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At least 397 records · Page 22Linked to original sources
PubMed2000

Outcome in 104 pubovaginal slings using freeze-dried allograft fascia lata from a single tissue bank.

We describe our experience with the use of allograft fascia lata for the treatment of stress urinary incontinence. One hundred and four patients underwent allograft fascia lata pubovaginal slings. Preoperatively, all were evaluated by a detailed urogynecologic evaluation, voiding diary, and pelvic examination. The pubovaginal sling was performed using a 2x15-cm freeze-dried nonirradiated cadaveric fascia lata specimen. Outcome measures were assessed by a urogynecologic questionnaire, pad usage, and disease-specific quality-of-life questionnaires. Eighty-eight percent (91 of 104) responded to a mailed urogynecology and disease-specific quality-of-life questionnaire with an average follow-up period of 19. 4 +/- 10.3 months. The mean preoperative daily pad usage was 4.6 +/- 3.0, postoperatively pad usage was 1.1 +/- 1.4 (P < 0.0001). Urge incontinence resolved in 41% (n = 24) of the 59 patients who complained of this preoperatively. Eighty-seven percent of the responders indicated that urinary incontinence was not substantially affecting their daily life. As in our preliminary report, the use of freeze-dried allograft pubovaginal sling continues to provide good results without adverse outcomes. A prospective, randomized comparison of autologous versus allograft slings and a review of preparation techniques used by tissue banks are needed.

Aged↗
PubMed2000

Is fascia lata allograft material trustworthy for pubovaginal sling repair?

OBJECTIVES: In a recent publication, cadaveric fascia lata used for pubovaginal sling procedures was reported as having an early, rapid, and high failure rate. Recurrent incontinence was reported to occur from 1 week to 5 months after surgery. The study concluded that cadaveric tissue should not be used for urogynecologic procedures. Their results, however, were significantly different from what we found in clinical practice. We reviewed our series of cadaveric pubovaginal slings to determine the occurrence of rapid breakdown of cadaveric sling tissue leading to recurrent stress urinary incontinence. METHODS: At our institution, since June 1998, pubovaginal slings have been performed using only cadaveric fascia lata. Because all of the failures in the aforementioned study occurred within 5 months (mean 11 weeks) of surgery, we included in our series only patients with a minimum of 12 months of follow-up to ensure a long enough follow-up period for failure of the donor tissue to occur. Duration of follow-up and current continence status was documented. RESULTS: Twenty-six patients, with a mean follow-up of 15 months (range 12 to 20), were evaluated. Twenty-four of 26 (92%) patients used one or fewer pads per day: 20 of 26 (77%) were completely dry and 4 of 26 (15.4%) used only one pad per day. Two of 26 (7.7%) required two pads per day. Twenty-five of 26 (96%) reported being "significantly improved" and were "very pleased and satisfied" with the results of surgery. CONCLUSIONS: We found no evidence of rapid degradation of solvent-dehydrated cadaveric tissue resulting in early recurrent incontinence. We think these data support the continued use of cadaveric allograft material, especially given its intraoperative and postoperative advantages. Clearly, long-term evaluation of the durability of the cadaveric slings in comparison with autologous fascia is warranted.

Adult↗
PubMed2003

Use of fascia-peritoneum patch as a pledget for an infected aortic stump.

Treatment of aortic prosthetic graft infections remains a challenge. One frequently encountered technical difficulty when removing an infected prosthetic aortic graft is how to close a short, friable remnant aortic stump. We present three case reports in which we used a layer of posterior rectus fascia-peritoneum to bolster oversewing a short infected aortic stump after removal of an infected aortic graft. All three patients underwent staged extra-anatomic axillary-to-femoral artery bypass procedures, with subsequent removal of the infected aortic graft as a second operation. Two of the three procedures were semi-elective, and one was done urgently because of a recurrent aortoenteric fistula. All three patients had less than 1 cm of remaining aortic neck below the renal arteries for closure. In each instance a segment of autogenous posterior rectus fascia-peritoneum was harvested and used as a circumferential pledget to bolster the anastomosis. No patient had stump blowout, and in no case was there computed tomography evidence of aneurysmal enlargement of the stump with follow-up of 12 and 24 months in two of the three survivors. Use of autogenous fascia-peritoneum is a durable and effective method to assist stump closure and prevent stump blowout after removal of infected aortic grafts.

