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PubMed2002

Tamoxifen decreases fibroblast function and downregulates TGF(beta2) in dupuytren's affected palmar fascia.

BACKGROUND: Dupuytren's contracture is a fibroproliferative disorder that is associated with increased collagen deposition. Isoforms of transforming growth factor beta (TGF(beta)), normally TGF(beta1) and TGF(beta2), are involved in the progressive fibrosis of Dupuytren's disease. It has been suggested that downregulation of TGF(beta) may be useful in the treatment of the condition. Tamoxifen, a synthetic nonsteroidal antiestrogen, is known to modulate the production of TGF(beta). This study examined the role of tamoxifen in decreasing fibroblast function and downregulating TGF(beta2). METHODS: Primary cultures of fibroblasts were obtained from Dupuytren's affected fascia and carpal tunnel affected fascia as a control. Collagen lattices were prepared and populated with the fibroblasts. The fibroblast-populated collagen lattices (FPCL) were then measured for contraction every 24 h for 5 days. Supernatant was obtained from the culture medium following completion of the FPCL portion of the experiment and used for a TGF(beta2) immunoassay. RESULTS: Dupuytren's affected fibroblasts contracted the FPCLs significantly more than carpal tunnel control fibroblasts. Treating the fibroblasts with tamoxifen caused a decreased contraction rate in both Dupuytren's affected fibroblasts and carpal tunnel controls. There was increased TGF(beta2) expression in the Dupuytren's affected fascia group compared to the carpal tunnel control group. Tamoxifen decreased TGF(beta2) expression in Dupuytren's affected fascia group but not in the carpal tunnel control group. CONCLUSION: TGF(beta) appears to be the key cytokine in the fibrogenic nature of Dupuytren's disease. Tamoxifen treatment has been demonstrated to decrease the function of fibroblasts derived from Dupuytren's affected fascia and downregulated TGF(beta2) production in these same fibroblasts. These data suggest a method to manipulate and control Dupuytren's contracture in the clinical setting.

Carpal Tunnel Syndrome↗
PubMed2001

Poor surgical outcomes after fascia lata allograft slings.

The objective of this retrospective case control study was to determine whether our poor surgical outcomes were associated with the material used to construct our pubovaginal slings. Autologous rectus fascia was used in 33 patients and cadaveric fascia lata was used in 12 patients who underwent pubovaginal sling placement for intrinsic urethral sphincter deficiency (ISD). Treatment was successful in 78.8% and 33.3% of patients who underwent rectus fascia and fascia lata allograft slings, respectively (P=0.006). Based on regression analysis, the sling material was found to be strongly associated with surgical outcome after controlling for all confounding variables (beta coefficient = 1,204.6, P<0.00005). We conclude that fascia lata allografts are a poor choice for pubovaginal slings.

Adult↗
PubMed2002

Vaginal erosion of cadaveric fascia lata following abdominal sacrocolpopexy and suburethral sling urethropexy.

The aim of this paper is to report vaginal erosion of cadaveric fascia lata used for abdominal sacrocolpopexy and suburethral sling urethropexy. The charts of patients who underwent abdominal sacrocolpopexy or suburethral sling urethropexy between March 1994 and February 1999 were reviewed for perioperative data. In 47 cases of abdominal sacrocolpopexy or suburethral sling, 32 utilized cadaveric fascia lata, with 11 for sacrocolpopexy and 22 for suburethral sling. Vaginal erosion of cadaveric fascia lata graft was noted in 5 (23%) following sling procedure and 3 (27%) following sacrocolpopexy, diagnosed a mean of 36.8 days (+/- 7.1, range 27-45) following surgery. These women were treated conservatively with estrogen vaginal cream, and both vaginal and oral antibiotics. Four of the 8 (50%) underwent excision of the exposed graft and reapproximation of the vaginal edges under local anesthesia, whereas the remainder responded to medical therapy alone. None of the patients experienced recurrence of vaginal vault prolapse or urinary incontinence following graft erosion. Comparison of women with vaginal erosion of cadaveric fascia lata to those without revealed an association with perioperative febrile morbidity (P=0.04), but not with age, hormonal or insurance status, body mass index, history of diabetes mellitus or smoking, length of surgery, estimated blood loss, change in hematocrit, or other perioperative complications. Vaginal erosion of cadaveric fascia lata utilized for abdominal sacrocolpopexy and suburethral sling was noted in 25% of our patients and may have an infectious etiology. Conservative treatment with antibiotics and estrogen is effective, but removal of exposed graft with vaginal closure may be necessary.

