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PubMed1975

Aortic valve replacement with frame-supported autologous fascia lata grafts. III. Haemodynamic and angiographic findings.

Thirty-two patients with a frame-supported, autologous, fascia lata graft implanted in the aortic annulus were investigated 11 to 36 months after the operation. The group comprised 7 patients with pure aortic stenosis, 10 with combined aortic stenosis and aortic incompetence and 15 with pure aortic incompetence. Six patients had concomitant mitral valve disease. The follow-up investigation included right heart and transseptal left heart catheterization, left ventricular angiocardiography through the transseptal route and a retrograde, supravalvular aortography with the cinétechnique. Cardiac output was essentially unchanged postoperatively. However, it had increased considerably in some patients in whom it was very low before the operation. Left ventricular systolic pressure decreased particularly in patients with pure aortic stenosis. Left ventricular enddiastolic pressure decreased from 12 to 7 mmHg at rest and from 25 to 18 mmHg during exercise. Left atrial (or pulmonary arterial wedge) mean pressure decreased from 14 to 2 mmHg at rest, and from 27 to 16 mmHg during exercise. In 76% of the patients a slight (grade I or II) central or paravalvular aortic regurgitation was observed on cinéangiograms. Regurgitation of grade III was found in one patient. Technical details in the construction of the valve, as well as structural changes in the fascia lata which may be responsible for stenosis and incompetence in some of these valves are discussed. Thus, although even patients with defective valves have shown considerable improvement, a close and continuous follow-up of these patients is necessary.

Adolescent↗

PubMed1975

[Cure of scleromalacia perforans manifesting in the course of rheumatoid arthritis with d-penicillamine and fascia lata-autograft (author's transl)].

A new treatment of a case of scleromalacia perforans, complicating rheumatoid arthritis is reported. To save the eye fascia lata was transplanted, preoperatively prednisolone and d-penicillamine was started, and this therapy was continued for one year thereafter. The effect was favorable, as pains vanished, and the grafted fascia remained whole. Cure of scleritis of the other eye hitherto unresponsive to local treatment was attained. Advantages of the combination of both immunosuppressive and surgical therapy is emphasized.

Aged↗

PubMed1976

Sequential hemodynamic studies following mitral fascia lata valve replacement.

Sequential hemodynamic studies were performed at mean intervals of 6 and 38 months following mitral valve replacement in 10 patients who had angiographically competent fascia lata valves and in whom preoperative hemodynamic studies were available. The cardiac index did not change significantly during postoperative studies as compared with the preoperative values, and its response in relation to oxygen uptake during exercise remained impaired. The mean pulmonary wedge and pulmonary artery pressures showed significant reduction at the first and the second postoperative studies, both at rest and during exercise. Progressive reduction in the pulmonary vascular resistance occurred in patients with high initial values, although the group mean did not alter significantly. The mean diastolic gradient across the mitral fascial valves averaged 8.1 +/- 1.3 mm Hg at rest rising to 22.5 +/- 2.4 mm Hg during exercise (P less than 0.001), and the calculated mitral valve area was 1.9 +/- 0.22 cm2 at rest and 2.36 +/- 0.3 cm2 during exercise (P less than 0.02). This study indicates that the insertion of stented mitral fascia lata valves results in significant hemodynamic improvement, which is maintained at least for 3 years after surgery, in patients with competent valves. However, a degree of obstruction to the forward flow is apparent especially during exercise, despite the central flow design of the valve.

Adult↗

PubMed1986

[Interwoven wire suture with fascia lata-plasty in the treatment of subcutaneous rupture of the Achilles tendon--an obsolete method?].

Lately there has been an increased incidence of rupture of the Achilles tendon following the general increase in mass sports. Surgery is the treatment of choice, and various methods are being described. We have been using the wire suture method with fascia lata plasty for more then twenty years. The rate of infection is 3.8% and that of rerupture 1.2%, figures that correspond to those stated for other surgical methods. Moreover, 87% of the patients were very satisfied with the result of the operation; they are fit for work without any restriction, and some of them even practise their sports activities as before. For this reason we consider that wire suturing with fascia lata plasty is by no means obsolete in the treatment of rupture of the Achilles tendon.

Achilles Tendon↗

PubMed1979

[Scanning electron microscopy study of autologous vein and fascia lata before and one year after implantation into the arterial blood stream].

The present communication deals with scanning electronmicroscopical changes of autologous vein and autologous fascia lata, which were used as arterial implants. We examined material, which could be removed during reoperation for vascular occlusion. After one year, the surface exposed to the blood stream shows a homogenous layer of fibrin. Whilst the elastic fibers of fascia lata-transplants have nearly completely disappeared, we can still find them in the vein. This might be the essential reason for the longer survival of venous implants into the arterial blood stream.

