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PubMed2003

Degenerative lesions of the plantar fascia: surgical treatment by fasciectomy and excision of the heel spur. A report on 38 cases.

The authors studied 38 cases of degenerative lesions of the plantar fascia which were treated surgically between 1989 and 1999. MRI showed chronic fasciitis in eight cases and an old rupture of the plantar fascia in 30 cases. Surgical treatment, which was performed in all cases after failure of conservative treatment of several months duration, combined excision of the fascia with resection of the heel spur. Histological examination found inflammation in all cases (fasciitis or rupture), calcification of the aponeurosis in four cases, cartilaginous metaplasia in four and fibromatosis in four. Patients were assessed a minimum of one year and a maximum of seven years after operation. The postoperative results were assessed using three criteria: resolution of pain, results on the static foot and patients' functional activity. Overall there were 24 very good and good results, nine fair and five poor. MRI performed at the time of follow-up revealed good healing of the plantar fascia in 16 cases, defects in two cases, inflammation in seven cases and defects associated with inflammation in 13 cases. Surgical treatment may be considered in cases where conservative treatment of talalgia has failed. Symptoms originating from degenerative damage to the plantar fascia, such as rupture or fasciitis, may benefit from fasciectomy. Short-term results show resolution of pain in 75% of cases, and a slight sagging of the plantar arch. Pre-operative MRI study is useful to determine the exact location of the lesions.

Adult↗
PubMed1992

Bone regeneration and tissue acceptance of human fascia lata grafts adjacent to dental implants: a preliminary case report.

The biologic principle of guided tissue regeneration (GTR) has been studied extensively in hopes of regenerating alveolar bone. Various materials have been utilized as regenerative membranes; however, all materials have disadvantages, and the ideal membrane material is yet to be identified. In this case report, human freeze-dried fascia lata strips were used as a regenerative barrier membrane in conjunction with the placement of endosseous root implants and demineralized, freeze-dried bone allograft. The major advantage in the use of human fascia lata for guided tissue regeneration is that a second procedure to remove the material is not necessary, and the fascia is accepted by the surrounding tissues without complication. There is acceptance of four endosseous root-form dental implants that were immediately placed into fresh extraction sockets and covered with demineralized freeze-dried bone allograft (DFDBA), with human freeze-dried fascia lata used to serve as a biocompatible, collagenous, regenerative augmentation membrane over the dental implants. The biologic concept of GTR is clinically applied to increase the dimensions of the edentulous, maxillary alveolar ridge with use of human freeze-dried fascia lata barrier membranes.

Adolescent↗
PubMed2003

[Effect of 17 beta-estradiol and phytoestrogen daidzein on the proliferation of pubocervical fascia and skin fibroblasts derived from women suffering from stress urinary incontinence].

OBJECTIVES: The past decade has witnessed many publications indicating that estrogens play an important role in the function of the female lower urinary tract. Sex steroids receptors have been discovered in areas of the brain involved in the initiation and control of micturition, as well as other target tissues: bladder, urethra and pubocervical fascia. Connective tissue metabolism and collagen biosynthesis are modulated by ovarian steroids. Estrogen deficiency has been linked to the reduction of total vaginal and periurethral collagen content. Therefore, menopause and hypoestrogenism have been associated with several urogenital complaints including stress urinary incontinence (SUI), urgency, recurrent infection and genitourinary prolapse. DESIGN: The main purpose was to evaluate the proliferation ability of fibroblasts from pubocervical fascia after exposure to 17 beta-estradiol and phytoestrogen daidzein. MATERIALS AND METHODS: Specimens of human pubocervical fascia were obtained from 8 perimenopausal women during IVS procedure. Fibroblasts were isolated and cultured by outgrowth technique. After reaching confluency fibroblasts were subcultured every four days and cells after passage number 3 to 8 were used for assessment. Next day culture medium was changed and cells were exposed to serial dilutions of 17 beta-estradiol and daidzein in medium supplemented with only Serum Replacement 2. Cell proliferation was assessed after 96 hrs by means of MTT method. A human skin fibroblast culture served as a control. RESULTS: Pubocervical fascia fibroblasts showed increased proliferation capacity after 17 beta-estradiol than daidzein treatment. Proliferative activity of skin fibroblast was lower when compared to genitourinary cells in all groups investigated. CONCLUSIONS: The results indicate that, at least in vitro, fibroblasts from pubocervical fascia taken from women suffering from SUI are more capable to proliferate after estrogen treatment, when compared to skin fibroblasts. This is an indirect rationale for local estrogen treatment in case of female SUI.