Cadaver↗
PubMed2002

Comparison of PTFE, pericardium bovine and fascia lata for repair of incisional hernia in rat model, experimental study.

Incisional hernia is a frequent complication of abdominal surgery developing in 11-20 % of patients undergoing an abdominal operation. Regarding morbidity and loss of manpower, incisional hernias continue to be a fundamental problem for surgeons. In this experimental study, three commonly used mesh materials (Goretex PTFE; Tutoplast Fascia lata; Tutopatch Pericardium bovine) were compared according to effectiveness, strength, adhesion formation, histological changes, and early complications. Three groups, each consisting of 14 rats, have been formed as group A: polytetrafluoroethylene (PTFE), group B: pericardium bovine and group C: fascia lata. Evaluations were achieved at the end of the first and second postoperative week, respectively. Adhesion formation, wound maturation, bursting pressure, and tensile strength were evaluated. No statistically significant difference regarding adhesion formation was observed between groups although adhesion formation was less significant in PTFE and pericardium bovine groups than in the fascia lata group. Bursting pressure and tensile strength values were significantly higher in PTFE group than in the fascia lata group ( P<0.05). No statistically significant difference was observed between groups regarding wound maturation. In this experimental model, PTFE and pericardium bovine were found to be superior to fascia lata in abdominal wall repair.

Animals↗
PubMed2005

A minimally invasive technique for harvesting autologous fascia lata for pubo-vaginal sling suspension.

OBJECTIVE: To access donor site morbidity associated with harvesting of autologous fascia lata for pubo-vaginal sling suspension in treating stress urinary incontinence. METHODS: A retrospective study was performed of 25 female patients who underwent pubo-vaginal sling suspension for stress urinary incontinence. Autologous fascia lata strip was harvested in all patients with a minimally invasive approach using a fascial stripper. Demographic, intraoperative, and immediate postoperative data were recorded to determine the incidence of complications. Follow-up data was reviewed for documentation of long-term complications. RESULTS: Adequate length of fascia lata was harvested in all of our patients. Ten patients required a single 2 cm incision just above lateral femoral epicondyle to harvest fascia lata. Twelve patients needed two incisions and remaining three required three incisions. There were no intraoperative complications. There was no incidence of wound related infection or hematoma in the immediate post-operative period. On follow-up no patient had bothersome problems pertaining to the site of graft harvesting. CONCLUSIONS: Harvesting fascia lata with fascial stripper is a minimally invasive which is easy to learn and provides an excellent fascial strip with minimal morbidity.

Fascia Lata↗
PubMed2006

Functional reconstruction of Achilles tendon defects combined with overlaying skin defects using a free tensor fasciae latae flap.

We present our experience in functional reconstruction of the Achilles tendon with large tissue defects following after trauma and infection. To cover the skin defect and to reconstruct the Achilles tendon we used the free tensor fasciae latae (TFL) flap. From 1997 to 2003 six males, ranging from 22 to 71 (average 38.6) years, underwent this reconstructive procedure. All of them had sustained a trauma with following loss of the tendon and of the overlying tissue. After initial debridements the reconstruction with a tensor fascia latae free flap was performed. To achieve a strong distal fascia lata attachment to the calcaneal bone, we developed a special method of fixation. After vertical osteotomy in the calcaneus the distal part of the fascia flap was introduced between the bone segments, which were fixed together with a spongiosa screw. For functional outcome, it was important to fix the foot in a 90 degrees position with tension on the vascularised fascia lata. The range of motion of the ankle of the reconstructed foot showed 93.7% in comparison to the normal foot. No flap failure occurred in any of the six patients. Simultaneous soft-tissue and function restoration of the foot with TFL free flap is in our opinion an optimal one-stage reconstructive procedure.

Achilles Tendon↗
PubMed2005

Does the thickening of Achilles tendon and plantar fascia contribute to the alteration of diabetic foot loading?

