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At least 199 records · Page 11Linked to original sources
PubMed1998

Long-term results of frontalis suspension using irradiated, banked fascia lata.

This study was undertaken to study the long-term rate of recurrence of ptosis and other postoperative complications after frontalis suspension using banked irradiated fascia lata. One hundred thirty-two lids of 72 patients underwent frontalis suspension between 1980 and 1989. The preoperative diagnoses included severe congenital ptosis (83%), blepharophimosis (10%), third nerve palsy (4%), and chronic progressive external ophthalmoplegia (3%). The age at the time of surgery ranged from 5 months to 19 years, with an average of 3 years and 5 months. In 46 patients (64%), surgery was done before age 3 years. The follow-up time ranged from 6 to 15 years, with a mean and median of 10 years. Good to excellent lid height was achieved immediately after surgery in all but three patients. Recurrence of ptosis occurred in 20 cases (28%), and 28 lids (21%). The time to reoperation ranged from 1 to 7 years, with an average of 3 years. Sixteen patients (80%) with recurrence were younger than 3 years of age. Reaction to donor fascia lata occurred in only two patients (3%). Only one patient suffered from excessive exposure keratopathy and required revision of the sling. Banked fascia lata is easy to use and should be considered as an alternative suspensory material in children younger than 3 years of age with congenital ptosis. The long-term reoperation rate in this cohort of patients was higher than the 5% rate reported for autogenous fascia, but lower than that previously reported for banked fascia lata (50% at 8 years).

Adolescent↗
PubMed1997

The anatomy and embryological origins of the fascia of Denonvilliers: a medico-historical debate.

PURPOSE: We reviewed the conflicting theories concerning the anatomy and embryological derivation of Denonvilliers' fascia since its first description in 1836. MATERIALS AND METHODS: An extensive review of the literature for the last 160 years was done. RESULTS: Various studies contributed to the debate on the anatomy and origins of Denonvilliers' fascia. We chose to review these studies because of their sound methodology, large numbers of cases and results, and the high quality of the macroscopic and/or microscopic evidence. CONCLUSIONS: Denonvilliers' fascia consists of a single layer arising from fusion of the 2 walls of the embryological peritoneal cul-de-sac. Histologically, it has a double-layered quality. The fascia of Denonvilliers extends from the deepest point of the interprostatorectal peritoneal pouch to the pelvic floor. A so-called posterior layer is in reality the rectal fascia propria.

Anatomy↗
PubMed2001

Fascia augmentation of the vocal fold: graft yield in the canine and preliminary clinical experience.

INTRODUCTION: Glottal insufficiency resulting from vocal fold bowing, hypomobility, or scar is frequently treated by injection augmentation. Injection augmentation with fat, collagen, gel foam, polytef, and recently, fascia lata has been previously reported. Variable graft yield and poor host-tissue tolerance have motivated the continued search for an ideal graft substance. STUDY DESIGN: A prospective trial of autologous fascia augmentation of the vocal cord in the human and in an animal model. METHODS: Autologous fascia injection augmentation (AFIA) was evaluated in 8 canines and 40 patients at our institution between 1998 and 2000. The animal study compared graft yield from AFIA with autologous fat yield. The outcome measure was graft yield calculated from histological examination of larynges 12 weeks after injection augmentation. Clinical trial outcome measures included symptom surveys, acoustical voice analyses, and subjective voice assessments. Mean follow-up was 9 months. RESULTS: In the canine larynx, the mean graft yield for AFIA was 33% (range, 5%-84%) compared with autologous lipoinjection (47%; range, 7%-96%; P =.57). Subjective improvement in vocal quality was reported by 95% of patients (38 of 40) after AFIA. Preoperative and postoperative voice analysis data were obtained from 26 patients. Subjective voice rating demonstrated a significant improvement after AFIA (P <.0001). Acoustical parameters of jitter, shimmer, noise-to-harmonic ratio, phonatory range, and degree unvoiced improved significantly (P <.05) in all patients after fascia augmentation. CONCLUSIONS: Based on the animal study, we concluded that graft yields are excellent but variable for AFIA. The result is similar in variability and overall yield to autologous lipoinjection. Subjective and objective analyses of voice outcomes after AFIA are universally improved. Fascia appears to be an excellent alternative to lipoinjection in properly selected cases of glottic insufficiency.

Adipose Tissue↗
PubMed1990

Transaxillary subpectoral augmentation in the ptotic breast: augmentation by disruption of the extended pectoral fascia and parenchymal sweep.

