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At least 235 records · Page 13Linked to original sources
PubMed2005

Initial incision of lateral pelvic fascia and early ligation of vascular pedicles during radical prostatectomy: potential to reduce positive margin rates.

OBJECTIVE: To report on our experience with a recently published technique to reduce positive margin (PM) rates (involving early incision of the lateral pelvic fascia, early release of the prostate and Denonvilliers' fascia off the rectum), with the additional modification of early ligation of the lateral vascular pedicles during radical retropubic prostatectomy (RP), as reducing PM rates continues to be an important oncological goal in RP. PATIENTS AND METHODS: One hundred consecutive men (mean age 61 years, pretreatment prostate-specific antigen level 8.9 ng/mL, and estimated blood loss 502 mL) underwent RP by one surgeon. The initial dissection involves early incision of the lateral pelvic fascia and developing the plane between the prostate and underlying rectum, before any apical dissection. This incision can be made medial to the neurovascular bundles in a nerve-sparing procedure. After this plane is developed, the lateral vascular pedicles to the prostate are also divided. Once these same manoeuvres are used contralaterally, the prostate is lifted off of the rectum and held in place only by the apex and bladder neck. The apical/urethral dissection is then carried out conventionally, followed by dissection/transection of the seminal vesicles and the bladder neck. RESULTS: The pathological stage included T2a (11%), T2b (69%), T3a (17%), T3b (3%), and N+ (2%); 20 patients had capsular penetration, at the posterolateral (in 15) and anterior aspect (in five) of the gland. The PM rate for the 100 consecutive patients was 13%, with PMs at the apex in 10, the base in two and posterolateral gland in one. No patient had a PM at the site of capsular penetration. When patients were stratified by low-moderate risk (pT2 and Gleason sum < or = 7) vs high risk (pT3 or Gleason sum > 7), the PM rates were 7.9% and 29.2%, respectively. CONCLUSIONS: Initial dissection of the lateral pelvic fascia, including developing a "perirectal pocket", and early ligation of the lateral pedicles, resulted in a low PM rate during RP. This experience supports the previous observations that early development of the pre-rectal fat plane may allow for more precise dissection below all layers of Denonvilliers' fascia and with a wider margin of periprostatic tissue.

Aged↗
PubMed2004

The new reconstruction technique in the treatment of the skin cancers located on the eyelid: Posterior temporalis fascia composite graft.

BACKGROUND: Difficulty of reconstruction of the eyelids arises from the need to reconstruct different supporting and covering structures in a single operation. Defects in the anterior lamella of the eyelids can be readily repaired with skin grafts or flaps but posterior lamellar reconstruction needs more complex applications. METHODS: We performed posterior lamellar eyelid reconstruction with posterior parts of the temporalis fascia, since their anatomical and histological features are very similar to the defects. Nine patients with skin tumors located on the periorbital region were treated with local skin flaps and deep layer of the temporalis fascia. RESULTS: Grafts were harvested very easily. There was no complication related with graft or donor site. Biopsy was performed in three cases and normal conjunctival elements were seen. Functional and acceptable aesthetically results were achieved in all patients. CONCLUSION: Ideal reconstructive material for replacement of the posterior lamina is still lacking. Tarsal reconstruction can be made with deep temporalis fascia with success since the thickness of the both tissues are very similar and also since the loose areolar layer of the temporalis fascia is very thin and highly vascularized, this layer can be used in reconstruction of the conjunctiva. According to our knowledge this is the first report of using of the posterior part of temporalis fascia as a composite graft in the literature.

Journal Article↗
PubMed2003

Contribution of plantar fascia to the increased forefoot pressures in diabetic patients.