BACKGROUND: The diabetic foot often undergoes abnormal plantar pressures, changing in walking strategy, ulcerative processes. The present study focuses on the effects that diabetes-induced alterations of Achilles tendon, plantar fascia and first metatarso-phalangeal joint-both anatomical and functional-may have on foot loading. METHODS: Sixty-one diabetic patients, with or without neuropathy, and 21 healthy volunteers were recruited. Thickness of Achilles tendon and plantar fascia was measured by ultrasound. Flexion-extension of the first metatarso-phalangeal joint was measured passively. Main biomechanic parameters of foot-floor interaction during gait were acquired and related to the above measurements. FINDINGS: Plantar fascia and Achilles tendon were significantly (P<0.05) thicker in diabetics than in controls; mean values (SD) for controls, diabetics without and with neuropathy were 2.0 mm (0.5), 2.9 mm (1.2) and 3.0 mm (0.8) for plantar fascia, respectively, and 4.0 mm (0.5), 4.6 mm (1.0) and 4.9 mm (1.7) for Achilles tendon, respectively. Flexion-extension of the first metatarso-phalangeal joint was significantly (P<0.05) smaller in diabetics than in controls; mean values (SD) for controls, diabetics without and with neuropathy were 100.0 degrees (10.0), 54.0 degrees (29.4) and 54.9 degrees (17.2), respectively. The increase in the vertical force under the metatarsals was strongly related (R=0.83, explained variance=70.1%) to the changes in the three above parameters. INTERPRETATION: Thickening of plantar fascia and Achilles tendon in diabetics, more evident in the presence of neuropathy, concurs to develop a rigid foot, which poorly absorbs shock during landing (performs the physiological impact force absorption during landing). More generally, an overall alteration of the foot-ankle complex motion likely occurs throughout the whole gait cycle, which partly explains the abnormal loading under the forefoot.

Achilles Tendon↗
PubMed2007

The anterior layer of Denonvilliers' fascia: a common misconception in the laparoscopic prostatectomy literature.

PURPOSE: Incision of the anterior layer of Denonvilliers' fascia is commonly cited as a key step in successful dissection of the vasa deferentia and seminal vesicles from the posterior bladder neck during laparoscopic radical prostatectomy. However, anatomical descriptions do not support the presence of Denonvilliers' fascia anterior to the seminal vesicles. To address this inconsistency we performed a detailed anatomical study of tissue planes encountered during laparoscopic dissection of the posterior bladder neck. MATERIALS AND METHODS: To grossly characterize the tissue planes encountered during laparoscopic posterior bladder neck dissection, ex vivo dissections were performed on 4 separate cystoprostatectomy specimens. Biopsies of the representative areas were obtained from 20 consecutive laparoscopic radical prostatectomy specimens by 2 dedicated uropathologists. RESULTS: Following incision into the posterior bladder neck mucosa, longitudinally oriented fibers were readily visualized, extending from bladder neck to prostate base. Histologically this anatomical landmark represents the fusion of 2 separate tissue layers, that is an inner lamella composed of longitudinally disposed smooth muscle fibers in continuation with the longitudinal fascia of the bladder detrusor (medial fascicle of the detrusor running in between the ureters) and an outer lamella composed of fibroadipose tissue in continuation with the bladder adventitia. CONCLUSIONS: Our anatomical and histological analysis refutes the prevailing belief in the laparoscopic literature that the longitudinal muscle fibers identified during dissection of the posterior bladder neck represent the anterior layer of Denonvilliers' fascia. They correspond to the posterior longitudinal fascia of the detrusor muscle that is externally upholstered by the bladder adventitia.

Fascia↗
PubMed2005

Use of rectus fascia graft for corporeal reconstruction during placement of penile implant.

OBJECTIVES: To report on the technique of using autologous rectus fascia graft for corporeal and tunica reconstruction during placement of an inflatable penile prosthesis. Reconstructing the corpora cavernosa and closing the tunica albuginea over an inflatable penile prosthesis can be challenging when severe fibrosis is encountered. METHODS: Fifteen patients with severe fibrosis of the corpora or tunica were included in this study. Eight patients had severe corporeal fibrosis secondary to an infected or malfunctioned penile prosthesis that had been previously removed, and seven had severe penile curvature secondary to tunical fibrosis with concomitant erectile dysfunction. All patients underwent corporeal or tunica reconstruction using autologous rectus fascia after placement of an inflatable penile prosthesis. Postoperatively, patients were evaluated at 1, 6, 12, and 24 months. Data on patient satisfaction, graft function, and complications were recorded. RESULTS: At a mean follow-up of 18 months (range 12 to 64), augmentation of the tunica or corporeal defect using autologous rectus fascia graft was successful in all patients. The penile prostheses were functioning properly with no evidence of graft infection, erosion, or abdominal wall hematoma. Patients demonstrated good results, with return to sexual intercourse at a mean of 9 weeks postoperatively (range 8 to 10). CONCLUSIONS: Use of an autologous rectus fascia graft for coverage of a tunical or corporeal defect during penile prosthesis placement in patients with corporeal or tunica fibrosis is surgically feasible, safe, and efficacious. Long-term follow-up of this reconstructive technique has demonstrated excellent clinical results with no morbidity related to the rectus fascia graft harvesting.