A new approach to transaxillary subpectoral breast augmentation based on an understanding of the anatomy of the extended pectoral fascia and the inframammary fold allows for the widespread application of this technique. Previous authors have stated that transaxillary augmentation is only applicable to a small subset of the general population and is contraindicated in mild degrees of ptosis or in large augmentations. The new approach, augmentation by disruption of the extended pectoral fascia technique and the parenchymal sweep maneuver, prevents high-riding implants and double folds. By disrupting the fascia, the lower portion of the implant is able to sit in a partially subglandular rather than subfascial plane. The anatomy and clinical implications of the extended pectoral fascia are discussed, as is the augmentation by disruption of the extended pectoral fascia technique. The parenchymal sweep maneuver is also described. Clinical cases are presented.

Breast↗
PubMed1997

Scarpa's fascia flap: anatomic studies and clinical application.

Fascia and fascia-subcutaneous flaps are thin, pliable, and well-vascularized tissue with aesthetic and functional advantages, particularly for the extremities and in the head and neck region. Although various donor sites have been used for these flaps, there is an occurrence of unsatisfactory donor-site defects that are often complicated by conspicuous, widened scars or alopecia. In addition, flap elevation is sometimes prolonged because of the demanding operative procedures as well as the impossibility of a two-team approach. In this anatomic and clinical study we present a new fascial flap that results in a minimal donor-site defect and a short and easy operative procedure. Scarpa's fascia, which can be used as both a free and a pedicled flap, is a well-defined single membranous sheet within the subcutaneous tissue layer at the lower abdominal wall. We studied its distribution, structure, and vascular supply in 27 fresh cadaver specimens. In addition, computed tomographic (CT) and ultrasound studies were performed in 13 healthy volunteers and in 3 cadavers before and after injection of diluted contrast material in the superficial epigastric artery. Finally, histologic examinations were done with hematoxylin and eosin or with reticulum and elastin. Our studies showed that Scarpa's fascia provides a thin, pliable, and well-vascularized flap pedicled on the superficial epigastric artery. After successful application of the Scarpa's fascia flap as a free flap in 3 patients and as a pedicled option in 1 patient, we can recommend this flap as a valuable tool for the reconstructive surgeon.

Abdominal Muscles↗
PubMed2005

A novel technique of harvesting temporalis fascia autografts for correction of recurrent blepharoptosis.

Patients with poor levator function require ptosis correction by a sling procedure. A variety of synthetic materials are available for this suspension, but there is a recognized complication rate. Autografts are less prone to infection and extrusion than alloplastic materials. Harvesting temporalis fascia has a number of advantages over the use of fascia lata and outcomes have been effective. Although we recommend the use of autogenous material for slings whenever possible, if alloplastic materials are used and subsequently fail, then temporalis fascia is our preferred solution. We describe a novel technique of harvesting the temporalis fascia and present 4 patients (6 eyelids) with failed silicone slings who were managed with temporalis fascia autograft. Follow-up ranged from 5 to 32 months. The average improvement in palpebral aperture was 3.6 mm (78%).

Adult↗
PubMed2004

Efficacy and morbidity of autologous fascia lata sling cystourethropexy.

PURPOSE: Sling cystourethropexy for intrinsic sphincter deficiency has more recently been accepted as effective surgical treatment for all types of stress urinary incontinence. We report our experience using autologous fascia lata for sling cystourethropexy, regarding treatment efficacy, harvest site morbidity and patient satisfaction. MATERIALS AND METHODS: A retrospective data base review identified all women who underwent sling cystourethropexy using autologous fascia lata for stress urinary incontinence. A followup survey study using questionnaires (Black and Urogenic Distress Inventory-6) combined with questions regarding pad use, satisfaction and leg morbidity was done. RESULTS: A total of 100 women who could be contacted and who had undergone autologous fascia lata sling cystourethropexy performed by a single surgeon between 1993 and 2002 were surveyed. Mean patient followup was 4.4 years (range 0.8 to 9.3). Of the women 85% stated that they were dry or improved and 93% were pain-free at the harvest site by 7 days. There was no harvest site infection and no lower extremity thrombotic complication. Of the patients 83% indicated that the procedure had a positive effect on their life with only 4% stating that it had a negative effect, while 77% were satisfied with the procedure, 82% would recommend the procedure to a friend with incontinence and 83% would undergo the procedure if making the decision again. CONCLUSIONS: Autologous fascia lata sling cystourethropexy is associated with high patient satisfaction and treatment efficacy comparable to that of other sling cystourethropexy materials, as determined by questionnaire. Harvest site morbidity is low. Sling cystourethropexy using autologous fascia lata should be considered as a primary surgical approach in women with stress urinary incontinence.