Aged↗
PubMedDate not supplied

Rupture of the plantar fascia.

Rupture of the plantar fascia in athletes engaged in sports that require running and jumping has been reported. However, spontaneous degenerative rupture of the plantar fascia is not well documented in the literature. This paper reports a patient with degenerative rupture of the plantar fascia.

Aged↗
PubMed1991

Anatomy of the temporalis fascia.

The anatomy of the different layers of the temporalis fascia is reviewed. The superficial and deep layers of the temporalis fascia have been studied by light microscopy to assess any histological difference between the two. We have also assessed the physical characteristics of the different layers by measuring their Young's modulus in the wet and dry states. Anatomically the superficial layer is part of the epicranial aponeurosis and thus covers nearly the entire lateral aspect of the skull. The deep temporal fascial layer covers exactly the temporalis muscle and measures 10 x 12 cm. The fascial layers have a separate arterial and venous supply enabling them to be used as a homograft, a rotation flap or free microvascular flap. Histologically there is no difference between the two layers. A study of the physical characteristics of the two fascial layers using Young's modulus revealed no significant difference in elasticity between the two. The most significant factor affecting the elasticity was the state of hydration of the fascia.

Elasticity↗
PubMed1998

Bone and temporal fascia graft for the closure of septal perforation.

OBJECTIVES: To assess the reliability of temporal fascia and bone graft for the closure of septal perforation. STUDY DESIGN: Prospective longitudinal non-randomized. METHODS: The repair of septal perforation was performed using endonasal dissection; suture of the borders of the perforation on at least one side, and interposition of a graft of temporal fascia with bone, either a perpendicular plate of ethmoid (six) if available or mastoid cortex (three) if not. RESULTS: All patients had closure without re-perforation. Eight out of nine patients had complete closure of the perforation (88.8 per cent). These patients had perforations of less than 3 cm in diameter. The ninth patient had a perforation of more than 3 cm diameter (3.5 x 2.5 cm), and obtained a closure of about 80 per cent of the original perforation. The remaining perforation was in the posterior part of the nose. The patient was relieved of his symptoms (crusting and bleeding). This incomplete closure was most probably due to migration of the graft immediately after surgery. There was no morbidity of the donor site or the ear in the mastoid cortex graft group of patients. This is to our knowledge the first report of the use of the mastoid cortex as a graft in septal perforation. CONCLUSIONS: We consider that the graft of temporal fascia with bone is very reliable, and the use of bone ensures closure while avoiding the complications of a lax septum in large perforations. The technique is suitable for perforations up to 2.5 cm diameter. Perforations larger than 3 cm in diameter are more difficult to close, but closure of the anterior part of the perforation will relieve the patient from the most annoying symptoms.

Ethmoid Bone↗
PubMed2002

PTFE-fascia patch inlay method for the anterior approach for cervical intradural spinal lesion.

STUDY DESIGN: A new method for prevention of cerebrospinal fluid leakage was studied. OBJECTIVE: To prevent cerebrospinal fluid leakage, we developed a polytetrafluoroethylene fascia patch inlay method. BACKGROUND: One of the major risks of the anterior approach for intra-dural spinal cord lesions is the cerebrospinal fluid leakage. METHODS: A small hemangioblastoma located on the ventral side of the cervical cord was resected with an anterior approach. The dural closure was performed using this polytetrafluoroethylene fascia patch inlay method. RESULTS: The patient had a satisfactory clinical course with no cerebrospinal fluid leakage. CONCLUSION: This polytetrafluoroethylene fascia patch inlay method is very effective. This method may provide both prevention of CSF leakage and future spinal cord adhesion to the dura.

Cervical Vertebrae↗
PubMed1999

Reoperation for recurrent saphenofemoral incompetence: a prospective randomised trial using a reflected flap of pectineus fascia.