OBJECTIVES: Secondary to peripheral neuropathy, plantar hyperpressure is a proven risk factor for foot ulceration. But limited joint mobility (LJM) and soft tissue abnormalities may also contribute. The aim of this study was to evaluate the relationships among thickness of plantar fascia, mobility of the metatarso-phalangeal joint, and forces expressed under the metatarsal heads. RESEARCH DESIGN AND METHODS: We evaluated 61 diabetic patients: 27 without neuropathy (D group), 19 with neuropathy (DN group), and 15 with previous neuropathic foot ulceration (DNPU group). We also examined 21 control subjects (C). Ultrasound evaluation was performed with a high resolution 8- to 10-MHz linear array (Toshiba Tosbee SSA 240). The foot loading pattern was evaluated with a piezo-dynamometric platform. First metatarso-phalangeal joint mobility was assessed with a mechanic goniometer. RESULTS: Diabetic patients presented increased thickness of plantar fascia (D 2.9 +/- 1.2 mm, DN 3.0 +/- 0.8 mm, DNPU 3.1 +/- 1.0 mm, and C 2.0 +/- 0.5.mm; P < 0.05), and significantly reduced motion range at the metatarso-phalangeal joint (D 54.0 +/- 29.4 degrees, DN 54.9 +/- 17.2 degrees, DNPU 46.8 +/- 20.7 degrees, and C 100.0 +/- 10.0 degrees; P < 0.05). The evaluation of foot-floor interaction under the metatarsal heads showed increased vertical forces in DN and DNPU and increased medio-lateral forces in DNPU. An inverse correlation was found between the thickness of plantar fascia and metatarso-phalangeal joint mobility (r = -0.53). The thickness of plantar fascia was directly correlated with vertical forces under the metatarsal heads (r = 0.52). CONCLUSIONS: In diabetic patients, soft tissue involvement may contribute to the increase of vertical forces under the metatarsal heads. Changes in the structure of plantar fascia may also influence the mobility of the first metatarso-phalangeal joint.

Diabetes Complications↗
PubMed1992

Cholinergic and GABAergic neurotransmission in the fascia dentata: electron microscopic immunocytochemical studies in rodents and primates.

This chapter summarizes immunocytochemical studies on the cholinergic and GABAergic innervation of dentate neurons. There are at least three types of neuron that give rise to the GABAergic innervation of dentate granule cells. First, there are the basket cells located in and directly underneath the granular layer. Their axons form a pericellular plexus around the cell bodies and proximal dendrites of the granule cells. Second are the dentate axo-axonic cells. These neurons are located in the innermost portion of the molecular layer and give rise to rows of boutons that impinge on the axon initial segments of the granule cells. Finally, there are GABAergic neurons in the septal region that are known to project to the hippocampus and fascia dentata. All types of GABAergic neurons establish symmetric synapses. Basket cells and axo-axonic cells are major inhibitory components of the fascia dentata. The septohippocampal GABAergic neurons selectively contact other GABAergic cells in the fascia dentata thereby serving disinhibition of the granule cells. The cholinergic fibers arising from the medial septum form a diffuse network in all layers of the fascia dentata. Electron microscopy reveals that both symmetric and asymmetric synapses are established. Cholinergic terminals contact granule cells as well as GABAergic and peptidergic neurons in the hilar region. The above data were obtained in rats. Preliminary studies in monkeys have shown that the types of cholinergic synapse are very similar in the rodent and primate fascia dentata. However, some differences were noted in the types of GABAergic synapse. We have thus observed numerous asymmetric synapses with spines in addition to the well-known symmetric synapses with dendritic shafts, cell bodies and axon initial segments.

Acetylcholine↗
PubMed1989

Comparison of the fascia iliaca compartment block with the 3-in-1 block in children.

A new single injection procedure, the fascia iliaca compartment block, is described for blocking the femoral, lateral cutaneous, and obturator nerves. The technique consists of injecting a local anesthetic immediately behind the fascia iliaca at the union of the lateral with the two medial thirds of the inguinal ligament, and forcing it upward by finger compression. This block was prospectively evaluated in 60 pediatric patients aged 0.7 to 17 years undergoing surgery of the lower limb, and then compared with a similar group of 60 children given a 3-in-1 block. Adequate analgesia was only obtained in 20% of the patients given 3-in-1 blocks (group 1), whereas the fascia iliaca compartment block proved to be easy, free of complications, and effective in more than 90% of patients (group 2). Such a high failure rate in group 1 was not due to misplacement of the needle since a femoral nerve block developed in all patients. Therefore it is unlikely that the local anesthetic can spread rostrally towards the lumbar plexus then return peripherally along the issuing nerves, and this was, indeed, not confirmed by radiological findings. In the authors' opinion, a multieffective block can only develop when the local anesthetic is introduced behind the fascia iliaca, which circumscribes a potential space where the femoral, lateral cutaneous, and obturator nerves run for a considerable part of their course. This report shows that deliberately injecting this space almost always results in an easy and effective block of these three nerves. The fascia iliaca compartment block can be recommended for use in children.

Adolescent↗
PubMed1990

Fascia lata and early spica casting as adjuncts in closure of bladder exstrophy.