Fascia Lata↗
PubMed2005

Live demonstration of microcirculation in the deep fascia and its implication.

The rich vascular network in the deep fascia has been emphasized by various scientists, but the actual demonstration of live circulation in the deep fascia has not previously been witnessed. Encouraged by the sight of live circulation in the web membrane of toad hind limb, a successful attempt was made to demonstrate the live circulation in the vascular network of the deep fascia. Fascial extensions of inferiorly based fasciocutaneous flaps were dissected in five patients with distal leg and heel defects. The fascial extension in continuity with a proximal retrograde fasciocutaneous flap was mounted on a glass slide and examined under a microscope. The authors witnessed the live microcirculation and the movement of individual red blood corpuscles in vascular channels of the deep fascia. The authors also noticed that the deep fascia has two layers with circulations that are independent of one other. A video recording was made to document these important features.

Adolescent↗
PubMed2005

Anatomy of pectoral fascia in relation to subfascial mammary augmentation.

The aim of this study is to elucidate the anatomic details of the pectoral fascia in relation to subfascial breast augmentation.Thirty-two breasts of Korean cadavers were dissected and studied grossly and microscopically. The superficial pectoral fascia (SPF) was easily undermined and separated with an Agris-Dingman dissector. A gentle pushing force by the dissector could stretch the SPF and extend the subfascial pocket further at the lateral border of pectoralis major muscle (PM). The dissector head stayed inside the pocket, not perforating through the fascia. Near the inferior border of PM at the level of the sixth intercostal space, the dissection was hard to advance down beyond rectus abdominis muscle (RA). Yet a continuous vigorous dissection led into the subcutaneous layer of the abdominal wall over RA. The SPF is thick and continues to superficial axillary fascia at the lateral end of the muscle. At the inferior border of the PM (sixth intercostal space), however, the pectoral fascia became thin and feeble. The subfascial implants should be placed under the SPF, laterally beyond the lateral border of PM and inferiorly under the glandular tissue of the breast below the sixth intercostal space.

Adult↗
PubMed2004

One-stage reconstruction of large midline abdominal wall defects using a composite free anterolateral thigh flap with vascularized fascia lata.

OBJECTIVE: Large midline abdominal wall defects are continuously a challenge for reconstructive surgeons. Adequate skin coverage and fascia repair of the abdominal wall is necessary for achieving acceptable results. The purpose of this paper is to present a new approach to abdominal wall reconstruction using a free vascularized composite anterolateral thigh (ALT) flap with fascia lata. METHODS: Seven patients with large full-thickness abdominal wall defects were successfully reconstructed by means of a composite ALT flap combined with vascularized fascia lata. The size of the skin islands ranged from 20 to 32 cm in length and 10 to 22 cm in width, and the vascularized fascia lata sheath measured 14 to 28 cm and 8 to 18 cm, respectively. Functional outcome of the abdominal wall strength and donor thigh morbidity were investigated by using a Cybex kinetic dynamometer. RESULTS: All flaps survived. No postoperative ventral hernia occurred except for one mild inguinal incision hernia. Subjectively there were no significant donor site problems. Objective assessment was performed in 4 patients 2 years postoperatively. In the reconstructed abdomen, isokinetic concentric and eccentric measurements of extension/flexion ratios of the abdominal wall strength showed no apparent decrease compared with other references. Functional evaluation of quadriceps femoris muscle contraction forces after free ALT composite flap harvest showed an averaged deficit of 30% as compared with the contralateral legs. However, no difficulties in daily ambulating were reported by the patients. CONCLUSION: The free composite ALT myocutaneous flap with vascularized fascia lata provides an alternative option for a stable repair in complex abdominal wall defects.

Abdominal Wall↗
PubMed1982

Tissue culture of surgically prepared temporalis fascia.

Temporalis fascia which is used to graft the tympanic membrane has been shown to be viable in tissue culture by a previous pilot study. This present study reports the effect on the viability of the fascia by scraping loose connective tissue from it and allowing it to dry. Pieces of fascia from 30 patients were each divided in 4 and prepared to give explants, fresh, fresh and scraped, dried, and dried and scraped. The fascia grew from 17 patients when cultured fresh, 5 when fresh and scraped, 1 when dried, and none when dried and scraped. These results are significantly different and show that the fascia is devitilized when prepared by the normal method for use in tympanoplasty.

Culture Techniques↗
PubMed2006

Sub-diaphragmatic fascia: role in the recurrence of hiatal hernias.

