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At least 271 records · Page 15Linked to original sources
PubMed1998

A histological study of Denonvilliers' fascia and its relationship to the neurovascular bundle.

OBJECTIVE: To evaluate the anatomical relationship between the nerves and fasciae at the site of dissection in a radical retropubic prostatectomy. MATERIALS AND METHODS: Eight adult male (autopsy) en bloc specimens of bladder and rectum were examined histologically after staining with either haematoxylin and eosin or S-100 protein (as a specific nerve stain). RESULTS: All specimens showed Denovilliers' fascia to have no clearly defined layers and no definable lateral edge. No distinct neurovascular bundle was seen but nerves were scattered throughout the fasciae, including medially towards the midline. CONCLUSION: In radical retropubic prostatectomy, a piece of Denonvilliers' fascia is taken with the specimen, thus removing these nerves. The loss of these nerve fibres may explain the significant rate of erectile dysfunction after 'nerve-sparing' surgery.

Aged↗
PubMedDate not supplied

Scleroderma-like indurations involving fascias: an abortive form of congenital fascial dystrophy (Stiff skin syndrome).

Four patients are described with stone-hard indurations of the skin and subcutaneous tissue, predominantly on the buttocks and thighs, in the areas of the thickest fascia lata and glutealis. All cases were sporadic, started in early infancy, were only slightly or not progressive, and showed no visceral involvement or immunologic abnormalities. In all, the hallmark of the disease was strikingly enlarged fascia. In one patient, typical features developed progressively for 9 years, and in two patients the changes remained abortive, limited to some areas, and not symmetrical. The fourth patient showed some similarity to profound morphea with no cutaneous involvement. Recognition of atypical or abortive cases of congenital fascial dystrophy, which is probably a variant of heterogeneous stiff skin syndrome involving exclusively fascia, is of practical importance, since no therapy is required. However, intensive rehabilitation should start in early infancy and continue throughout life. The genetic defect of molecular organization of collagen in the fascia results in formation of giant amianthoid-like collagen fibrils.

Adult↗
PubMed2001

Nerve conduit using fascia-wrapped fibrocollagenous tube.

The purpose of this study was to evaluate the application of autogenous fascia as a framework of a fibrocollagen tube for a nerve conduit in Japanese white rabbits. The fascia was wrapped with a double layer around a silicone rod 3.0 mm in diameter. After the implantation of the fascia-wrapped silicone rod into a subcutaneous pocket for 2 weeks, a 3.0 x 30-mm fascia-wrapped fibrocollagen (FFC) tube was prepared. With microvascular techniques, the tube was interposed into a right sciatic nerve gap which was 25 mm long. The results of nerve regeneration in the FFC tube group, in particular, the formation of epineurium, were able to stand comparison with the results of a control group under both histologic and electron micrographic examination.

Animals↗
PubMed2002

Free fascia temporalis interpositioning as a treatment for wrist ankylosis.

The fascia temporalis is a thin and well-vascularized tissue and, for this reason, its use in reconstructive surgery is versatile. It can be used as an island flap in defects of the head and neck or as a free flap in reconstructions of different anatomic regions. As a "living" spacer in the treatment of wrist ankylosis, its use has not yet been described. The authors present the transfer of the free fascia temporalis into the wrist as a treatment of wrist ankylosis in patients affected by severe rheumatoid arthritis. Four flaps in three patients were performed. Preoperative flexion/extension in the wrist was absent or almost absent and painful, resulting in severely impaired daily activities. After resection of the distal ulna, distal radius, and the proximal surfaces of the proximal row of the carpal bones was performed, the free fascia was used to replace the wrist joint. Postoperative wrist flexion/extension was 45 to 50 degrees on average. In all patients, this procedure allowed painless motion of the wrist, and in all patients, daily activities were improved. A 2-year follow up showed no recurrence of wrist problems and a maintained articular space. In the treatment of wrist ankylosis, the use of the free fascia temporalis offers a good alternative to arthrodesis, maintaining sufficient function for daily activities.

Adult↗
PubMed1995

Fascia-vascularized vs. muscle-vascularized prefabricated flaps using tissue expanders: an experimental study in a rat model.

