Autogenous fascia harvest
This is Richard Allen at the University of Iowa. This video demonstrates harvesting of autogenous fascia for a frontalis sling in a patient with congenital ptosis.
A line has previously be drawn from the lateral knee to the anterior iliac crest. An incision is made along the line inferiorly where one can palpate the inferior aspect of the muscle. Dissection is then performed through the subcutaneous fat with scissors to the fascia. Metzenbaum scissors are then used to bluntly dissect along the surface of the fascia so that the stripper can be advanced. A 15 blade is then used to develop a tongue of fascia that is parallel to the fascia strands. This tongue is the engaged with 4-0 vicryl suture so that the tongue can be introduced into the Crawford fascia stripper. The instrument shown is the Crawford fascia stripper. It has a guillotine mechanism on the end of it so that when you pull back it cuts the fascia. The 4-0 Vicryl is introduced through the slot and then the stripper is advanced with gentle pressure. Sometime this is easier to pass than others, but in general it is passed along the line that was previously drawn. Hemostats are then used to engage the tongue because if you pull on the sutures you will pull the sutures through the fascia. This gives a little extra tension so you can fully introduce the fascia stripper. The guillotine mechanism is then engaged and the fascia is removed. The stripper is removed from the incision and the incision is closed with deep interrupted 4-0 monocryl sutures and 5-0 prolene sutures placed in a vertical mattress fashion through the skin. The leg is check for hematoma formation and the area is dressed with antibiotic ointment and Tegaderm.