Adult↗
PubMed2002

The frictional properties at the thoracic skin-fascia interface: implications in spine manipulation.

OBJECTIVE: To assess the friction at the thoracic skin-fascia interface to determine the potential reaction force vectors during thoracic manual therapy. DESIGN: A basic in vivo study of human subjects, documenting the frictional properties at the interface between the thoracic skin and underlying fascia. BACKGROUND: Chiropractors, and other spine manipulative therapists, during thoracic manipulation have been attempting to apply force vectors to spine tissues in specific directions in addition to those applied normal to the skin. For obliquely applied forces to be directly transmitted to the underlying vertebrae, either friction is required at the skin-fascia interface or the applied force must "hook" on a bony process. METHODS: Subjects were placed in the prone position with the thoracic skin exposed. The posterior thoracic region was loaded with normal forces, incrementally from 125.3 to 392.9 N. The interface between the load and the skin was either a plexiglass plate or modelled hands. A force was then applied to either apparatus in the cephalad direction. The applied forces and corresponding displacements were measured using a load cell and an optoelectronic camera system, respectively. Chiropractors then performed actual thoracic manipulation to determine if they could maintain their location of contacts (spinous process/transverse process) on the underlying vertebra. RESULTS: Each of the subjects exhibited negligible friction between the thoracic skin and underlying fascia for both the plexiglass and modelled hand contacts. Furthermore, in each case, the apparatus travelled a distance greater than that between two transverse or spinous processes without showing an abrupt change in the slope of the force-displacement curves. The hands of chiropractors performing thoracic manipulation travelled a similar distance during the dynamic thrust. CONCLUSIONS: The skin-fascia interface over the thoracic spine exhibits negligible friction. Therefore, the reaction force from a thoracic vertebra will be normal to the overlying skin. Furthermore, the data show that the ability to "hook" either a thoracic transverse or spinous process in the superior-inferior direction during a manipulative thrust may be greatly over-rated. RELEVANCE: During thoracic spinal manipulation, one cannot direct a force vector to a thoracic vertebra at a given angle by simply directing their thrust in that direction.

Adult↗
PubMed1996

Banked human fascia lata for the suburethral sling procedure: a preliminary report.

OBJECTIVE: To report our initial experience with allogenic (human cadaver donor) fascia lata for the suburethral sling procedure. METHODS: Allogenic fascia lata for the suburethral sling procedure has been used in our practice since July 1994. Fascial grafts were obtained from licensed tissue banks. Women who underwent this procedure were followed prospectively to determine the incidence of perioperative complications, the incidence of local wound complications at the sling insertion site, and the subjective and objective cure rates. RESULTS: Sixteen women underwent the suburethral sling procedure with allogenic fascia. Fourteen had genuine stress urinary incontinence and two required replacement of a previously placed synthetic graft because of chronic infection. Follow-up ranged from 6 months to 1 year. No patient developed sinus tract formation or persistent granulation tissue. Two of 16 patients (12%) developed abdominal wound infections, which resolved with local care. The mean duration of postoperative bladder drainage was 29 days. One patient continued to require intermittent catheterization at 187 days. Among the 14 women with preoperative genuine stress incontinence, the subjective cure rate was 86% and the objective cure rate was 79%. The two patients who required replacement of a chronically infected synthetic graft remained subjectively continent. CONCLUSIONS: These preliminary data suggest that allogenic fascia lata is an acceptable material for the suburethral sling procedure. This material may be considered as an alternative to autologous fascia, which must be harvested from the patient intraoperatively, and to synthetic materials, which have been associated with local complications in up to 40% of cases.

Aged↗
PubMed2000

Cadaveric fascia lata sling: analysis of five recent adverse outcomes.

