Fascia lata and costal cartilage: the build for large perforations

Stacked cartilage and fascia fill the space the mucosa cannot bridge.

First described by : Ozdilek, Kilavuz and Serin, J Craniofac Surg 2020, for endoscopic fascia lata placement; most of the series come from Deniz Hancı and his team in Istanbul, between 2020 and 2026.

Fascia lata is the sheath around the thigh muscles: thick, wide, strong, and harvestable in quantity without touching the nose. Interposed between the two mucosal layers, it fills the space the flaps cannot cover, the usual situation in perforations over 2 cm. To give the nose its rigidity back, it is often combined with costal cartilage carved into a plate, with its perichondrium, as a sandwich. The graft has no blood supply of its own: it depends on healthy surrounding mucosa to be colonised.

1. 1Harvest of fascia lata through a few centimetres of incision on the outer thigh.
2. 2If needed, harvest of costal cartilage and its perichondrium, carved into a flat plate the size of the defect.
3. 3Assembly: rigid cartilage for the framework, fascia as the healing surface, sometimes perichondrium on the mucosal side to improve take.
4. 4Usually an open approach, with mucosal flaps brought together as far as possible; the fascia fills what does not meet.
5. 5Silicone splints for 2 to 3 months, rinses, and complete smoking cessation throughout healing.

Named variants

• Large perforations, beyond 2 cm, where mucosal flaps do not meet.
• Patients whose nasal mucosa must be spared: nothing is harvested inside the nose.
• Cases needing genuine framework reconstruction (early saddle nose, loss of support).
• Patients who accept a thigh harvest, and a rib harvest if required.
• Salvage after a failed local technique, with septal mucosa left available.

• Current smoking: in the Tricellufuse series, every failure was a smoker.
• Inflamed or poorly vascularised mucosa: the graft has no vessels of its own and depends on it.
• Refusal of a rib harvest when the framework has to be rebuilt.
• Contraindication to costal harvest (thoracic history, unacceptable pneumothorax risk).
• Anyone looking for a technique with long published follow-up: these series are recent and single-centre.

Published results

• Thigh donor site: pain for several weeks, haematoma, a scar a few centimetres long.
• Costal harvest: chest pain, risk of pneumothorax, a scar.
• Non-vascularised graft: failure if the surrounding mucosa is inflamed or the patient smokes.
• Long splinting (2 to 3 months) with crusting and blockage.
• Single-centre Turkish series, modest numbers, no head-to-head comparison with other families.

1. 1Is a rib harvest necessary in my case, or is fascia enough?
2. 2What is your pneumothorax rate, and how do you monitor for it?
3. 3How long will my thigh hurt?
4. 4What happens to the graft if I do not stop smoking completely?
5. 5What follow-up do you have on patients you operated on more than two years ago?

Write the answers down: they are what lets you compare two opinions.

Where it is done

Related techniques