Arteries↗

PubMed1983

[Treatment of severe ptosis by suspension of the upper eyelid using the autogenic frontal muscle and fascia lata. Analysis of 34 interventions].

The surgical procedure using frontalis muscle and autogenous fascia lata suspension (Beard, Crawford) gives good results in the correction of severe blepharoptosis. Personal experience of 34 operations (23 patients) is reported. The level of the palpebral margin remains stable and there is no long-term undercorrection. The autogenous fascia lata is, in our experience, better than the other sling procedures. There is good tissular adhesion and less necrosis. The disadvantages are the constant lid lag in downward gaze and the scar on the thigh. The lagophthalmos is well tolerated and needs neither drops nor ointments 3 months post-operatively. Complications were infection (1 case) and corneal ulceration in a patient with traumatic ptosis and complete ophthalmoplegia. The sling must be deep and must support the suspensor ligament of Whitnall without perforating the conjunctiva. This step requires the use of a Reverdin needle, and is controlled by a finger applied in the superior fornix.

Blepharoptosis↗

PubMed1981

Functional differentiation within the tensor fasciae latae. A telemetered electromyographic analysis of its locomotor roles.

Electromyograms recorded by three or four fine-wire bipolar electrodes inserted along a transverse line across the right tensor fasciae latae of ten normal adults (five men and five women, twenty to thirty-six years old) during a standardized series of exercises and locomotor activities demonstrated different functional roles for the anteromedial and posterolateral fibers of the muscle. Although anatomical dissections in six normal cadavera demonstrated that the force of contraction of the tensor fasciae latae could be transmitted to the knee by the iliotibial tract, the observed activity of this muscle can be explained completely in terms of its action at the hip. The anteromedial fibers have a greater mechanical advantage for hip flexion than do the posterolateral fibers, whereas the posterolateral fibers possess a better mechanical advantage for hip abduction and internal rotation. During walking the anteromedial fibers were electromyographically silent, whereas the posterolateral fibers were active near heel-strike. For all subjects, increased locomotor velocity (during jogging, running, and sprinting) was associated both with increased activity of the anteromedial fibers near toe-off apparently to assist deceleration of extension and acceleration of flexion of the thigh, and with increased activity of the posterolateral fibers at heel-strike.

Adult↗

PubMed1983

Use of temporal fascia and muscle as an autograft.

A wide variety of materials have been used for reconstruction around the eyelids and orbit, including alloplastic materials, such as polyfilament surgical suture (Supramid), silicone, and Teflon, that have a tendency toward early infection or late extrusion. Preserved homografts, such as sclera or fascia lata, are unlikely to extrude but have variable absorption rates. Autografts have proved over the years to be the best, most reliable, and least reactive material for reconstruction. Our use of temporal fascia and muscule grafts has been quite successful.

Adult↗

PubMed1992

A new instrument for fascia placement.

An orthopedic instrument is presented as an alternative to the Wright needle for placement of fascia lata in the tarsofrontalis. This tool is easier to handle and allows more accurate fascia placement than the Wright needle.

Equipment Design↗

PubMed2006

Dissection of a rare accessory muscle of the leg: the tensor fasciae suralis muscle.

We report a case of the rare tensor fascia suralis muscle. This muscle was found during the routine dissection of the lower extremity in an adult male cadaver. No other anomalies were noted in this specimen. The innervation of this muscle was via the tibial component of the sciatic nerve. Although seemingly rare, the tensor fascia suralis muscle may be considered by the clinician in the differential diagnosis of masses over the posterior lower extremity.

Adult↗

PubMed2002

Incidence of the superficial fascia and its relevance in skin-sparing mastectomy.