Adult↗
PubMed1991

[The reality and usefulness of Halban's fascia].

The authors, in this article, have reviewed the different proofs that confirm that Halban's fascia does exist. The authors have been able to find, separate out and use Halban's fascia in a series of 263 vaginal operations for genital prolapse taking the anatomo-surgical approach. From the histological approach, they have shown that Halban's fascia is constituted by fibro-connective tissue strips between which there are large numbers of blood vessels and muscles and nerve endings. From the point of view of embryogenesis, they believe that Halban's fascia comes from the same mesenchyme layer as that which gives rise to the corpus spongiosus of the penis. As far as sexual physiology is concerned, the authors review the various clinical experiments that have been carried out throughout the world medical literature which shows that there is an erogenous zone in the upper anterior part of the vagina and they believe that Halban's facia, which is homologous with the corpus spongiosus, is the site of origin of vaginal orgasm. Finally, as far as physiology and biology of reproduction is concerned, they believe that the vaginal fluid that is secreted by Halban's fascia during intercourse plays an important role for the survival of spermatozoa.

Fascia↗
PubMed1990

[Development of the rectal fascia].

The development of the fascia recti was investigated by 300-600 microns thick sections through the pelves of 8-35-week-old human fetuses, of newborn children and adults. The pelves were impregnated with an epoxy resin and cut with a diamond wire-saw. We here report that the fascia recti develops as part of the adventitia recti. In 9-week-old fetuses the latter consists of condensed mesenchyme which in 18-20-week-old fetuses develops to a fibrous connective tissue surrounding the rectum. In newborn children adipose tissue starts spreading between the connective tissue lamellae of the adventitia recti and thereby separates them. The most external of these connective tissue lamellae is rather dense and can be regarded as fascia recti. In the adult we found it not always as strongly marked as in newborn children. The close developmental relations between the fascia recti and the tissue of the adventitia recti might be seen as cause for the temporary stop of tumor spread at the fascia recti.

Adipose Tissue↗
PubMed1987

The dorsal thoracic fascia: anatomic significance with clinical applications in reconstructive microsurgery.

The anatomic distribution and potential arterial flow patterns of the circumflex scapular artery were investigated by Microfil injection. These studies demonstrated that the circumflex scapular artery lies within the dorsal thoracic fascia, which plays a significant role in the circulation of the overlying skin and subcutaneous tissue. We conclude that scapular/parascapular flaps are fasciocutaneous flaps, the dorsal thoracic fascia can be transferred as a free flap without its overlying skin and subcutaneous tissue, and intercommunication exists between the myocutaneous perforators of the latissimus dorsi myocutaneous flap and the vascular plexus of the dorsal thoracic fascia. We present microvascular cases in which the vascular properties of the dorsal thoracic fascia facilitated wound closure with free fascia flaps or expanded cutaneous or myocutaneous flaps.

Adult↗
PubMed1981

[Afferent and efferent innervation of the human fascia lata femoris during prenatal ontogeny].

