Outcomes of fascia lata, rectus fascia and allogenic materials in pelvic floor reconstruction: a scoping review of patient and graft factors.

Abstract

Introduction & Objectives: Biological grafts are increasingly used in pelvic floor reconstruction for pelvic organ prolapse (POP) and stress urinary incontinence (SUI) following concerns about synthetic mesh safety. However, the biomechanical and clinical performance of autologous and allogenic materials such as human fascia lata, remain incompletely understood. This review aimed to evaluate how biological graft characteristics and patient-specific factors affect healing, mechanical properties, and clinical outcomes following pelvic reconstructive surgery. Method(s): A systematic search of MEDLINE, Embase, and Google Scholar (1990-2025) was performed for studies examining autologous fascia lata (aFL), autologous rectus fascia (aRF), cadaveric fascia lata (cFL), and alternative allogenic grafts in POP and SUI surgery. Eligible studies included comparative and biomechanical analyses, clinical trials, and large case series reporting anatomical outcomes, functional outcomes, and surgical complications. Data were summarised focusing on biomechanical properties, clinical outcomes, and comparative surgical efficacy. Result(s): Forty-eight studies were included. aFL demonstrated regional and sex-based biomechanical variability, with the lateral thigh demonstrating greater strength and thickness compared with other graft sites. aFL and aRF performed similarly for POP and SUI repair, with low recurrence rates (<10%) and minor adverse events. Harvest morbidity was less with aFL than with RF, with associated improvements in hospital length of stay and functional recovery, though minor complications such as seroma, paraesthesia and cosmetic concerns were commonly reported. cFL outcomes varied with graft processing: non-irradiated, solvent-dehydrated grafts produced better durability and lower failure than irradiated or freeze-dried tissue, though early satisfaction and quality of life improvement were high (80-100%) despite objective anatomic failure. Both allograft and autograft materials had reduced rates of erosion and infection compared to synthetic mesh, though mesh demonstrated superior anatomical durability. Conclusion(s): aRF, aFL and cFL provide valuable alternative biological grafts for pelvic floor reconstruction, particularly in the current regulatory environment. Material selection should be guided by patient-specific factors, anatomic considerations, and surgeon expertise. Future research should focus on standardising processing methods and optimising patient selection. Collectively, these findings underscore an urgent need for robust, prospective research to define optimal graft selection that will truly advance long-term outcomes for women undergoing pelvic floor reconstruction.