The role of tensor fascia lata (TFL) graft in wound treatment: a case report.

Abstract

Introduction and importance: Combat-related injuries to the upper limb pose significant reconstructive challenges, particularly in resource-limited, conflict-zone settings. Innovative strategies are essential to preserve hand function, and the choice of an optimal reconstruction remains complex. Temporary wound dressings must foster healing and protect vital structures during the interval before definitive closure. This report evaluates the effectiveness of a tensor fascia lata (TFL) graft combined with negative-pressure wound therapy (NPWT) as a temporary dressing for complex wounds in austere environments.

Case presentation: A 32-year-old right-hand-dominant soldier suffered shrapnel trauma to his left distal forearm, causing transection of the flexor tendons to the middle, ring, and little fingers, as well as the ulnar nerve and artery. Surgical exploration and repair were performed, after which a full-thickness TFL graft was applied as a dermal matrix substitute, in conjunction with intermittent NPWT at -100 mmHg. By the third week, robust granulation tissue was evident, allowing for successful skin grafting instead of flap reconstruction. At 7 weeks, the patient achieved more than 90 degrees of finger flexion with a QuickDASH score of 15.9%, indicating mild disability.

Clinical discussion: The TFL graft's collagen-rich extracellular matrix provides mechanical integrity and supports tissue hydration, angiogenesis, and tendon gliding. Combined with NPWT, the graft offers a vascularized scaffold, while NPWT evacuates fluids and promotes tissue approximation. This combination may substitute for commercial acellular dermal matrices at a substantially lower cost.

Conclusion: TFL grafts, especially when integrated with NPWT, represent a robust, versatile, and practical solution for temporary wound coverage in complex injuries, particularly in resource-constrained settings.