16 seromas and 59 mild paresthesia events across 111 harvests in 108 patients; this is a different indication and extent of harvest. Neither series verifies Crawford-specific morbidity.[9][10]

Comparison to Alternative Harvest Techniques​

TechniqueIncisionLength obtainedBest fit
Stripper-assisted narrow stripLimited incision(s); additional incision may be neededProcedure-dependentNarrow graft with suitable donor fascia; inspect actual width/length
Open direct-vision harvestIncision scaled to sheet/patchLarger, shaped graft possibleLarge sheet graft; direct visualization; morbidity depends on graft and technique
Endoscope-assisted~ 2 cm10–17 cmDirect visualization through small incision; longer OR time[6][15]
"Kite-tail" no-stripper~ 2 cm~ 12.5 cmWhen stripper unavailable; small incision with Z-plasty dissection[16]
High-thigh incisionTechnique-dependentVariablePotentially concealed scar in an ophthalmic series; no comparative herniation estimate[5]

Limitations​

  • Blind dissection. The stripper advances subcutaneously without direct visualization; risk of irregular strip width, incomplete harvest, or inadvertent injury to adjacent structures. Endoscope-assisted variants exist for this reason.[6][15]
  • Muscle herniation (prolapse). The fascial defect can lead to visible muscle prolapse (26.7% in the Bleyen pediatric ptosis series). Severity and incidence may differ with graft size and patient population.[7]
  • Age limitation. Deenstra's series favored operating around age 4 to 5 years, when the leg has enough fascia; for children under 2 years, preserved (banked) fascia lata has been used.[3][17]
  • Instrument-dependent. Requires the Crawford stripper; alternative techniques (kite-tail, endoscopic) for centers without the instrument.[16]
  • Donor-site complications. In a 24-patient ptosis harvest series, 67% reported early pain on walking, usually resolving within a week; bleeding or hematoma, infection, seroma and sensory or cosmetic symptoms remain relevant across harvest methods, but no universal Crawford-specific rate follows from this series.[14]

Pubovaginal Sling Context​

The autologous fascia-lata PVS sits in a specific lineage in SUI surgery:

  • Aldridge / Goebell-Stoeckel rectus-fascia sling. Autologous-fascia sling tradition predating PVS.
  • Pubovaginal sling (Blaivas / McGuire). Modern PVS paradigm; autologous rectus fascia or fascia lata.
  • Stripper-assisted fascia-lata PVS. One limited-incision harvest paradigm when the chosen graft can be obtained as a strip.[19]
  • Tension-free vaginal tape (TVT). Synthetic mesh midurethral sling that dominated 1996–2010s.
  • Mesh-avoidant autologous PVS. Continued clinical option, without evidence here that a particular stripper is central to its use.[9]

Historical Context — J. Stewart Crawford​

J. Stewart Crawford was an ophthalmic surgeon whose name is attached to fascia lata frontalis suspension.[3] His contributions to ophthalmic surgery were foundational:

  • Frontalis-sling technique with fascia lata strips (1956) for severe congenital ptosis with poor levator function; it couples the tarsal plate to the frontalis muscle using a sling, allowing brow-driven eyelid elevation.
  • Used autogenous fascia lata for frontalis suspension, an enduring material option. A Cochrane review found insufficient comparative evidence to identify the most successful material, so a blanket lower-recurrence or superiority ranking is not established by that review.[1][2][3]
  • The fascial stripper that carries his name enables limited-incision harvest of fascia lata strips for the sling procedure; ophthalmic series report harvest with a Crawford stripper.[7]
  • Crawford lacrimal intubation probe (Crawford tube). A separately named nasolacrimal-intubation instrument. The cited groove-director article documents the probe but does not establish its inventor or identity with this fascia stripper.[4]

See also: Raz-Pereyra Trocar, Stamey Needle, Autologous Fascia Lata.

References​

1. Rosenberg JB, Andersen J, Barmettler A. "Types of materials for frontalis sling surgery for congenital ptosis." Cochrane Database Syst Rev. 2019;4:CD012725. doi:10.1002/14651858.CD012725.pub2

2. Ahmad R, Rehman U, Sohaib Sarwar M, et al. "Use of autogenous fascia lata slings in the surgical correction of ptosis: a systematic review of the literature and meta-analysis." Br J Oral Maxillofac Surg. 2024;62(2):128–39. doi:10.1016/j.bjoms.2023.11.013

3. Deenstra W, Melis P, Kon M, Werker P. "Correction of severe blepharoptosis." Ann Plast Surg. 1996;36(4):348–53. doi:10.1097/00000637-199604000-00004