The aim of this study was to compare the applicability and viability of a fascia-vascularized pedicle (FVP) with those of a muscle-vascularized pedicle (MVP) in the prefabrication of a secondary vascularized pedicle flap using a tissue expander. Experiments were carried out in 32 male Wistar rats. The animals were divided into two groups--Group 1 (n = 10), using a skeletonized pedicle of the right saphenous artery, vein, and nerve with a segment of 8 x 10 mm fascia on its distal end (FVP group); and Group 2 (n = 10), using a 3-mm perivascular cuff of muscle with a segment of 8 x 10 mm fascia and gracilis muscle on its distal end (MVP group). The experiments demonstrated that there was a larger area of flap survival in the expanded muscle-vascularized pedicle flaps (96.6 +/- 3.6 percent) than that found in the expanded fascia-vascularized pedicle flaps (83.0 +/- 14.4 percent) in this rat model (p < 0.005). The microangiography of the flaps showed increased vascularity of the muscle cuff at the end of the vascular pedicle in Group 2.

Angiography↗
PubMed2001

Estrogen, progesterone, and androgen receptor expression in levator ani muscle and fascia.

Previous studies have reported controversial data on estrogen receptor (ER) expression in levator ani muscle. We investigated ER expression in levator ani muscle and fascia and compared it with the expression of progesterone receptor (PR) and androgen receptor (AR). The study included 55 women undergoing surgery for gynecological (asymptomatic, n = 10) or urogynecological conditions (symptomatic, n = 45). The asymptomatic and 21 of the symptomatic women received no hormone replacement therapy (HRT). The remaining 24 symptomatic women received some form of HRT. Biopsies were taken from the levator ani muscle and the overlying fascia, and quantitative measurements of immunohistochemical staining by image analysis were made. None of the levator ani muscle samples showed any evidence of nuclear ER expression in striated muscle fibers, but some cells in the muscular stroma did express ER. However, PR and AR expression was found in both muscle and stromal cells. Levator ani fascia showed nuclear ER, PR, and AR expression to varying degrees. There was a significant increase (p < 0.03) in ER expression in levator ani fascia of symptomatic patients without HRT when compared with asymptomatic age-matched women. The ER expression was significantly lower (p < 0.001) in postmenopausal symptomatic women receiving long-term estrogen replacement compared with age-matched women without HRT. Our data indicate that ER expression is significantly higher in symptomatic women compared with age-matched asymptomatic females. However, long-term estrogenization causes significant decrease of ER expression.

Adult↗
PubMed2005

Alterations in the extracellular matrix proteoglycan profile in Dupuytren's contracture affect the palmar fascia.

Dupuytren's disease is a palmar fibromatosis associated with changes in fibroblast activity that also affect the metabolism of extracellular matrix components. In contrast to disease connected alterations in collagen and non-collagenous glycoproteins (mainly fibronectin), the metabolism of proteoglycans, being glycosaminoglycan modified glycoproteins, is poorly understood. Thus, the aim of the present study was the characterization of matrix proteoglycans (PGs) derived from normal fascia and Dupuytren's fascia. Extracted and purified PGs (particularly small PGs) were analysed for content, molecular mass, immunoreactivity and glycosaminoglycan chain structure. The matrix of normal fascia mainly contains decorin [small dermatan sulfate (DS) PG] with biglycan (another small DSPG) and large chondroitin sulfate(CS)/DSPG representing minor components. Dupuytren's disease is associated with the remodeling of matrix PG composition. The most prominent alteration is an accumulation of biglycan frequently bearing DS chains with higher molecular masses. Moreover, the amount of large CS/DSPG is increased. In contrast, decorin displays changes affecting mainly DS chain structure reflected in (i) an increase in some chain molecular masses, (ii) an enhanced content of iduronate disaccharide clusters, and (iii) oversulfation of disaccharide repeats. The PG alterations observed in Dupuytren's fascia may influence the matrix properties and contribute to disease progression.

Adult↗
PubMed1993

Tensor fascia lata V-Y retroposition myocutaneous flap: clinical experience.