OBJECTIVE AND DESIGN: in 1978 Sheppard described using a flap of pectineus fascia in an attempt to reduce the further development of neovascularised veins at the saphenofemoral junction. The perceived benefits of this manoeuvre have not been tested by a prospective randomised trial. MATERIALS AND METHODS: consecutive patients with symptomatic recurrent varicose veins referred to a single consultant were examined for evidence of further reflux from the saphenofemoral junction. This was subsequently confirmed in forty limbs (thirty-seven patients) by descending venography. All had features of a neovascularised segment. These patients were treated by complete exposure and ligation of the recurrences arising from the common femoral vein, with or without the placement of a flap of pectineus fascia (prospectively randomised). The patients were assessed a minimum of eighteen months later by both clinical examination and duplex ultrasound scanning. RESULTS: six patients were lost to follow-up. This left seventeen limbs remaining in each half of the study. The characteristics in each group were broadly matched. CONCLUSIONS: this study failed to demonstrate any apparent benefit from the application of a flap of pectineus fascia. Most patients showed evidence of re-recurrence arising from the common femoral vein.

Adult↗
PubMed2001

The histochemical structure of the deep fascia and its structural response to surgery.

The histochemical structure of the deep fascia and its interface with the underlying muscle was examined in ten pigs. This structure was also evaluated after it had been raised as a fascial flap and in another site after the underlying muscle surface had been disrupted. The deep fascial is a simple structure of densely-packed collagen bundles and elastin fibres, and has hyaluronic acid concentrated on its inner surface, which is in contact with the underlying muscle. There is no specialised lining of this surface of the fascia to account for its gliding properties. The post-surgical specimens demonstrated preservation of the structure of the interface between fascia and muscle, including the retention of the hyaluronic acid lining, if the epimysium was intact. However, if the epimysium was disrupted, the structure of the interface was obliterated.

Animals↗
PubMed2004

Structural and functional regeneration of muscle-related axons after transection and repair of the rat sciatic nerve using nonvascularized autologous fascia as a barrier between tibial and peroneal nerve fascicles.

Aberrant reinnervation of target organs caused by misdirected axonal growth at the repair site is a major reason for the poor functional outcome usually seen after peripheral nerve transection and repair. This study investigates whether the criss-crossing of regenerating rat sciatic nerve axons between tibial and peroneal nerve fascicles can be reduced by using non-vascularized autologous fascia as a barrier. The left sciatic nerve was transected and repaired at midthigh as follows: epineurialy sutures (Group A); fascicular repair of tibial and peroneal nerve fascicles (Group B); fascicular repair of tibial and peroneal nerve fascicles separating the two fascicles by non-vascularized autologous fascia (Group C). In the control Group D, only the left tibial fascicle was transected and repaired. Five months postoperatively, the outcome of regeneration was evaluated by histology, by retrograde tracing, and by assessment of the contraction force of the gastrocnemius and tibial anterior muscles. The tracing experiments showed that muscle reinnervation was less abnormal in Group C than in Groups A and B. However, muscle contraction force was not better in Group C than in Groups A and B. With respect to the peroneal nerve innervated muscle, the contraction force in Group C was significantly lower than in Group B. The histologic picture indicated that this inferior result in Group C was due to nerve compression caused by fibrotic scar tissue at the site of the fascia graft. Results of this study show that a non-vascularized autologous fascial graft used as a barrier between two sutured nerve fascicles in adjacency reduces criss-crossing of regenerating axons between the fascicles, but causes significant nerve compression.

Animals↗
PubMed1985

[Anatomy of the visceral fascia of the pelvis from the didactic viewpoint].