The broad fascia have been studied in 256 extremities of human embryos and fetuses treated by methods of impregnation after Bielschowsky - Gros and Rasskazova, histologically after Falck - Hillarp - Govyrin, Karnovsky - Roots and by incubation of slices in 2% glyoxylic acid. The first neural elements as fasciculi of neural fibres are discovered in 8-9 week-old embryos. Cholinesterase and catecholamines are detected in nerves of the vegetative neural system on the 11-12th week of the intrauterine life, thus demonstrating the appearance of the mediator stage in functioning the autonomic nervous system. Receptor structures having the appearance of simple branching bushes are revealed in the broad fascia in 3-3.5-month-old fetuses. During prenatal ontogenesis the neural apparatus of the broad fascia is becoming more complex, the number of types and total amount of free and incapsulated receptors are increasing, the latter being revealed in 5-month-old fetuses. At the stage of development free neural terminals predominate, and by the time of birth, the number of incapsulated receptors is increasing. The greatest number of the neural terminals are situated in the anterior and external parts of the broad fascia. Cholinergic and adrenergic neural fibers from plexus in the broad fascia, situating mainly near blood vessels.

Adrenergic Fibers↗
PubMed1994

[Anatomical consideration of anesthetic dispersion into abdominal cavity causing broad unilateral anesthesia after inadvertent local anesthetic infusion into endothoracic fascia].

Recently we reported a case of inadvertent migration of an epidural catheter into the endothoracic fascia. Anesthetic injection into the fascia brought a broad unilateral analgesia. To clarify the mechanism of anesthesia. We studied how the anesthetic agent spreads into the abdominal cavity from the endothoracic fascia. The crimson dye, the substitute of the anesthetic agent, reached the transversial fascia in the abdominal cavity through medial and lateral arcuate ligament. Subcostal nerve, iliohypogastric nerve, ilioinguinal nerve, genitofemoral nerve and lateral femoral cutaneous nerve were found to be in the course of dye dispersion. The renal adiposal fascia plays a role of a reservoir for the anesthetic agent and prevents the further anesthetic dispersion.

Abdomen↗
PubMed1997

Pubovaginal slings using fascia lata for the treatment of intrinsic sphincter deficiency.

PURPOSE: Various materials and techniques have been used to construct a pubovaginal sling. We believe that fascia lata has several advantages and report our experience. MATERIALS AND METHODS: A total of 32 female patients with urodynamically proved intrinsic sphincter deficiency underwent a pubovaginal sling procedure using fascia lata. An unscarred fascial strip 24 to 28 x 2 cm. was attached to itself over a 3 to 4 cm. bridge of abdominal wall fascia. Results were tabulated by chart review and an independent patient survey. RESULTS: Chart review revealed that 28 of 32 patients (87%) required no pads, and 3 improved and 1 did not. An independent patient survey revealed that 70% of patients (21 of 30) required no pads, 20% required 1 to 3 small pads and 10% required more than 3 small pads per day. Of the patients 80% would undergo the procedure again. CONCLUSIONS: Excellent results can be obtained with fascia lata for the treatment of intrinsic sphincter deficiency. A long, wide strip of fascia attached to itself allows for precise tensioning and good urethral closure, and minimizes the risk of obstruction.

Adult↗
PubMed1997

The perinephric space and renal fascia: review of normal anatomy, pathology, and pathways of disease spread.

The perinephric space is a cone-shaped retroperitoneal compartment containing the kidney, adrenal gland, perinephric fat, fibrous bridging septa, and a rich network of perirenal vessel and lymphatics. Perinephric space pathology may originate from within or outside the confines of the perirenal fascia. Most intrinsic perinephric space disease arises from the kidney or adrenal gland, and secondarily involves the perinephric space. Disease originating outside the cone of renal fascia may spread to the perinephric space via lymphatics (i.e., metastatic spread) or by directly transgressing perirenal fascial planes (e.g., invasive tumor or infections). Additionally, infiltrating soft tissue or rapidly accumulating retroperitoneal fluid may travel into or out of the perinephric space via perinephric bridging septa and renal fascia. In this article, we review the normal anatomy of the perinephric space and renal fascia, emphasizing the significance of retroperitoneal interfascial planes and perinephric bridging septa as a potential conduit for retroperitoneal disease spread. This review of normal anatomy and pathways of disease spread serves as background for a discussion of a variety of specific pathologic conditions that may involve the perinephric space and retroperitoneal fascia, including pancreatitis, retroperitoneal hematoma, urinoma, metastatic disease, and perirenal varices.

