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PubMed1985

Histopathologic condition of fascia lata implant 42 years after ptosis repair.

Fascia lata implants have been employed since the early part of this century in the repair of blepharoptosis. Although much has been written concerning surgical techniques and results of implanting different preparations of fascia lata, there are relatively few reports of long-term histopathologic follow-up of recovered tissue. In the case described herein, autogenous fascia lata was recovered at the time of repeated surgery and examined 42 years later. On microscopic examination the tissue was viable but demonstrated significantly more vascularization, fibroblastic infiltration, and incorporation with surrounding structures than previously reported implants.

Aged↗

PubMed1984

Effects of structure and strain measurement technique on the material properties of young human tendons and fascia.

It is generally recognized that the organization of collagen bundles in soft tissues strongly influences their material properties. To study this, sixty failure tests were conducted on double-layered fascia lata, 'isolated' parallel-bundled tendons (gracilis and semitendinosus) and parallel-bundled bone-patellar tendon-bone units taken from about the knees of eighteen young human donors (mean age of 26 yr). Surprisingly, most material parameters for the two-layered fascia lata did not differ significantly from corresponding values for the isolated tendons and tendon-bone preparations, suggesting their longitudinal fibers predominated during loading. Differences were present however between the gracilis tendon and all other tissues for both modulus and maximum stress. The large variations in reported maximum and failure strains for tendons, fascia and other collagenous tissues prompted the other phase of the study. During 15 of the 60 failure tests, surface markers were simultaneously filmed to determine; differences between local surface strains and grip to grip values; the amount of tissue slippage and/or failure occurring in the grips; and the effect of strain measurement technique on tissue moduli and failure energy densities. Maximum local strains were found to be 25-30% of grip strains for all tissues tested. Some slippage and/or failure could be seen in all isolated tissues which were gripped directly although their maximum grip strains were similar to values for tendon-bone units. For all tissues, two to three fold differences were also found in moduli and failure energy densities between grip and midregion measurements.

Adult↗

PubMed1975

Clinical and hemodynamic results of mitral valve replacement with autologous fascia lata grafts. Studies in patients with competent prostheses.

Nine patients with severe mitral disease were studied before and six months after mitral valve replacement with a three-cusp stented prosthesis using fresh autologous fascia lata tissue. Only patients in whom there was no auscultatory and angiographic evidence of incompetence of the replaced valve were selected for restudy. All patients claimed a marked improvement in their exercise capacity after operation and there was a significant reduction in radiographic heart size. The cardiac output at rest and the response to exercise were both reduced before operation and were unchanged after valve replacement. The elevated pulmonary arterial and wedge pressures were significantly reduced after operation in all patients both at rest and during exercise, but in no instance were the postoperative exercise values within normal limits. Left ventricular end-diastolic pressure was within normal limits at rest and during exercise in all patients after valve replacement but the average pressure gradient across the fascia lata valve was 6+/-1 mm Hg at rest and 18+/-3 mm Hg during exercise. These findings indicate that altough replacement of the diseased mitral valve with a competent fascia lata prosthesis afforded substantial symptomatic relief, reduction of cardiac enlargement and a lowering of the pulmonary vascular pressures, this artificial valve offered a significant obstruction to left ventricular diastolic filling, particularly during exercise.

Adult↗

PubMed1975

Aortic valve replacement with frame-supported autologous fascia lata grafts. I. Technical consideration and early results.