A modification of the standard tensor fascia lata myocutaneous flap, namely, the tensor fascia lata V-Y retroposition flap, is a reliable, durable, efficient, well-tolerated, and technically straightforward procedure. Indications include trochanteric pressure ulcers, nonhealing, failed hip arthroplasties, and soft tissue defects after regional tumor excisions. In 70 TFL V-Y retroposition flap reconstructions performed, the overall postoperative complication rate was 23%, with 4 total flap failures. Sixty-three percent of complications were treated with local wound care, thus avoiding repeat surgery. Rerotation of this flap is not only possible, but also just as reliable as the initial procedure. The tensor fascia lata retroposition flap offers advantages over many of the other tensor fascia lata flap variations.

Adolescent↗
PubMed1986

The anatomy of the fasciae of the face and neck with particular reference to the spread and treatment of intraoral infections (Ludwig's) that have progressed into adjacent fascial spaces.

Descriptions of the fasciae of the lower half of the face and of the adjacent cervical fasciae have long been puzzling and descriptively much too complex. For this reason, medical students, young medical and dental practitioners, and at times even senior surgeons frequently do not understand the anatomy of the cervicofacial fasciae, which plays such an important role in the spread and subsequent final localization of primary intraoral infections. This article attempts to simplify the descriptions of these fasciae, in particular, their sites of origin and insertion.

Airway Obstruction↗
PubMed1984

Parotid fascia and face lifting: a critical evaluation of the SMAS concept.

Classical anatomists were mistaken in their description of the parotid and masseteric regions. According to their description, the fascia superficialis (or SMAS) would be in continuity with the platysma. Data from fresh cadaver dissections, histology, and embryology indicate, on the contrary, that it is the parotid fascia, which is continuous with the platysma. Comparative anatomy provides further confirmatory evidence, demonstrating that the parotid fascia is only the uppermost part of a muscle that has undergone fibrous degeneration. This muscle is the "primitive" platysma. In consequence, the sub-SMAS dissection plane is too superficial and creates a purely fatty flap. Conversely, deep dissection below the parotid fascia (and therefore below the primitive platysma) respects the true anatomic features and guarantees the solidity of the flap and the safety of the facial nerve.

Animals↗
PubMed1989

The VY tensor fasciae latae musculocutaneous flap.

When first introduced in 1978, the tensor fasciae latae flap was used both as a free-tissue transfer and as a local rotational flap. Its use as a free flap has diminished as other more appropriate flaps for free-tissue transfer have been described. The tensor fasciae latae flap has remained, however, an instrumental flap in the coverage of anterior and posterior soft-tissue defects around the hip region. The purpose of this paper is to present a new design of the tensor fasciae latae flap in the coverage of trochanteric pressure sores. By essentially creating a VY advancement flap into the trochanteric defect with the tensor fasciae latae, one can cover the trochanteric defect with the best-vascularized portion of the flap and avoid the dog-ear deformity.

Adolescent↗
PubMed1997

Tensor fasciae latae flap: alternative donor as a functioning muscle transplantation.

The functioning tensor fasciae late muscle was used for a patient with both a complete defect of the deltoid muscle and a defect of overlying skin. The configuration of the tensor fasciae latae including the length of the muscle belly as well as the muscle fiber arrangement was similar to that of the deltoid. In addition, the spatial relationship between the muscle, donor vessels, and motor nerve fulfilled the requirements for the recipient site of deltoid reconstruction. The transferred muscle successfully replaced the function of the deltoid and provided sufficient strength for elevation of the arm. Simultaneous skin coverage was also satisfactory. The case report here clearly indicates that the tensor fasciae latae muscle is a promising candidate for functioning muscle transplantation, and can also be applied for other disorders. However, several points such as limited motor nerve length should be considered when tensor fasciae latae is used as a functioning muscle.

Fascia Lata↗
PubMed2001

Correction of sunken and/or multiply folded upper eyelid by fascia-fat graft.