Diagnostic Imaging↗
PubMed1975

Crossed pathways from the entorhinal area to the fascia dentata. I. Normal in rabbits.

The entorhinal area projects to the Ammon's horn and the fascia dentata by way of the medial and lateral perforant paths that originate in the medial and lateral part of that area, respectively. The two tracts terminate at different laminar levels in the molecular layers of the ipsilateral hippocampal regio inferior and fascia dentata. Using the Fink-Heimer technique, each of the perforant paths in the normal rabbit is now shown to innervate the antero-dorsal extremes of the Ammon's horn and fascia dentata in both hemispheres. The crossed and uncrossed components of each path innervate homotopic zones on each side. This bilateral innervation contrasts with the situation in the rat where only very weak crossed components exist. Degeneration particles in the fascia dentata contralateral to a lesion of the perforant paths diminish in number along the course of the fibers as they proceed away from the midline, but are traceable for several millimeters. Crossed fibers are shown to pass from one hemisphere into the other directly through the fused molecular layers of the fasciae dentatae. The bilateral innervation in the rabbit indicates that even though the axons of the perforant paths are highly specific with respect to the class of neuron and the dendritic segments upon which they form synapses, they apparently do no possess a mechanism by which they can distinguish between the receptive fields in the two hemispheres. It is concluded that during ontogeny the perforant path fibers from both sides most likely compete for available synaptic sites in the rostral part of their terminal fields and that their relative amounts in the two hemispheres is governed by spatial and temporal factors.

Animals↗
PubMed2000

Complete groin lymphadenectomy with preservation of the fascia lata in the treatment of vulvar carcinoma.

OBJECTIVE: The goal of this study was to assess the local groin recurrence of vulvar carcinoma in patients treated by complete groin node dissection with preservation of the fascia lata (GNDPFL). METHODS: This study is a retrospective chart review of 60 patients with Stage I-IV vulvar carcinoma who underwent radical vulvectomy and GNDPFL between 1990 and 1998. All superficial inguinal nodes and the deep femoral nodes on the anterior and medial surfaces of the femoral vein within the fossa ovalis were removed en bloc while sparing the fascia lata and the cribriform fascia over the femoral artery. RESULTS: Of the 60 study patients, 14 patients had Stage I disease, 20 Stage II, 21 Stage III, and 5 Stage IV. The mean number of nodes removed was 10 per groin. Thirty-nine patients had benign nodes on groin dissection. None of these 39 patients developed cancer recurrence in the dissected groins. Twenty-one of the sixty study patients (34%) had malignant nodes on groin dissection. Of these 21 patients, 2 experienced cancer recurrence in the groins. Our study describes a groin recurrence rate of 7.6% in patients with fewer than three malignant unilateral groin nodes. Postoperatively, 13% of patients developed lymphedema and 15% formed lymphoceles. CONCLUSIONS: The zero groin recurrence rate in patients with negative nodes and the low rate of recurrence in patients with positive nodes indicate that groin lymphadenectomy with preservation of fascia lata is complete, therapeutic, and comparable to radical techniques of lymphadenectomy involving skeletonization of femoral vessels, resection of fascia lata, and muscle transposition.

Adult↗
PubMed1985

The development of Ammon's horn and the fascia dentata in the cat: a [3H]thymidine analysis.