During the period November 1969 to June 1972, a frame-supported autologous fascia lata graft was implanted in 71 consecutive patients with surgically treated aortic valve disease at the Department of Thoracic & Cardiovascular Surgery, University Hospital, Uppsala. The follow-up period was between 1 and 4 years. Eleven patients died within 28 days of the operation (16%) and 13 after discharge from hospital (18%); the cumulative mortality was thus 34%. Forty-five percent of the patients who died had associated cardiovascular or other diseases. The causes of death were infection (10), myocardial failure (6), myocardial infarction (3), cerebral damage (3), and intraoperative aortic dissection from the cannulation site (2). The majority of the deaths (88%) occurred within 6 months and all within 13 1/2 months after operation. Two fascia lata valves were removed because of endocarditis 23 and 26 months, respectively, after operation. Two valves were also removed on account of mechanical malfunction. The remaining 44 patients with fascia lata valves had returned to work. No embolic complications occurred, despite the fact that only patients with a concomitant prosthetic mitral valve or atrial fibrillation received anticoagulatant treatment. Haemodynamic studies of the valve in vitro and pressure measurements during the operation showed that the valve had a low primary systolic peak gradient of 0-16 mmHg. Certain modifications in the construction aimed at improving the haemodynamic properties of the valve are discussed. Increased stringency in the sterility precautions during the valve construction procedure may have contributed to the fact that early endocarditis, which is a serious complication, did not occur in any of the last 43 patients. As yet the observation time is too short to judge, however, to what extent susceptibility to infection and possible late changes of the valve can affect its function.

Adolescent↗

PubMed1975

Morphologic observations on heart valve prostheses made of fascia lata.

A cooperative, international study permitted morphologic observations on 58 fascia lata heart valve prosthese. Thirty-nine had been in position less than a year, the remainder for periods up to 50 months. The fascial cusps, no matter whether free or stent mounted, underwent changes that included death of the original fascia and vacuolar, degenerative changes if a valve had been in situ more than 3 years. Formation of a pseudointima on a cusp's surface caused it to shrink. The rate of progression and severity of the changes varied from prosthesis to prosthesis. Severe cusp shrinkage caused valve incompetence. That seemed particularly likely in mitral and tricuspid prostheses and explains why their use has been abandoned. Clinically, fascia lata aortic valves function satisfactorily for several years. However, their long-term value is still uncertain. Morphologically, the specter of late calcification and other degenerative changes haunt their use until more, from long-term survivors, are available for study.

Aortic Valve↗

PubMedDate not supplied

The late fate of autologous fascia lata valve grafts in the aortic position.

Fascia lata has been used for aortic valve replacement in 206 patients over a period of 10 years. Important advantages of this method are easy availability of the fascia tissue, excellent valve function in the early follow-up, and the absence of thromboembolic complications and of anticoagulant therapy. Long-term follow-up revealed a 10% incidence of infective endocarditis. Late deterioration of valve function occurred in 60% of patients after an average interval of five years. Electron microscopic study of fascia lata valve cusps removed one to seven years after implantation showed no endothelial layer, but an amorphous surface coating. The tissue remained viable, but showed necrotic foci and areas of proliferation. These morphologic alterations caused thickening and sclerosis of the valve cusps, which were responsible for the late deterioration of valvular function.

Aortic Valve↗

PubMed1990

Bone-patellar ligament-bone and fascia lata allografts for reconstruction of the anterior cruciate ligament.

A prospective study was performed of the first forty-seven consecutive patients who had repair of a ruptured anterior cruciate ligament and replacement with an allograft. Patients who had a rupture of another ligament were excluded, to provide a homogeneous group. Twenty-two patients received a fascia lata allograft and twenty-five patients received a bone-patellar ligament-bone allograft. All patients were enrolled in an exercise program to facilitate motion of the knee immediately after the operation, and all patients returned for postoperative evaluation (mean, forty months; range, twenty-five to sixty-seven months). The results were based on a comprehensive subjective and objective rating system, which assessed twenty factors. On testing with the KT-1000 arthrometer, 69 per cent of the patients had less than three millimeters of increased anterior-posterior displacement of the knee that had been operated on compared with the contralateral knee, 26 per cent had three to five millimeters, and 5 per cent had more than five millimeters. The knees that had a bone-patellar ligament-bone allograft had significantly lower values for anterior-posterior displacement than did those that had a fascia lata allograft (p less than 0.05). Just one patient, the only one in whom the fascia lata graft failed, had giving-way. There were no infections, and there was no evidence of rejection of the allograft or documented transmission of disease at the time of writing. A strict rating system was used. Eighteen patients (38 per cent) had an excellent result, twenty-four (51 per cent) had a good result, and five (11 per cent) had a fair or poor result. Motion of the knee immediately postoperatively was not deleterious to the allograft, and, because limitations of motion were identified and treated in the early postoperative period, full motion (0 to 135 degrees) was restored in all knees.