Correction of the skeletal defect seen in the exstrophy complex consists of reconstitution of the pelvic ring. Long-term success depends upon the formation of a fibrous union between the pubes. When this union does not occur diastasis of the pubis results. Long-term urological success appears to be related to adequate pubic approximation. We used fascia lata to construct an anterior pelvic ligament between the pubic bones in 7 patients. In the 6 patients for whom followup is available the fascia lata has persisted and appears to be viable histologically on biopsy specimens obtained at a subsequent operation. Because the fascia lata holds the pubis together so well we have been able to cease Bryant's traction in children by 2 weeks and place them into a cast. This has resulted in early discharge from the hospital in all patients. For these reasons we believe that fascia lata is a useful adjunct in the armamentarium of materials used to reapproximate the pubis.

Bladder Exstrophy↗
PubMed1990

Fascia lata graft as a dural substitute in neurosurgery.

We present 37 cases in which fascia lata was used for dural patching when there was inadequate regional tissue, such as pericranium or temporalis fascia to repair the dural defect. Operative indications included tumor in 17 patients (46%), trauma in nine (25%), cerebrospinal fluid fistula in seven (19%), infection in two (5%), dural patching in two (5%). Follow-up ranged from one month to five years, with an average follow-up of two years. There were no cranial or spinal complications related to the fascia lata grafting (including cerebrospinal fluid leakage, meningitis, and wound infection). Fascia lata is relatively simple to obtain, but harvesting necessitates a second incision; this second incision resulted in no complications in our patients.

Adult↗
PubMed1975

Fascia lata valves: a clinicopathological study.

Sixteen frame-mounted fascia lata valves removed from the mitral, aortic or--in one patient--pulmonary position have been detailed histologically. These valves had remained in 15 patients (11 men and four women) for periods varying between 10 and 44 months. The reason for the original transplantation was either chronic rheumatic endocarditis or calcific aortic disease. In the mitral position, the leaflet in position nearest the site of the original anterior mitral valve cusp showed the least changes. The remaining two leaflets of the fascia lata valve in the mitral position, as well as those removed from the aortic or pulmonary position, showed more severe changes; these consisted of degeneration of collagen tissue and often a severe decrease of nuclei belonging to the fibroblastic series. These changes, as well as superimposition of fibrin or fibrous tissue, tended to become more pronounced the longer the valve had remained in the patient. Viability studies in valves removed from two patients have also been undertaken showing very greatly reduced activity. The possible causes for valve dysfunction have been reviewed, and the findings in this study suggest that contraction of fibrous tissue, which sandwiches the fascia lata valve cusps, may contribute to failure of satisfactory valve function. It is concluded that fascia lata forms a poor substitute for replacement of diseased cardiac valves.

Adult↗
PubMed1979

[Scanning electron microscopy study of autologous fascia lata and bovine xenograft as arterial prosthesis. An experimental study].

The present communication deals with the decomposition of thrombi and the formation of an endothelium in two different vascular prothesis. Devitalized bovine arteries which were enzymatically reduced to a collagen reticulum, and tubes made of autologous fascia lata were implanted into the arterial bloodstream of dogs. The implants were left in place for a time ranging between 30 min and four months. They were examined by scanning electronmicroscope with the cortical point method. This enabled us to reach the following conclusions: unprepared autologous fascia lata implanted into the arterial bloodstream has much more thrombogenous qualities than solcograft. The decomposition of thrombi and the formation of an endothelium is much faster accomplished in fascia lata than in the devitalized bovine artery. It is not possible to distinguish solcograft and fascia lata by the formation of endothelium only.

Animals↗
PubMed1974

The late results of cardiac valve replacement using autologous fascia lata.

Over an eight-month period beginning in November 1969, 53 patients received 63 fascia lata heart valves at the Toronto General Hospital. The late results of this form of valve substitution are reviewed. The fascia used to fashion the tricuspid valve underwent progressive thickening and contracture and this process caused failure of the prosthesis within months of insertion. The mitral fascial prosthesis failed in a similar manner although the process took longer. The aortic fascia lata valve, however, has not shown progressive thickening after 3(1/2) years and it has so far retained its functional integrity. Indeed, we have been impressed by the excellent clinical results and absence of complications such as thromboembolism although anticoagulation has not been used. We therefore consider that fascia lata valves offer a suitable alternative to other forms of aortic valve substitution, but are unsatisfactory for tricuspid or mitral valve replacement.

Adult↗
PubMed1981

[Contribution to the study of the vascularization of the fascia lata tensor muscle].