The present [3H]thymidine autoradiographic analysis of neurogenesis demonstrates that the neurons which populate the adult cat hippocampus are born between embryonic day (E)22 and E42. In contrast, although neuronal production in the fascia dentata begins on the same day, granule cells in this area continue to be produced throughout prenatal life and into early postnatal life, and probably continues at an extremely low rate well into adulthood. Three major sets of spatiotemporal gradients characterize the production of neurons in Ammon's horn and the fascia dentata. The first set involves the radial axis. Within the hippocampus there exists an inside-out gradient. The reverse gradient is present in the fascia dentata, i.e. outside-in. The second set of gradients involves the transverse or rhinodentate axis. In general the CA3 neurons are born earlier than the CA1 neurons. Within both neuronal layers of the fascia dentata, the hidden blade cells tend to be born earlier than those of the exposed blade. Again, the pattern in the fascia is the reverse of that in the hippocampus proper. A temporal to septal gradient is also present, but this is the weakest of the gradients.

Animals↗
PubMed1994

Use of the double-layered free temporal fascia flap for upper extremity coverage.

Two layers of fascia exist in the temporal region, the temporoparietal fascia and the deep temporal fascia. Both can be elevated on a single vascular pedicle based on the superficial temporal artery, the double-layered temporal fascia flap. In our study, six patients who underwent upper limb coverage using the double-layered temporal fascia flap are reviewed, and the versatility of this thin flap is discussed.

Adult↗
PubMed2004

A randomised study of axillary drainage and pectoral fascia preservation after mastectomy for breast cancer.

BACKGROUND: To reduce the risk of seroma after modified radical mastectomy in breast cancer patients, the use of suction axillary drainage is a standard procedure. The optimal time to remove the drain is not established. Whether the removal or preservation of the pectoral fascia influences the risk of seroma formation or loco-regional recurrence rate remains unclear. METHOD: The trial included 247 patients with breast cancer who underwent modified radical mastectomy in five Swedish hospitals 1993-1997. The median follow-up time was 6 years. One hundred and twenty-two and 125 patients, respectively, were randomised between removal versus preservation of the pectoral fascia. Of these 247 patients a total of 198 patients were also randomised to have the drain removed 24 h postoperatively or to keep the drain in until discharge had decreased to less than 40 ml/24 h. RESULTS: Early removal of the axillary drain was associated with significantly more seromas and a shorter average postoperative hospital stay. There were no differences between the two groups regarding the rate of wound infections and/or hematoma formation. Removal or preservation of the pectoral fascia did not influence the formation of seroma or the amount of peroperative bleeding. A trend towards an increased risk for chest wall recurrence was observed in patients with preserved pectoral fascia (16/125 compared with 8/122; hazard ratio=2.0, 95% confidence interval=0.9-4.7). CONCLUSION: Early removal of axillary drain shortened the duration of hospital stay without any increase in wound complications. However, it yielded a significantly higher incidence of seroma. Seroma formation and the chest wall recurrence rate was not significantly influenced by the preservation of the pectoral fascia or not.

Aged↗
PubMed1999

Use of a parotid fascia flap to prevent postoperative fistula.

OBJECTIVE: The purpose of this study was to investigate the usefulness of a fascia flap technique designed to improve the post-operative results of regional excision in cases of benign tumor in the superficial lobe of the parotid gland and to reduce formation of postoperative fistula. STUDY DESIGN: During surgery in each of 32 patients with benign tumor in the superficial lobe of the parotid gland, a fascia flap was raised from beneath the ear lobe, placed in its original position, and firmly sutured after regional resection of the tumor. The results were compared with those in a control group of 30 patients, whose operations were the same as those of the experimental group except for the fact that the fascia overlying the tumor was excised with the tumor in the controls. RESULTS: The wounds of the 32 patients repaired with the fascia flap healed well without any complication. Among the 30 patients in the control group, fistula occurred in 4 patients (13.3%). The difference was significant when the 2 groups were compared (chi2 test: P = .049 , P < .05). CONCLUSIONS: Use of a parotid fascia flap in partial parotidectomy for benign tumors in the superficial lobe holds promise for the prevention of postoperative fistula formation.