Activities of Daily Living↗

PubMed1977

Use of autologous fascia lata as a pericardial substitute following open-heart surgery.

Thirteen patients requiring repeat open-heart surgery had autologous free fascia lata grafts implanted to effect complete pericardial closure. In four patients, the graft was used to augment the pericardial space because of myocardial failure and enlargement. In the remainder, fascia lata was used because shrinkage, scarring, or absence of the pericardium from prior operation prevented primary closure. No hemodynamic problems related to implantations of the grafts were seen. The harvesting of the grafts produced no functional deficits, and complications at the donor site were insignificant. Complete pericardial closure with fascia lata protects underlying myocardial structures (i.e., saphenous vein grafts) in the event that further reoperation for bleeding or infection is required. In addition, it provides for compartmentalization of the mediastinum, allowing accurate assessment of the site of postoperative bleeding.

Adolescent↗

PubMed1978

Comparative analysis of isolated aortic valve replacement with fascia lata and homograft valves.

Thirty-eight consecutive patients who underwent isolated replacement of the aortic valve with fascia lata in 1970 were compared with a similar series of patients undergoing homograft replacement of the aortic valve. These series were well matched in number, age sex of patients, symptomatology, valvular disease, electrocardiographic and roentegenographic changes, and preoperative cardiac catheterization data. The mean follow-up time was 73 months in the fascia lata series and 69.1 months in the homograft series, and all the post-operative survivors were reviewed. The early and long-term results were similar of the two series, and there was no statistical difference in the operative and late mortality, the incidence of early and late diastolic murmurs, valve failure necessitating valve replacement, infective endocarditis, thromboembolism, over-all survival, and survival with an intact valve. It is concluded that the long-term results of valve replacement using these two tissues, in the aortic position, are similar and there is little to choose between the two types of valves. If fascia lata, as we believe, is no longer acceptable as a satisafactory valve substitute, then homograft valves are not acceptable either.

Adolescent↗

PubMed1981

The use of autogenous fascia lata to correct lid and orbital deformities.

Autogenous and homologous fascia lata have been used to correct many problems in ophthalmic surgery. This paper has described the use of autogenous fascia late to correct lid retraction secondary to thyroid ophthalmopathy, cicatricial entropion and extruding orbital implants. The surgical procedures have been briefly discussed, as well as the presentation of one clinical example of each procedure the pathologic and immunologic aspects of fascia lata grafts will be reported at a later date.

Adult↗

PubMed2005

Temporal fascia as interpositioning material in cases of temporomandibular ankylosis.

OBJECTIVE: To evaluate the efficacy of temporal fascia as interpositioning material after treatment of TMJ ankylosis with gap arthroplasty. DESIGN: An interventional study. PLACE AND DURATION OF STUDY: The study was carried out at the Department of Oral and Maxillofacial Surgery, Mayo Hospital, Lahore, during June 1999 to June 2001. PATIENTS AND METHODS: A total of 51 patients, 23 males and 28 females, of temporomandibular ankylosis were treated with gap arthroplasty and temporal fascia was used as interpositioning material. RESULTS: Out of 51 cases, 28 had excellent results, 20 were declared good and 3 presented with recurrence. CONCLUSION: Temporal fascia works as excellent interpositioning material with minimum morbidity and no complications. Moreover, it is easier to raise, comes from same operation field and is dispensable.

Adolescent↗

PubMed2000

Anatomical study on arteries of fasciae in the forearm fasciocutaneous flap.