Sunken and/or multiply folded upper eyelid is one of the common, troublesome complications that can occur after Oriental blepharoplasty. In addition to orbital volume depletion, the traumatic surgical procedure of excessive fat removal might result in a varying degree of adhesion and injury to the orbital septum. Adhesiotomy followed by a restoration of volume is generally believed to be the logical way to correct such deformity. To restore volume and prevent re-adhesion, local tissues of the upper eyelid, free-fat graft, and dermis-fat graft have been used. However, local tissues are usually insufficient because of previous surgery, and the survival rate of grafted fat is often unpredictable. Moreover, the heaviness of the dermis-fat composite makes it a less than satisfactory choice. The authors value the use of free fascia-fat composite grafts for the treatment of such disfigurements. The fascia-fat composite is expected to have a better survival rate than free fat alone and to be lighter than a dermis-fat composite. In addition, the fascia-fat composite is abundant throughout the body and provides anatomical structure more similar to that of the repair site, namely, the damaged orbital septum and fat. The authors prefer the mons pubis, preauricular, and temporal areas for the donor site depending on the status of the damage. They treated 13 patients with sunken and/or multiply folded upper eyelids by fascia-fat composite grafts and obtained satisfactory results.

Adipose Tissue↗
PubMed2001

Free tensor fasciae latae perforator flap for the reconstruction of defects in the extremities.

In the three cases presented in this study, free tensor fasciae latae perforator flaps were used successfully for the coverage of defects in the extremities. This flap has no muscle component and is nourished by muscle perforators of the transverse branch of the lateral circumflex femoral system. The area of skin that can by nourished by these perforators is larger than 15 x 12 cm. The advantages of this flap include minimal donor-site morbidity, the preservation of motor function of the tensor fasciae latae muscle and fascia lata, the ability to thin the flap by removing excess fatty tissue, and a donor scar that can be concealed. In cases that involve transection of the perforator above the deep fascia, the operation can be completed in a very short period of time. This flap is especially suitable as a free flap for young women and children who have scars in the proximal region of the lateral thigh or groin region that were caused by split-thickness skin grafting or full-thickness skin grafting during previous operations.

Adult↗
PubMed2002

A microdissected thin tensor fasciae latae perforator flap.

A new method, named "microdissection," has been introduced to create a thin flap by elevating the tensor fasciae latae perforator flap to serve as microdissected thin tensor fasciae latae perforator flap. In microdissection, perforators that run in the posterolateral direction in the adipose tissue after penetrating the deep fascia are dissected meticulously using an operative microscope, and a thin flap is elevated in a single process. The caliber of the perforator artery and vein in the tensor fasciae latae muscle measures approximately 0.7 mm and 0.9 mm, respectively. When transplanting the flap, an end-to-side anastomosis to the main artery measuring 1 to 2 mm is preferable to avoid the risk of arterial thrombosis. In contrast, an end-to-end anastomosis of the perforator vein to the comitans vein of the main artery can be performed safely. In the present study, 11 flaps were transplanted to the sites of skin defects of the neck, hand, axilla, knee, and foot. The author considers that the first clinical indication of this flap is reconstruction of hand skin defects.

Adult↗
PubMed1999

Attachments of the posterior layer of lumbar fascia.

STUDY DESIGN: Superficial and deep laminae of the posterior layer of lumbar fascia were dissected. The lumbar portion was measured for evidence of segmental thickenings. Superior attachments were dissected, documented, and photographed. OBJECTIVES: To verify the existence of posterior accessory ligaments and establish the superior attachments and fiber angles of the posterior layer of lumbar fascia. SUMMARY OF BACKGROUND DATA: There have been two small dissection studies on the posterior layer. Their findings are conflicting in several areas of clinical significance. Thickenings in the lumbar region were described in one study, but have not been verified. The superior attachments of the posterior layer have not been formally documented. METHODS: Study 1: In 21 embalmed cadavers, the lumbar region of the posterior layer was dissected. The lumbar spinous processes and adjacent fascia were marked. The fascia was removed and examined, and its thickness measured with a manual micrometer. Results were statistically analyzed. Study 2: Superior attachments of the posterior layer in 20 cadavers were dissected and photographed. Capacity to transmit tension was estimated and documented photographically, and fiber angles measured in situ. RESULTS: Study 1: There was no evidence of macroscopic segmental thickening in the posterior layer. Study 2: The superficial lamina was continuous superiorly with the rhomboids, and the deep lamina with the tendons of splenius cervices and capitis. These previously undocumented attachments were of variable thickness and fibrosity, and capable of transmitting tension. CONCLUSIONS: Both superficial and deep laminae of the posterior layer are more extensive superiorly than previously thought. This may have implications for certain tests used in assessment and management of low back pain such as the slump and "nonorganic" tests. The thickness of the superior attachments is variable. Their capacity for load bearing is yet to be quantified.