4. Anderson RL, Yen MT, Hwang IP, Lucci LM. "A new groove director for simplified nasolacrimal intubation." Arch Ophthalmol. 2001;119(9):1368–70. doi:10.1001/archopht.119.9.1368

5. Naugle TC, Fry CL, Sabatier RE, Elliott LF. "High leg incision fascia lata harvesting." Ophthalmology. 1997;104(9):1480–8. doi:10.1016/s0161-6420(97)30107-9

6. Naik A, Patel A, Bothra N, et al. "Endoscope-assisted harvest of autogenous fascia lata in frontalis suspension surgery: a minimally invasive approach revisited." Indian J Ophthalmol. 2018;66(3):440–4. doi:10.4103/ijo.IJO_819_17

7. Bleyen I, Hardy I, Codère F. "Muscle prolapse after harvesting autogenous fascia lata used for frontalis suspension in children." Ophthalmic Plast Reconstr Surg. 2009;25(5):359–60. doi:10.1097/IOP.0b013e3181b1e67a

8. Link MJ, Converse LD, Lanier WL. "A new technique for single-person fascia lata harvest." Neurosurgery. 2008;63(4 Suppl 2):359–61. doi:10.1227/01.NEU.0000327035.12333.E3

9. 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." Neurourol Urodyn. 2024;43(5):1185–91. doi:10.1002/nau.25462

10. Delu AA, Terrani KF, Funk JT, Twiss CO. "Harvest of large fascia lata autograft: outcomes in 108 patients." Neurourol Urodyn. 2024;43(5):1179–84. doi:10.1002/nau.25464

11. Khiami F, Wajsfisz A, Meyer A, et al. "Anterior cruciate ligament reconstruction with fascia lata using a minimally invasive arthroscopic harvesting technique." Orthop Traumatol Surg Res. 2013;99(1):99–105. doi:10.1016/j.otsr.2012.09.017

12. Ângelo ACLPG, de Campos Azevedo CI. "Minimally invasive fascia lata harvesting in ASCR does not produce significant donor site morbidity." Knee Surg Sports Traumatol Arthrosc. 2019;27(1):245–50. doi:10.1007/s00167-018-5085-1

13. Indorewala S. "Dimensional stability of free fascia grafts: clinical application." Laryngoscope. 2005;115(2):278–82. doi:10.1097/01.mlg.0000154733.54152.54

14. Wheatcroft SM, Vardy SJ, Tyers AG. "Complications of fascia lata harvesting for ptosis surgery." Br J Ophthalmol. 1997;81(7):581–3. doi:10.1136/bjo.81.7.581

15. Malhotra R, Selva D, Olver JM. "Endoscopic harvesting of autogenous fascia lata." Ophthalmic Plast Reconstr Surg. 2007;23(5):372–5. doi:10.1097/IOP.0b013e3181469cbd

16. Evereklioglu C. "'Kite-tail' fascia lata strips technique: frontalis suspension using a non-endoscopic minimally invasive single-thigh incision approach." Br J Ophthalmol. 2012;96(4):570–5. doi:10.1136/bjophthalmol-2011-300400

17. Woo KI, Kim YD, Kim YH. "Surgical treatment of severe congenital ptosis in patients younger than two years of age using preserved fascia lata." Am J Ophthalmol. 2014;157(6):1221–6. doi:10.1016/j.ajo.2014.02.041

18. University of Iowa Head and Neck Protocols. Fascia lata harvest. Operative teaching protocol; distinguish narrow-strip from open sheet harvest.

19. Chibber PJ, Shah HN, Jain P. "A minimally invasive technique for harvesting autologous fascia lata for pubo-vaginal sling suspension." Int Urol Nephrol. 2005;37(1):43–6. doi:10.1007/s11255-004-6080-7.

20. Bausch + Lomb STORZ. Crawford fascia stripper N4298 product listing. Product specification.

21. Bausch + Lomb. Crawford fascia stripper N4298 instructions for use and reprocessing. Rev. 2022-10; English PDF p 1.

22. American Urogynecologic Society. Harvest of autologous fascia lata from the thigh: surgical technique video. 2017; technique details here from its text summary.

23. Kagoura E, Katoh S, Nishimoto H, et al. "Rectovaginal fistula treated with combination of gracilis muscle flap and fascia lata graft: a case study." J Jpn Soc Surg Wound Care. 2026;17(3):93–97. doi:10.11310/jsswc.17.93.

24. Das B, Snyder M. "Rectovaginal Fistulae." Clin Colon Rectal Surg. 2016;29(1):50–56. doi:10.1055/s-0035-1570393.