The arteries of the forearm flap were studied systematically and quantitatively to determine the survival mechanism of fasciocutaneous flaps and provide morphological basis for clinical application. Fourteen forearms from fresh adult cadavers were investigated by methods of dissection under operating and biological microscopes, tissue clearing, tissue sectioning, and image analysis. There were four arterial types in the forearm flaps in which the intermuscular space cutaneous artery was predominant in number. Both intermuscular space cutaneous arteries and intermuscular septal cutaneous arteries anastomosed by branches as arterial chains along the intermuscular spaces and septa where the stem arteries ran through. Arteries of each type gave off epi- and subfascial branches to the deep fascia, and the former were greater in number and larger in diameter. In the same way, the vascular network was thicker in the epifascial level than that in the subfascial level. The percentage of the area of blood vessels in deep fascia (Aa%) was larger than that of the superficial fascia. In the forearm, the deep fascial vasculature is the main pathway through which the fasciocutaneous flap gains its blood supply, and the epifascial vascular network is especially important. It would be better to select the fascial pedicle where the arterial chain exists.

Adult↗

PubMed1989

Morphology of the lingual apparatus of the domestic chicken, Gallus gallus, with special attention to the structure of the fasciae.

A detailed redescription of the mechanically interacting structural elements of the lingual apparatus of the domestic chicken, Gallus gallus, revealed the functional and constructional role of organized connective tissue (i.e., ligaments and fasciae) as structural elements that ensure the proper biomechanical interactions among the various structures within the lingual apparatus (e.g., cartilaginous and bony skeletal elements, muscles, salivary glands, epithelial structures). Fasciae, together with extrinsic muscles, also connect the lingual apparatus to the other components of the feeding apparatus, such as the skull, jaw apparatus, and larynx. For example, the hyoid apparatus is attached to the skull by a sheath-like fascia (F. vaginalis), the internal structure of which is described here for the first time. Thus, the hyoid suspension in birds differs fundamentally from that in mammals. This study is the first to examine all biomechanically functioning structural elements that are part of the galliform lingual apparatus in a systematic and comprehensive manner. It also provides a set of novel characters that may be useful for future comparative studies in evolutionary and functional morphology.

Animals↗

PubMed2003

Anatomy of the arcus tendineus fasciae pelvis in females.

Because of its proximity to the urethra, the anterior part of the arcus tendineus fasciae pelvis (ATFP) may be used in urethrosuspension procedures for urinary stress incontinence. In this study, 10 embalmed female cadaver hemipelves were dissected and their gross anatomy described. In females, the ATFP is a condensation of the endopelvic fascia. The anterior attachment of the ATFP is to the caudal inner surface of the body of the pubic bone at a site averaging 4 mm lateral to the pubic symphysis and covering an average area of 53 mm(2). Posteriorly, it attaches to the medial surface of the ischial spine. In nine of the 10 hemipelves the first anterior centimeters of the ATFP have a clear lateral fixation either to the lateral part of the levator ani muscle (n = 1), to the fascia covering the obturator internus muscle (n = 7), or to the obturator membrane (n = 1). Medially from the ATFP derives a 2-3-cm long flat fibrous attachment to the posterolateral aspect of the urethra. In eight unembalmed cadavers, the ATFP gave way at a pulling force of 8.2 kg (range = 3.5-11.5 kg). The ATFP resists caudal movement of the proximal anterior vaginal wall and the urethra in the upright posture and, therefore, may be suitable for urethrosuspension procedures.

Adult↗

PubMed1983

A 200-kd protein isolated from the fascia adherens membrane domains of chicken cardiac muscle cells is detected immunologically in fibroblast focal adhesions.

On the premise that the fascia adherens of cardiac muscle cell intercalated disk membranes is a structure that is closely homologous to the focal adhesions formed by fibroblasts, a fascia adherens preparation was isolated from chicken cardiac muscle, and was analyzed for its protein composition. A prominent 200-kilodalton (kd) protein was purified from the fascia preparation and shown to be antigenically unrelated to several previously characterized cytoskeletal proteins, including cardiac myosin and vinculin. With monospecific antibodies to the 200-kd protein, an identical or closely similar intracellular protein was shown to be associated with the focal adhesion plaques of fibroblasts.