The fascia-like formations of the pelvic subserosum are unsatisfactorily interpreted by the classical interpretations of "hypogastric gain" or "fibroglia". However, these two opposing concepts can be reconciled if the connective tissue of the female minor pelvis is not seen as a unit but rather as a complex structure. In the surroundings of the pathways directed towards, or originating from, the pelvic viscera, ontogenesis results in a densification of the at first very loose connective tissue and eventually in the formation of fascia-like structures. Hence, these are not primarily basic structures of the vessels and nerves, but originate wherever pathways are already present. Three "roads" lead from three roots in three planes to the inner genital. The road of the veins runs in a "transverse" plane ("horizontal" plane in the standing woman) to the lateral pelvic wall. This is responsible for the formation of the ligamentum cardinale which has been described as the central part of the "fibroglia". The arterial road runs craniocaudally in a "frontal" plane. The branches of the hypogastric artery (a. iliaca interna) have taken densified webs of fascia with them which produce the pattern of "hypogastric gain". The neurovegetative road originates at the sacrum at the foramina sacralia anteriora, and is in "sagittal" position. Loose connective tissue remains between the densification zones, and it is here where surgery can be performed practically without causing any trauma.

Arteries↗
PubMedDate not supplied

Collagen I/III and matrix metalloproteinases (MMP) 1 and 13 in the fascia of patients with incisional hernias.

The late appearance ofincisional hernias several years after laparotomy and the high recurrence rates after operation strongly imply the presence of a disorder of the connective tissue, although a specific defect in patients with incisional hernias has not yet been identified. In the present study we used both immunohistochemistry and Western blot analysis to evaluate the ratio of collagen I and III and the expression of the metalloproteinases (MMP) 1 and 13 in the fascia of patients with incisional or recurrent incisional hernias. Samples of healthy skin or stable skin scar in patients without hernias served as controls. Altogether, our data indicated a significantly decreased ratio of collagen I/III in the fascia of patients with incisional hernias and recurrent incisional hernias. Furthermore, in these patients the expression of MMP-1 was decreased compared to the controls, whereas MMP-13 could not be detected in any fascia sample, with or without hernias present. For the first time, our results give evidence of the existence of a possible collagen disorder in these patients. The decreased ratio ofcollagen I/III is explainable due to a relative increase of collagen type III, which is known to be characterized by thin fibril diameters and lowered mechanical strength. The altered collagen ratio might be the result of the decreased activity of MMP-1, whereas the absent MMP-13 expression did not seem to modify the scar formation. Thus, our data indicate the presence of collagen metabolic disorders in patients with incisional hernias and recurrent incisional hernias. Furthermore, these results might explain the poor results of a mesh-free hernia repair, which again builds up scar tissue of inadequate collagen composition and strength.

Adult↗
PubMed1991

Microsurgical reconstruction: experience with free fascia flaps.

Microsurgical reconstruction can often benefit from the thin, pliable, and vascular characteristics of free fascia flaps. Investigation to identify donor sites and to maximize reliability of these flaps continues. Microfil injections of the thoracodorsal artery confirm the ability to use the fascia overlying the serratus anterior muscle as a free flap based on this vessel. We have used this flap in distal extremity wounds in 4 patients with one failure (venous thrombosis). Free fascia flaps from other donor sites have been used in 9 patients in a variety of locations (head and neck, hand, and extremity) with excellent results. We conclude that when thin, well-vascularized tissue is required for reconstructive purposes, the skin-grafted free fascial flap provides excellent durable coverage with minimal donor site complications.

Adult↗
PubMed1991

HIV and banked fascia lata.

Concern over the transmission of communicable diseases through donor tissue has recently increased. Nine hundred and fifty-nine pieces of banked homologous irradiated fascia lata have been distributed to ophthalmic plastic surgeons nationwide over the past 3 years since the establishment of the Wills Eye Hospital Fascia Lata Bank. Safeguards taken against the transmission of disease include strict donor selection; negative antibody testing for human immunodeficiency virus (HIV), rapid plasma reagin (RPR), and hepatitis B surface antigen (HbsAg); heat treatment; and radiation sterilization with 4 million rads of cobalt-60 gamma radiation. To date, no cases have been reported of the transmission of HIV through surgical implantation of banked irradiated homologous fascia lata.

Eye Banks↗
PubMed1998

Vocal fold augmentation by injection of autologous fascia.