OBJECTIVES: To report a series of adverse outcomes of urethral sling procedures that used allograft fascia lata and to review the literature regarding the use of this material in genitourinary reconstruction. METHODS: Five neurologically normal patients presented to our center between August 1999 and October 1999 with complaints of recurrent incontinence or voiding dysfunction after undergoing urethral sling procedures at outside institutions that used fascia lata allografts. All patients underwent a thorough evaluation, including history and physical examination, voiding cystourethrography, and urodynamic studies. Sections of fascia were removed for histology in 2 patients at the time of operation. RESULTS: Three patients were diagnosed with de novo bladder outlet obstruction, 1 with recurrent urethral hypermobility, and 1 with intrinsic sphincteric deficiency. Histology of cadaveric fascia demonstrated collagen with almost complete absence of cellularity. There was no evidence of capillary or fibroblast ingrowth. All patients underwent reoperation and have had clinical improvement with short-term follow-up. CONCLUSIONS: Although distressing, the present series of adverse outcomes may simply reflect an overall increase in the number of sling procedures being performed nationally. Although decreased operative time and morbidity have been attributed to the use of fascia lata in urethral sling procedures, it is essential to ensure that long-term safety and efficacy will not be jeopardized before accepting it as a new standard of care.

Adult↗
PubMed2001

High failure rate using allograft fascia lata in pubovaginal sling surgery for female stress urinary incontinence.

OBJECTIVES: To present our unfavorable experiences using allograft fascia lata. Allograft fascia lata is an attractive sling material providing less pain, a shorter operation time, and a reported effectiveness equal to autologous fascia. METHODS: A total of 18 women (mean age 51.7 years, range 37 to 76) underwent pubovaginal sling surgery for stress urinary incontinence between March 1999 and July 1999 and were enrolled in this study. Solvent dehydrated gamma-irradiated human fascia lata with a size of 7 x 2 cm was used as the sling. The results were collected with a questionnaire survey. RESULTS: All patients were followed up for a mean of 9.2 months (range 6.9 to 11.6). Thirteen patients considered the surgery successful or to have provided improvement, with a mean of 82.5% (range 50% to 100%) subjective improvement. Five patients (27.8%) had significant failure with full recurrence of incontinence within 3 to 6 months. CONCLUSIONS: Solvent dehydrated gamma-irradiated allograft fascia is not reliable in pubovaginal sling surgery. The high failure rates within a short period prohibit its use in the operative management of stress urinary incontinence.

Adult↗
PubMed2002

Preservation of muscle fascia to decrease lymphedema after complete axillary and ilioinguinofemoral lymphadenectomy for melanoma.

BACKGROUND: In patients with melanoma, there is considerable concern about the clearance of clinically negative nodes, partly because of the unacceptable morbidity reported after regional lymphadenectomy. The advent of sentinel lymph node biopsies has allowed us to select those patients with positive sentinel lymph nodes for completion node dissections. The purpose of this article is to demonstrate that when complete lymph node dissection is indicated, it can be performed with a low risk of lymphedema using the fascia-preserving technique. STUDY DESIGN: The records of 209 consecutive patients with melanoma who underwent fascia-preserving axillary (n = 116) or ilioinguinofemoral (n = 93) lymphadenectomy by a single surgeon between January 1984 and April 1998 were reviewed. In each operation, care was taken not to disrupt the muscle fascia at the site of lymphadenectomy. RESULTS: In the fascia-preserving axillary group, there were 59 men and 47 women with mean age of 53 years (range 21 to 79 years). There were three recurrences (3%) outside the borders of dissection. Transient upper extremity edema (8%) resolved over a median of 5 months, and permanent upper extremity edema occurred in 5% of patients. In the ilioinguinofemoral group, there were 19 men and 37 women with a mean age of 52 years (range 21 to 88 years). There was one recurrence (2%) outside the borders of dissection. Transient lower extremity edema (48%) resolved over a median of 12 months, and permanent lower extremity edema occurred in 14% of patients. CONCLUSIONS: Preservation of the muscle fascia during lymph node dissection results in a lower incidence of permanent edema, with no increased risk of recurrence.

Adult↗
PubMed2001

Dermatan sulfates of normal and scarred fascia.