Animals↗

PubMed1979

Tympanoplasty using formaldehyde formed fascia grafts.

The closure of total perforations of the tympanic membrane has always been more difficult than lesser eardrum defects. Postoperative anterior sulcus blunting and graft lateralization occur with greater frequency in this situation and thus compromise results. In 1975, Rodney Perkins developed and described a technique for the closure of such total perforations which involved the use of formaldehyde treated temporalis muscle fascia, shaped by means of a metal mold into the configuration of a normal tympanic membrane and medial end of the bony external ear canal. This formaldehyde formed fascia (FFF) graft impressed us with its adaptability and logic. This article is a review of 139 cases involving the use of formaldehyde treated grafts not only for closure of total performations, but also for closure of total performations with concomitant middle ear ossicular reconstruction. The postoperative nonperforation rate in this series is 96.4%; blunting and/or graft lateralization was absent in 94.2% of cases. Closures of the air-bone gap to within 20 db occurred in 74% of cases with an overall gain in hearing for all cases of 84%. We believe that formaldehyde formed fascia grafts are an effective tool for the closure of total tympanic membrane perforations with or without concomitant ossicular chain reconstruction.

Adolescent↗

PubMed2003

New experimental composite flap model in rats: gluteus maximus-tensor fascia lata osteomuscle flap.

Experimental animal models need to be developed for studies of composite flaps that have often recently been used for defects of both bone and soft tissues. A consistent anatomy, simple surgical technique, and reliable blood flow are essential for the success of experimental flap studies. Here we propose a gluteus maximus-tensor fascia lata osteomuscle flap in rats as a model of these qualities. Gluteus maximus and tensor fascia lata muscles and the adjacent iliac bone segment were combined as a lateral circumflex femoral artery-based flap. To test the reliability of this composite flap, three types of composite tissues were harvested and replaced: osteomusculocutaneous flap, osteomuscle flap, and osteomuscle composite graft. The osteomusculocutaneous flap was elevated by including a skin island over the gluteal region. The osteomuscle graft was formed by deliberately dividing the vascular pedicle of the osteomuscle flap. Direct observation revealed complete necrosis of the skin islands in all osteomusculocutaneous flaps. Microangiography of the flap demonstrated that both muscles and the attached bone were supplied by the pedicle. Dye studies with nitro blue tetrazolium (NBT) and India ink demonstrated dye uptake in both muscle and bone components in osteomuscle flaps. Histological examinations also demonstrated the viability of both tissues only in the flap group. Bone scintigraphy performed in flaps on postoperative day 7 demonstrated radionuclide uptake, confirming perfusion of the bony segment. The gluteus maximus-tensor fascia lata osteomuscle flap is a reliable and simple model for composite flap studies that offers the following advantages: 1) it is a new composite flap which includes bone, 2) it can be dissected easily with the naked eye, without using the microscope, 3) it has a long pedicle for flap displacement, and 4) it is a small animal model.

Animals↗

PubMed2006

Tuberculosis of the endothoracic fascia.

A 13-year-old boy presented with a history of respiratory infection that had progressed for 3 months. A chest X-ray showed pathological findings that suggested endothoracic fascia compromise (Skarby sign). The thorax computerized axial tomography scan revealed multiple opacities in the fascia. A biopsy was performed, and a pathological lymph node with caseous material was obtained. Thirty days later, Mycobacterium tuberculosis var. hominis was obtained from the culture. The diagnosis of tuberculosis of the endothoracic fascia was confirmed. Treatment included 9 months with isoniacide and rifampin, and 2 months with pirazynamide and streptomycin, with excellent response. Vitamin B6 was added.

Adolescent↗