Aged↗
PubMed2004

Eustachian tube patency and function in tympanoplasty with cartilage palisades or fascia after cholesteatoma surgery.

OBJECTIVE: To compare the Eustachian tube patency and function after tympanoplasty with either cartilage palisades or fascia grafting after one-stage surgery in children with tensa cholesteatoma. STUDY DESIGN: In children operated for tensa cholesteatoma, cartilage palisade tympanoplasty was performed in 32 ears and fascia tympanoplasty in 29 ears. The patency of the Eustachian tube was evaluated by the Valsalva maneuver before the operation, 1 to 3 months after the operation, and at a follow-up examination 46(1/2) months later (median). Eustachian tube function was evaluated by the nine-step inflation/deflation tympanometric test and the Toynbee test at the follow-up examination. Otomicroscopy and hearing evaluation were performed before and after surgery as well as at the follow-up. MAIN OUTCOME MEASURES: Eustachian tube patency and function. Hearing, postoperative eardrum perforation/retraction, and cholesteatoma recurrence. RESULTS: The Valsalva maneuver was positive in 30% of the ears before the operation, in 65% primarily after the operation, and in 78% at the follow-up examination. A poor tubal function was found in 57% at follow-up. Overall, the late functional hearing results were better in ears with a positive Valsalva maneuver. There were no differences in tubal patency or function in relation to graft material, cholesteatoma, and tympanoplasty type. In ears with a poor tubal function, the hearing results were significantly better in the palisade group (63% success), compared with the fascia group (17% success). All of the four perforations, most of the retractions, and a single moist eardrum were found in the fascia group at the reevaluation. We found no correlation between the condition of the eardrum and the Eustachian tube function at the last evaluation. However, in ears with a poor tubal function, a nonretracted, nonperforated drum was found with higher frequency in the palisade group. Decision matrix analysis showed that the last postoperative Valsalva maneuver was the best predictor of the drum condition at the reevaluation. CONCLUSIONS: The Eustachian tube patency frequently improves after tympanoplasty after cholesteatoma surgery in children, regardless of graft material. The patency and function of the Eustachian tube seem to be without relation to graft material, cholesteatoma, or tympanoplasty type. Cartilage palisade tympanoplasty may be a better reconstruction technique after cholesteatoma surgery, especially in ears with a poor tubal function.

Acoustic Impedance Tests↗
PubMed2005

Processed fascia lata as an alternative implant material in evisceration.

PURPOSE: To examine the use of processed fascia lata strips as an implant material in evisceration. METHODS: This is a prospective, interventional, noncomparative case series. Eight patients underwent standard evisceration of an eye with subsequent primary insertion of processed fascia lata strips in the scleral shell. They were clinically examined at regular postoperative intervals (up to 20 months) and had computed tomography and magnetic resonance imaging scans of the orbits at the 12-month interval. The development of vascularity of the scleral shell contents was assessed with the intravenous administration of a contrast-enhancing agent. RESULTS: The fascia lata strips were incorporated without significant complications in all cases. The maintenance of adequate volume and position of the eviscerated globe was confirmed by both computed tomography and magnetic resonance imaging scans. T1-weighted magnetic resonance imaging studies with intravenous administration of contrast-enhancing agent and fat-saturation sequences revealed the development of vascularity of the scleral shell contents. CONCLUSIONS: Processed fascia lata may be a useful alternative implant material in evisceration. Possible advantages of its use may include protection against extrusion, custom volume selection and easy intraoperative manipulation.

Aged↗