Close up of autogenous fascia harvest
This is Richard Allen at the University of Iowa. This video demonstrates a close up of the harvesting of autogenous fascia.
An incision is made through the skin and blunt dissection is carried out through the subcutaneous fat to the fascia plane. The fascia is easily identified by its glistening white appearance. Metzenbaum scissors are then introduced through the incision to bluntly dissect along the surface of the fascia. A 15 blade is then used to make a horizontal incision through the fascia. A tongue of fascia is then developed which is parallel to the strands of the fascia. The Metzenbaum scissors are used to further develop the tongue. A 4-0 Vicryl suture is then used to engage the tongue in order to introduce the tongue into the Crawford fascia stripper. The Crawford fascia stripper is then introduced and advanced to cut a strip of fascia. A hemostat is then used to pull the fascia and the stripper is advanced further with gentle pressure. This should slide relatively easily parallel to the fascia strands. The guillotine mechanism is engaged and the fascia is removed. This demonstrates the guillotine mechanism. The incision is then closed with deep interrupted 4-0 Monocryl sutures and then 5-0 prolene sutures through the skin in a vertical mattress fashion. Some surgeons will close the fascia, but I do not. At the conclusion of the case the leg is dressed with antibiotic ointment and Tegaderm and the patient returns in one week for suture removal.