We evaluated the composition of dermatan sulfates (DS) derived from 23 samples of normal and 23 samples of scarred fascia lata. We analyzed the molecular weight of intact DS chains and the length of chain regions comprising: (1) clusters of L-iduronate-containing disaccharides ("iduronic sections"); (2) clusters of D-glucuronate-containing disaccharides ("glucuronic sections"); and (3) copolymeric sections with both types of disaccharides. A portion of scarred fascia DS chains demonstrated higher molecular weight compared with those from normal tissue. Most disaccharides of DS chains derived from both fascia types form copolymeric segments - heterogeneous in size - with alternatively distributed single disaccharides with glucuronic residues and mainly single ones with iduronate. Only a small number of disaccharides form "glucuronic sections" of heterogeneous size or short "iduronic sections". However, the scarred fascia DS chains demonstrate an increased content of shorter "glucuronic sections" and shorter, often oversulfated, copolymeric segments. It seems that in normal fascia, the DS chain type with a single, long copolymeric region and a single, shorter "glucuronic section" is predominant, while in scarred tissue an increase in multidomain DS chain content may occur.

Adult↗
PubMed2000

Anatomy of Denonvilliers' fascia and pelvic nerves, impotence, and implications for the colorectal surgeon.

BACKGROUND: The development and anatomy of Denonvilliers' fascia have been controversial for many years and confusion exists about its operative appearance. Better appreciation of this poorly understood anatomy, and its significance for impotence after rectal dissection, may lead to further functional improvements in pelvic surgery. METHOD: A literature review of the embryology and anatomy of Denonvilliers' fascia and impotence after pelvic rectal surgery was undertaken. RESULTS: Denonvilliers' fascia has no macroscopically discernible layers. The so-called posterior layer refers to the fascia propria of the rectum. The incidence of erectile and ejaculatory dysfunction after rectal excision is high in older patients, and when performed for rectal cancer. There is no consensus about the relationship of Denonvilliers' fascia to the plane of anterior dissection for rectal cancer. CONCLUSION: Colorectal surgeons should focus on the important anatomy between the rectum and the prostate to improve functional outcomes after rectal excision. A classification of the available anterior dissection planes is proposed. Surgeons should be encouraged to document the plane used as well as outcome in terms of sexual function.

Autonomic Nervous System↗
PubMed2001

Treatment of temporomandibular joint ankylosis with temporalis muscle and fascia flap.

This study sought to determine the efficacy of interpositional arthroplasty with temporalis muscle and fascia flap in the treatment of unilateral temporomandibular joint (TMJ) ankylosis in adults. This retrospective study of seven cases evaluated the postoperative results of interpositional arthroplasty on temporalis muscle and fascia flap in adults. The operative protocol for unilateral TMJ ankylosis entailed, (1) resection of ankylotic mass, (2) intraoral ipsilateral coronoidectomy, (3) contralateral coronoidectomy when necessary, (4) interpositional tissue transfer to the TMJ with temporalis muscle and fascia flap, (5) maxillomandibular fixation (MMF), and (6) early mobilization and aggressive physiotherapy. The results of this protocol were encouraging, while the functional results of interpositional arthroplasty on temporalis muscle and fascia flap were satisfactory. The findings of this study support the use of temporalis muscle and fascia flap in adult patients with unilateral TMJ ankylosis. Early postoperative initial exercise, physiotherapy, and strict follow-up play an important role in preventing postoperative adhesions.

Adult↗
PubMed2000

Congenital fascial dystrophy: abnormal composition of the fascia.

BACKGROUND: A scleroderma-like genetic disease, congenital fascial dystrophy, probably a variant of stiff skin syndrome described by Esterly and McKusick, was found to be related to genetically determined fascial abnormalities. Our previous electronmicroscopic study disclosed as a main pathologic finding presence of giant amianthoid-like collagen fibrils in the affected fascia. OBJECTIVE: The aim of the present study was to disclose the collagen abnormalities in the affected and control fascias and in the patient's fibroblast cultures derived from the skin and fascia. METHODS: The study was performed by histologic, immunohistochemical, and electronmicroscopic techniques. Immunohistochemical studies were done with the use of monoclonal antibodies: anti-collagens I, III, IV, and VI, anti-laminin, anti-fibronectin, anti-desmin, anti-spectrin, anti-vimentin, anti-laminin, anti-heparan sulfate, and anti-alpha-actinin. Electronmicroscopic studies were performed on the fascia sections and on cultured fibroblasts. RESULTS: The main abnormality leading to giant collagen fibril formation was presence of myofibroblasts, absence of collagen III, and overproduction of spectrin and collagen type VI, mainly its filamentous form. CONCLUSION: Our findings suggest that the abnormal composition of the fascia could depend on modulation of fibroblasts into myofibroblasts capable of producing spectrin and long-spacing collagen.

Child↗