Vocal fold augmentation by injection under direct visual control is a quick and simple operation. However, when autologous fat or bovine collagen is used, resorption creates a problem. The low metabolic requirements and the relatively stable histologic character of free fascial grafts make autologous fascia a fascinating material in vocal fold augmentation. This research project was carried out to establish a suitable method to transplant fascia into a vocal fold and to assess its impact on the voice. A piece of fascia lata was chopped with a scalpel. The material was injected in the lateral aspect of the thyroarytenoid muscle using a pressure syringe. Nine subjects with a paralyzed vocal fold were analyzed after the injection. The postoperative voice, rated by a panel of experienced listeners, was significantly better than the preoperative (P < 0.05). Five of nine voices were rated normal or near normal after the procedure. The mean maximal phonation time increased significantly (P < 0.01). All patients considered that their voice had improved, and eight of nine regarded it as good. No one reported deterioration of the result during the follow-up (mean duration, 10 months; range, 3 to 18 months).

Aged↗
PubMed2002

Autologous transplantation of fascia into the vocal fold as a treatment for recurrent nerve paralysis.

OBJECTIVES: To apply the technique of autologous transplantation of fascia graft into the vocal fold for glottal insufficiency due to recurrent nerve paralysis and to evaluate the results in eight patients who underwent the procedure. STUDY DESIGN: Technical modifications were made in transplantation of the temporal fascia into the paralyzed vocal fold. Eight patients underwent the surgery, and their phonatory function was examined preoperatively and postoperatively. METHODS: The following surgical techniques were applied to prevent the falling-off of the graft: 1) a roll-shaped fascia graft was prepared before the transplantation and 2) a pocket was made within the lamina propria mucosa using a newly devised special elevator. The maximum phonation time and airflow rate during sustained phonation (in four cases) were measured, and perceptual evaluation of voice quality was made using the GRBAS scale by speech pathologists before and after the surgery. RESULTS: All the cases showed no evidence of falling-off of the graft. Elongation of the maximum phonation time and improvement in voice quality were obtained in all cases postoperatively. CONCLUSION: The method proved to be useful for the treatment of glottal insufficiency due to recurrent nerve paralysis.

Aged↗
PubMed2001

Dural reconstruction with fascia, titanium mesh, and bone screws: technical note.

OBJECTIVE: After the resection of cranial base tumors, there may not be enough free dural margin left for reconstruction after involved bone and dura have been removed. In such a situation, dural reconstruction becomes a problem. We propose a new technique of dural closure in such cases. METHODS: A fascial graft is prepared from either fascia lata, abdominal fascia, pericranium, or temporal fascia and is trimmed to a size slightly larger than that of the dural defect. The fascial graft is placed over the dural defect and affixed to the underlying bone with a piece of titanium mesh, titanium screws, or both. The graft is then reinforced with fibrin glue. RESULTS: This method of dural reconstruction has been used in five patients with basal meningiomas. Three were in the petromastoid area, and two were in the planum-ethmoid area. None of these patients experienced postoperative cerebrospinal fluid leak, and none experienced any complications related to the reconstruction. CONCLUSION: This technique of dural reconstruction can be used in selected cases of basal tumors without enough free dural margin to sew into a fascial graft.

Biocompatible Materials↗
PubMed1988

Temporalis fascia grafts for facial and nasal contour augmentation.

For the past 70 years, fascial grafts have been used in reconstructive surgery mainly because of their tensile strength. Although the thigh (fasciae latae) has been the principal donor site, fascia taken from the temporalis muscle has the advantages of (1) ease of harvest under local anesthesia, (2) usually being in the same operative field, (3) minimal postoperative discomfort, and (4) negligible residual scar deformity. These grafts can be effectively used as the sole source of contour augmentation of facial depressions in primary as well as secondary rhinoplasty. Such grafts undergo an initial uniform shrinkage (approximately 20 percent) during the first 4 to 6 weeks postoperatively due to compaction and condensation of the fibrous tissue of the fascia, after which the grafts stabilize and become firm. Concavities should be overcorrected accordingly. No inflammation or encapsulation has been seen clinically or histologically in 18 patients followed for periods ranging from 6 to 18 months.

Adolescent↗