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Editor,—Wheatcroft et al are to be congratulated on their excellent article concerning complications of fascia lata harvesting for ptosis surgery in 24 consecutive patients.1
I do have some concern about their statement that leg scarring was considered unsightly in 38% of their patients, but was considered “a minor problem in all cases”. Furthermore, they provided a graphic picture of a leg scar with a “poor cosmetic result”. I believe that the more litigious American patient might not find this a minor problem. Also, if a keloid were to form at the incision used by the authors superior to the knee joint in the lateral aspect of the thigh (as the majority of surgeons do worldwide), the level of patient satisfaction might be quite low.
The authors did not encounter herniation of the muscle belly or haematoma formation in their series, but do provide references mentioning these problems.2-4 A larger series of patients may have manifested these complications.
I have had conversations with a number of colleagues who have encountered one or more of the above complications following use of the traditional above the knee incision.
We have published a technique of harvesting fascia lata between the greater trochanter and iliac crest in an attempt to decrease the problems of a conspicuous scar, herniation of the muscle belly, and haematoma formation.5 As was the case with the authors, we did not encounter these problems in our series.
With this technique a scar, keloid, or herniation of the muscle belly would be covered with short legged wearing apparel, undergarments, or a bathing suit.
With our technique, one can visualise the entire extent of the dissection, especially with the use of a fibreoptic retractor. In the event of a haematoma, increased exposure can aid in solving this problem and also provide visualisation of dissection of the tissue surrounding the fascia to be removed.
We suggest consideration of an incision between the greater trochanter and the iliac crest for harvesting fascia lata.
Editor,—We are very grateful to Dr Naugle for his comments on our paper. We have read with interest his recent publication which describes the approach to the fascia lata through a high leg incision. From the excellent results reported by Naugle and colleagues this approach is a good alternative to the conventional low incision placed above the knee. However, to date we have no experience with this approach.
Both papers agree that autogenous fascia lata is the best material for routine brow suspension procedures. The main disadvantage of the lower incision is that the scar can be conspicuous. The main advantage of the higher incision is a less conspicuous scar. Although we reported that few of our patients found the scar unacceptable, clearly they would prefer to avoid an obvious scar altogether.
One of the disincentives to the use of autogenous fascia lata is the perceived difficulty in harvesting it. The low incision approach is not difficult to learn and is reasonably quick. We shall certainly use the high incision technique in a series of our patients to assess the relative ease of the surgery.
We congratulate Naugle and colleagues on the introduction of this new technique.