One of the most common causes of a failed Nissen fundoplication is disruption of the crural repair. We investigated the thickness of the subdiaphragmatic fascia overlying the right and left limb of the right crus in cadavers to determine any difference. Sub-diaphragmatic fascia specimens were obtained from three sites adjacent to the hiatus in 20 preserved cadavers. One square centimeter of fascia was excised 3 cm from the arch of the hiatus on each side and approximately 2-3 mm from the edge of the hiatal opening (labeled RL and LPL). A third sample was taken 1 cm from the arch of the hiatus on the left side (labeled LAL). The thickness of these tissues was measured. The mean tissue thickness of RL, LPL and LAL were 0.22 mm, 0.23 mm and 0.4 mm, respectively. There was no difference in tissue thickness between the lower specimens on both sides (RL vs. LPL); however, LAL was significantly thicker than both RL and LPL (P < 0.05). The thickness of the subdiaphragmatic fascia overlying the right and left limb of the right crus does not differ significantly in the region used for crus closure during antireflux surgery; however, the fascia on the left is thicker anteriorly.

Cadaver↗
PubMedDate not supplied

A biomechanical analysis of solvent-dehydrated and freeze-dried human fascia lata allografts. A preliminary report.

UNLABELLED: This study compares the basic mechanical properties of two groups of commercially available fascia lata allografts processed by different means (solvent-dehydrated and sterilized via gamma radiation, and freeze-dried without secondary sterilization). The results reveal significantly (P less than 0.05) higher stiffness, higher maximum load to failure, and higher maximum load per unit width of graft with the solvent-dried as opposed to the freeze-dried fascia lata. Subsections of individual solvent-dried specimens were also more uniform in their mechanical properties than those of the freeze-dried allografts. CLINICAL RELEVANCE: Fascia lata is used as a graft material in a variety of orthopaedic procedures. Allograft fascia lata offers an increased cross-sectional area of material and eliminates the morbidity associated with the harvesting of autologous tissues. However, the structural uniformity of such large grafts has been questioned. Processing techniques used in the sterilization and storage of such grafts is varied and represents a potential source of variation in the mechanical properties of allograft specimens. The results of this study suggest that a commercially available solvent-dehydrated form of fascia lata provides a more suitable grafting material than freeze-dried specimens obtained from tissue banks.

Adult↗
PubMed1991

Quantifying the spread of botulinum toxin through muscle fascia.

Botulinum toxin was recently approved for treating several head and neck dystonias. Paralysis of neighboring muscles is the major complication of its use. Spread of toxin from the injected muscle has been suggested as an etiology. This study examines how botulinum toxin crosses muscle fascia by a novel method of quantifying muscular paralysis. Botulinum toxin (0.2 to 10 U) was placed onto the fascia of rat tibialis anterior (TA) muscles (n = 6). Toxin was also placed on dose-matched muscles that had their fascia surgically removed (n = 6). Twenty-four hours later, the nerve to the tibialis anterior was electrically stimulated to deplete the muscle fibers of glycogen. Toxin-paralyzed fibers retained their glycogen and appeared purple on periodic acid-Schiff (PAS) stain. Botulinum toxin easily passed through muscle fascia even at subclinical doses. The presence of fascia reduced the spread of botulinum toxin by 23%. These results suggest that spread of botulinum toxin can be prevented only by delivering small doses to the center of a target muscle.

Animals↗
PubMed2003

Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study.

BACKGROUND: Approximately 10% of patients with plantar fasciitis have development of persistent and often disabling symptoms. A poor response to treatment may be due, in part, to inappropriate and nonspecific stretching techniques. We hypothesized that patients with chronic plantar fasciitis who are managed with the structure-specific plantar fascia-stretching program for eight weeks have a better functional outcome than do patients managed with a standard Achilles tendon-stretching protocol. METHODS: One hundred and one patients who had chronic proximal plantar fasciitis for a duration of at least ten months were randomized into one of two treatment groups. The mean age was forty-six years. All patients received prefabricated soft insoles and a three-week course of celecoxib, and they also viewed an educational video on plantar fasciitis. The patients received instructions for either a plantar fascia tissue-stretching program (Group A) or an Achilles tendon-stretching program (Group B). All patients completed the pain subscale of the Foot Function Index and a subject-relevant outcome survey that incorporated generic and condition-specific outcome measures related to pain, function, and satisfaction with treatment outcome. The patients were reevaluated after eight weeks. RESULTS: Eighty-two patients returned for follow-up evaluation. With the exception of the duration of symptoms (p < 0.01), covariates for baseline measures revealed no significant differences between the groups. The pain subscale scores of the Foot Function Index showed significantly better results for the patients managed with the plantar fascia-stretching program with respect to item 1 (worst pain; p = 0.02) and item 2 (first steps in the morning; p = 0.006). Analysis of the response rates to the outcome measures also revealed significant differences with respect to pain, activity limitations, and patient satisfaction, with greater improvement seen in the group managed with the plantar fascia-stretching program. CONCLUSIONS: A program of non-weight-bearing stretching exercises specific to the plantar fascia is superior to the standard program of weight-bearing Achilles tendon-stretching exercises for the treatment of symptoms of proximal plantar fasciitis. These findings provide an alternative option to the present standard of care in the nonoperative treatment of patients with chronic, disabling plantar heel pain.