The tensor fascia lata is a short flat muscle arising from the anterior superior iliac spine and inserting into the fascia lata at mid thigh. It is supplied by three arterial pedicles of unequal importance, branching from the external iliac, gluteal and deep femoral arteries. The 'dominant' blood supply is carried by the lateral circumflex femoral artery which comes from the deep femoral and enters the muscle, approximately 8.8 cm beneath the anterior superior iliac spine. This vessel varies in size from 2 to 3.5 mm; it is 8 cm long but can be lengthened by ligating the branch for the vastus lateralis. On the deep sheath of the iliotibial tract it gives off three branches which supply each third of the fleshy body. The upper branch runs vertically to the iliac insertion of the muscle but not so far as the iliac crest and provides no cutaneous twig. On the contrary, the mid branch runs transversally through the muscle and sends perforating vessels to the skin overlying the fascia lata 6--7 cm below the anterior superior iliac spine. The descending branch runs parallel to the muscular fibers of the muscle and supplies the skin of the lateral lower thigh down to 8 cm above the knee. So the pedicle supports an area of the skin which is double the length (22 cm) and triple the width (9.5 cm) of the fleshy body. The tensor fascia lata including the two layers of the iliotibial tract but excluding its upper insertion, together with the skin of the lateral aspect of the thigh can be safely used as a myocutaneous flap for covering defects of the trochanteric, ischial and sacral areas.

Fascia↗
PubMed1977

Repair of ptosis using frontalis muscle and fascia lata: a 20-year review.

The results of an analysis of the surgery ("Repair of Ptosis using Frontalis Muscle and Fascia Lata") carried out on 316 lids is presented. The main indication for this operation is a large congenital ptosis with minimal levator function. Conclusions from the study indicate that autogenous fascia is an ideal tissue for lid suspension, and is better than stored fascia. Stored fascia does present some problems but is useful in small children or when the patient does not want a scar on the leg. Bilateral repair for unilateral ptosis is recommended for symmetrical results. The best ages for surgery is between 3-1/2 and 6 years of age, as these young corneas rapidly adapt to the exposure problems. It is very important to check the corneal sensation before carrying out the surgery. When this operation is done on older patients with acquired ptosis, e.g. ptosis associated with myasthenia gravis, corneal exposure problems frequently result.

Blepharoptosis↗
PubMed2007

Deep fascia on the dorsum of the ankle and foot: extensor retinacula revisited.

This study revisits the anatomy of the deep fascia over the distal leg, ankle, and dorsum of the foot. The arrangement of the deep fascia in these regions was recorded in 14 lower limbs of adult cadavers using photographs and drawings. The fascial layer from all three sites was subsequently removed in toto, and serial thickness measurements were made along its entire length. In addition, fiber disposition was studied under polarized light, and sections were stained to demonstrate collagen. The arrangement of deep fascia is complex. A common and novel finding at all levels is a crisscross, lattice-like arrangement of fibers. There was little evidence of the clearly defined sturdy band of the superior extensor retinaculum (SER) or of the Y-shaped inferior retinaculum (IER) commonly illustrated in topographical anatomy texts. The SER is a complex area with several thickenings commencing about 3 cm proximal to the tip of the lateral malleolus and gradually increasing to reach a maximum of 270 microm about 5 cm above the malleolus, then gradually returning to original thickness, about 9 cm above the malleolus. Fibers crossing diagonally to each other are a feature of the region. The IER characteristically has two forms: either a cross-shaped band (9 specimens) or a thickened "node" with small extensions radiating toward the malleoli (5 specimens), located about 1-2 cm distal to the lateral malleolus and centred over the common tendon of extensor digitorum where it has maximum thickness (430 microm). The deep fascia is thickened and firmly attached over both malleoli and to the tarsals and metatarsals along both borders of the foot. In general, the deep fascial structures were thicker in males than those in females.

Aged↗
PubMed2005

Penile resurfacing with vascularized fascia lata.

Penis resurfacing is a challenging procedure, and should simultaneously ensure erectile function, tactile sensibility, sexual satisfaction, and aesthetic integrity. This article presents three cases with penile skin defects treated by means of a pedicled fascia lata attached either to the tensor fascia lata (one case) or an anterolateral thigh flap (two cases). The cause of the wounds included electrical burn, Fournier's gangrene, and self-mutilation. The size of flaps ranged from 10-13 cm in width and 15-30 cm in length. All flaps included vascularized fascia lata, which covered part or the circumference of the penis. All flaps survived completely. The lateral cutaneous nerve of the thigh was included in the designed flaps in all instances, and normal protective sensation was recorded postoperatively. The patients reported normal erectile function and ability to perform intercourse. The flaps, though relatively bulky and hairy, had a good color and texture match with the penis and suprapubic region. Based on our limited experience, we believe that the anterolateral thigh flap has greater dimensions with a longer pedicle, and allows for greater flexibility in flap design compared to the tensor fascia lata flap. An anterolateral thigh flap can be safely thinned in a second stage, and it is our flap of choice for penis resurfacing.

