Beyond Conventional Donor Tendons: Flexor Tendon Reconstruction with Fascia Lata—A Narrative Review and Case Illustration

Background: Hand flexor tendon injuries can be treated with primary repair by direct tenorrhaphy or, when this option is not feasible, with secondary repair by reconstruction with tendon grafts. Commonly used autologous grafts include palmaris longus and plantaris; however, these may be congenitally absent or unavailable. Fascia lata (FL) is widely used for ligament and tendon reconstruction in other anatomical regions, but its use in hand surgery is rarely reported. Methods: A narrative review of the literature was conducted using the PubMed and Scopus databases to identify clinical and experimental studies on the use of FL grafts in tendon reconstruction. Relevant case reports and series were analyzed to summarize indications, techniques, and outcomes. A representative clinical case is also presented to illustrate the use of FL in a 2-staged flexor tendon reconstruction. Results: FL has demonstrated favorable biomechanical and histological properties across multiple sites including shoulder, knee, Achilles tendon, and upper limb, with satisfactory long-term outcomes. Only a few reports have described its use in hand flexor tendon reconstruction, generally noting good motion recovery and low donor-site morbidity. The reported case illustrates a successful 2-stage reconstruction of a flexor digitorum profundus tendon using a rolled FL graft in a 20-year-old patient. Conclusions: FL represents a reliable and versatile autologous graft option when conventional donor tendons are unavailable. Further biomechanical and clinical research is needed to establish its long-term performance and optimal applications in hand surgery.