Adenolymphoma↗
PubMed1995

Opposite changes in GABAA receptor function in the CA1-3 area and fascia dentata of kindled rat hippocampus.

Muscimol-stimulated radiotracer 36CI- uptake in synaptoneurosomes was used to investigate the function of the GABAA receptor complex in the CA1-3 area and fascia dentata (granular and molecular layers and hilus) of rats kindled by stimulation, twice a day, of the Schaffer collateral fibers. Two kindled groups were studied: (a) 24 h after the last generalized tonic-clonic seizure [fully kindled (FK) stage] and (b) 28 days after the last generalized seizure (long-term stage). Synaptoneurosomes were prepared in parallel from subslices of the CA1-3 area and fascia dentata. In FK animals, the muscimol-stimulated 36CI- uptake was significantly reduced by 21% in the CA1-3 area in comparison with nonstimulated controls, whereas a significant increase of 29% was found in the fascia dentata. Significant changes were no longer present at 4 weeks after the last generalized seizure. The observed changes in muscimol-stimulated 36CI- uptake at the FK stage closely parallel the recently observed changes in [3H]muscimol binding in the CA1 area and fascia dentata. These results indicate that kindling causes a transiently decreased GABAA receptor-mediated function in the CA1-3, in contrast to an increased GABAA receptor-mediated function in the fascia dentata.

Animals↗
PubMed2001

Comparison of video urodynamic results after the pubovaginal sling procedure using rectus fascia and polypropylene mesh for stress urinary incontinence.

PURPOSE: Video urodynamic changes were compared after the pubovaginal sling procedure using rectus fascia or polypropylene mesh in women with stress urinary incontinence. MATERIALS AND METHODS: A total of 50 women with various types of stress urinary incontinence were treated with the pubovaginal sling procedure using randomly abdominal rectus fascia in 24 or polypropylene mesh in 26. The sling was placed at the level of the bladder neck and tied with sufficient tension to prevent urinary leakage without obstructing the bladder outlet. Video urodynamics were performed preoperatively, and 7 to 14 days and 3 to 6 months postoperatively in all cases. Surgical results and urodynamic changes after the pubovaginal sling procedure were compared in the 2 groups. Long-term results were evaluated at a mean followup of 2 years. RESULTS: Complete continence was achieved in 23 patients (95.8%) in the rectus fascia group and 26 (100%) in the polypropylene mesh group, including 1 initial failure with reoperation, at a median followup of 24 and 23 months, respectively. The subjective success rate was 91.6% for rectus fascia and 92.3% for polypropylene mesh. The main cause of dissatisfaction was persistent urge incontinence and dysuria in 2 cases each. In each group video urodynamics revealed a mild but nonsignificant decrease in maximum urinary flow and a significant increase in bladder neck opening time at 7 to 14 days versus baseline. However, these parameters returned to baseline within 3 to 6 months postoperatively. Voiding pressure, cystometric capacity and post-void residual urine also showed no significant change in either group after the pubovaginal sling procedure. Patients treated with a polypropylene mesh sling had a shorter operative time and hospital stay, a higher spontaneous voiding rate after catheter removal and a lower incidence of wound pain after surgery. One patient treated with polypropylene mesh had sling margin extrusion. The incidence of new onset detrusor instability and persistent dysuria was similar in the 2 groups. Transrectal sonography of the sling showed that it was located beneath the bladder neck and proximal urethra in all patients in each group. CONCLUSIONS: The results of this study show that the pubovaginal sling procedure using rectus fascia or polypropylene mesh as the sling material had similar effectiveness for treating female stress incontinence but the polypropylene group had more rapid recovery. Postoperatively video urodynamics demonstrated that the pubovaginal sling using either sling material did not cause bladder outlet obstruction with proper surgical technique.

Fasciotomy↗