Achilles Tendon↗
PubMed2005

The effects of bone marrow-derived mesenchymal stem cells and fascia wrap application to anterior cruciate ligament tissue engineering.

After an anterior cruciate ligament (ACL) injury, surgical reconstructions are necessary in most cases, either with autografts, allografts, or artificial ligaments. Potential tissue-engineered ligaments would circumvent the disadvantages apparent in these methods. While seeding of mesenchymal stem cells (MSCs) and fascia wrap could potentially improve tissue regeneration and mechanical properties, their exact roles were evaluated in the current study. Knitted biodegradable scaffolds of poly-L-lactic acid (PLLA) and poly-glycolic-lactic acid (PGLA) yarns were used to reconstruct ACL in 48 rabbits. These were divided into four equal groups: only knitted scaffolds were used in group I; knitted scaffolds and mesenchymal stem cells were used in group II; knitted scaffolds, MSCs, and fascia lata were used in group III; knitted scaffolds and fascia lata were used in group IV. Carboxyfluorescein diacetate (CFDA)-labeled MSCs were used to trace the fate of seeded cells in groups II and III. Histology, Western blot analysis, and mechanical properties of reconstructed ACL were analyzed after 20 weeks. Fibroblast ingrowths were seen in all four groups while CFDA-labeled MSCs could be found after 8 weeks of implantation in groups II and III. Both the amount of collagen type I and collagen type III in groups III and IV were significantly higher than in group II, which was much higher than in group I. Both maximal tensile loads and stiffness of the reconstructed ACLs in groups I, II, III, and IV were significantly lower than normal controls after 20 weeks of implantation. It is concluded that MSCs could promote synthesis of collagen type I and collagen type III in tissue-engineered ligaments, while fascia wraps have stronger effects. Both MSC seeding and fascia wrap could not enhance ultimate tensile load and stiffness.

Animals↗
PubMed2002

[Experimental study on repair of articular cartilage defect in large area with chondrocytes cultured on fascia].

OBJECTIVE: To study the biological characteristic and potential of chondrocytes grafting cultured on fascia in repairing large defect of articular cartilage in rabbits. METHODS: Chondrocytes of young rabbits were isolated and sub-cultured on fascia. The large defect of articular cartilage was repaired by grafts of freeze-preserved and fresh chondrocytes cultured on fascia, and free chondrocytes respectively; the biological characteristic and metabolism were evaluated by macroscopic, histological and immunohistochemical observations, autoradiography method and the measurement of nitric oxide content 6, 12, 24 weeks after grafting. RESULTS: The chondrocytes cultured on fascia maintained normal growth feature and metabolism, and there was no damage to chondrocytes after cryopreservation; the repaired cartilage was similar to the normal cartilage in cellular morphology and biological characteristics. CONCLUSION: Chondrocytes could be cultured normally on fascia, which could be used as an ideal carrier of chondrocytes.

Animals↗
PubMedDate not supplied

Scleral fixation of posterior chamber intraocular lenses using fascia lata to cover the knots.

BACKGROUND AND OBJECTIVE: To describe the use of fascia lata to cover the polypropylene knots of scleral fixated posterior chamber intraocular lenses (PCIOL). PATIENTS AND METHODS: Fascia lata was used to cover the knots of scleral fixated PCIOL in 5 eyes with significant scleral thinning. Four of the 5 eyes had the PCIOL insertion and the fascia lata patching in the same setting. The fifth eye previously had scleral fixated PCIOL with late suture erosion through a partial thickness scleral flap. RESULTS: There was no suture exposure or graft thinning throughout a follow-up period of 8 to 16 months. The eyes tolerated the fascia lata well with no early or late postoperative complications. CONCLUSION: Fascia lata provides an effective means to cover the knots of scleral fixated PCIOL, especially in aphakic patients with significant scleral thinning.

Adult↗