Adult↗
PubMed1996

Microfilament system in the microvascular endothelium of the palmar fascia affected by mechanical stress applied from outside.

The effect of externally applied mechanical stress was investigated by thin section electron microscopy of the microvessels in the unaffected palmar fascia in the carpal tunnel syndrome and in patients with Dupuytren's contracture before and after application of a continuous elongation device. In the unaffected palmar fascia the microfilaments of the endothelial cells were connected to a few adherens junctions and focal contacts; stress fibres were absent. In the cord of Dupuytren's disease the microfilaments were increased in quantity. The length ratios of the connections with the lateral and basal cell membrane were significantly higher than in the control group and increased to an even greater extent in the continuously extended fascia. Stress fibres appeared in the endothelial cells of postcapillary venules in the nonextended cord and in the endothelium of both arterioles and venules after extension elongation. the numerous intermediate filaments and the rare microtubules remained unchanged in the endothelial cells of all palmar fasciae analysed. In the endothelial cells of the microvessels the mechanical stress applied from outside mainly affected the contractile component of the cytoskeleton.

Actin Cytoskeleton↗
PubMed1997

The reinforcement of tracheoplasty with a self-fascia lata and Gelatin-Resorcin-Formal (GRF) glue.

We examined the efficacy of protecting the suture line in tracheoplasty by using a self-fascia lata and Gelatin-Resorcin-Formal (GRF) glue. Fifteen dogs underwent a resection of four rings of the trachea and reconstruction, and we then observed them for one month; group A (n = 5) without reinforcement, group B (n = 5) with a self-fascia-lata spread with GRF glue, and group C (n = 5) with only a self-fascia-lata. In the reinforced dogs (group B, three cases, and group C, five cases), in which the continuity of the suture line had been conserved, eight cases were resistant to pressures of from 240 mmHg to 300 mmHg, and two cases (both in group B) which had a partial discontinuity of the suture line were resistant to the same pressure of 160 mmHg. But in the five dogs without reinforcement (group A), four died from infection due to leakage of the trachea within 2 weeks; only one that had a continuity of the suture line survived and was resistant to pressure of 300 mmHg. These results show that a reinforcement of tracheoplasty using a self-fascia lata and GRF glue is useful for preventing air leakage from the suture line.

Animals↗
PubMed1997

[Relevance of the fascia transversalis in inguinal hernia repair using total extraperitoneal plastic reconstruction].

During total extraperitoneal dissection of inguinal hernias, an artificial preperitoneal cavity is created in the supravesical space by using a balloon dissector. During the operative procedure in vivo and while examining cadavers specially fixated according to the method developed by Thiel in 1992, we investigated the position relative to the balloon the transversalis fascia could be found in and what happened to it during inflation of the balloon. In all cases, the fascia medial to the inferior epigastric arteries was adjacent to the peritoneum and lateral to the abdominal wall. We observed systematic tearing of the fascia along the lateral umbilical plica (inferior epigastric artery). These results suggested that the transversalis fascia could be used only laterally for reinforcement of the dorsal wall of the inguinal canal and/or the support of a mesh used to cover the inguinal floor.

Fascia↗
PubMed2005

Surgical outcome of abdominal sacrocolpopexy with synthetic mesh versus abdominal sacrocolpopexy with cadaveric fascia lata.

Nineteen women who had an abdominal sacrocolpopexy (ASC) with synthetic mesh and 18 women who had an ASC with freeze-dried, irradiated cadaveric fascia lata returned for blinded pelvic organ prolapse quantification (POPQ) examinations. The mean relative vaginal descent (delta) from perfect total vaginal length in the mesh group was 1.1 (0.3) cm, and the delta in the fascia group was 2.8 (0.8) cm (p=0.02, Mann-Whitney U). The proportion of women with "optimal" surgical outcome in the mesh group was 89% and 61% in the fascia group (p=0.06, Fischer's exact test). This study suggests that cadaveric fascia lata may not be a good choice for ASC.

Aged↗