BACKGROUND: With the move away from classical radical mastectomy to ever more skin-sparing procedures, there has been an ongoing discussion about how much skin and subcutaneous tissue should be resected to perform an adequate mastectomy while leaving viable skin flaps. One of the common recommendations is to dissect just superficial to the superficial layer (SL) of the superficial fascia of the breast. This, in turn, has revived the old, unsolved controversy about the existence or absence of the SL, a fascia that reportedly encloses the mammary gland ventrally. In skin-sparing mastectomies (SSM), which combine tumor resection with immediate breast reconstruction, the ideal would be to create skin flaps that are thin enough to remove all breast tissue but at the same time are thick enough to preserve flap circulation. The feasibility of meeting these two goals simultaneously and the possible role and relevance of the SL as a guide to dissection in SSM was examined in this study. METHODS: Sixty-two breast resection specimens from 31 women who underwent breast reduction were examined histologically to determine whether the SL was present, whether breast tissue could be detected within or beyond this SL, the measured distance between the caudal border of the dermis and the SL or the breast tissue, and whether the thickness of the subcutaneous fat layer was correlated with the patients' physical data, such as body weight or body mass index (BMI). RESULTS: The SL was absent in 44% of resection specimens. When the SL was present, 42% of specimens contained several islands of breast tissue within the SL. No breast tissue was found beyond the SL. The minimal distance between the SL and the dermis varied from 0.2 mm to 4.0 mm; the minimal distance between the breast tissue and the dermis was 0.4 mm. In 50% of specimens, the minimal distance between the dermis and the SL or breast tissue was < 1.1 mm. A distance of > or = 5 mm was encountered in only 17% of specimens, and a distance of > or = 10 mm was encountered in only 5% of specimens. No significant correlation between the right and left breast was found with any of the parameters examined. A weak negative correlation was seen between the BMI and the mean thickness of the subcutaneous fat (P = 0.049; correlation coefficient [r] = -0.39; Spearman rank correlation). CONCLUSIONS: Histologic evaluation revealed that the SL is not present in all breasts and, thus, cannot serve as a reliable plane of dissection. Furthermore, if the SL is present microscopically, then it often is too thin and delicate to be detectable macroscopically. Finally, even if the SL is present and visible macroscopically, the distance to the overlying skin is so small in the majority of patients that a dissection superficial to the SL would not leave viable skin flaps in skin-sparing mastectomies.

Adult↗

PubMed2003

Compliance of the bladder neck supporting structures: importance of activity pattern of levator ani muscle and content of elastic fibers of endopelvic fascia.

AIMS: Firm bladder neck support during cough, suggested to be needed for effective abdominal pressure transmission to the urethra, might depend on activity of the levator ani muscle and elasticity of endopelvic fascia. METHODS: The study group of 32 patients with stress urinary incontinence and hypermobile bladder neck, but without genitourinary prolapse, were compared with the control group of 28 continent women with stable bladder neck. The height of the bladder neck (HBN) and compliance of the bladder neck support (C) were assessed, the latter by the quotient of the bladder neck mobility during cough and the change in abdominal pressure. By using wire electrodes, the integrated full-wave rectified electromyographic (EMGave) signal of the levator ani muscle was recorded simultaneously with urethral and bladder pressures. The pressure transmission ratio (PTR), time interval between the onset of muscle activation and bladder pressure increment (DeltaT), and area under the EMGave curve during cough (EMGcough) were calculated. From bioptic samples of endopelvic fascia connecting the vaginal wall and levator ani muscle, elastic fiber content was assessed by point counting method. Mann-Whitney test was used to compare all the variables. Correlations between the parameters were evaluated by using the Spearman correlation coefficient. RESULTS: In the study group, HBN was significantly lower (P < 0.001), C was significantly greater (P < 0.001), and PTR was significantly lower (P < 0.001). In the study group, the muscular activation started later (median, DeltaT(l), -0.147 second; DeltaT(r), -0.150 second), and in the control group, it preceded (DeltaT(l), 0.025 second; P < 0.001; DeltaT(r), 0.050 second; P < 0.001) the bladder pressure increment. EMGcough on the left side was significantly greater in the study group (P < 0.046). Elastic fiber content showed no difference between the groups. The analysis of all patients revealed negative correlations between C and PTR (r = -0.546; P < 0.001) and between C and DeltaT(l) (r = -0.316; P < 0.018). CONCLUSIONS: Firm bladder neck support enables effective pressure transmission. Timely activation of the levator ani seems to be an important feature.

Adult↗

PubMed1994

Pelvic fascia strength in women with stress urinary incontinence in comparison with those who are continent.

Biophysical properties of the anterior vaginal wall as well as the rectus fascia were evaluated in vivo by penetrating the Stamey needle into these tissues of 26 female patients with stress incontinence in comparison with those of 21 continent subjects. The results demonstrated that shear strength of the anterior vaginal wall was lower in incontinent patients than in continent subjects (P < 0.01). Shear strength of the rectus fascia in the patients, which was not supposed to be related to urinary incontinence and should have had the same strength as the control subjects, was also found to be lower than the control (P < 0.01). Shear strength of the vaginal wall was not correlated with age irrespective of their continence status (P > 0.05). Based on our findings it is concluded that some women suffering from stress incontinence may have a hereditary disorder of biophysical properties of the tissues.

Adult↗

PubMed1997

Fascia: an illustrative problem in international terminology.

As a result of international nomenclatures being in Latin, with the terms usually being undefined and translated into national vernacular languages, the same terms have been used in different ways in different countries. Fascia is an example of this, the limits of the meaning of the word differing in English-, French- and German-speaking countries. These differences are itemized in a comparative table. In 1989 the General Assembly of the International Federation of Associations of Anatomists [IFAA] created the Federative Committee on Anatomical Terminology [FCAT] with a remit to create a new terminology for the anatomical sciences with full democratic consultation with the member societies of IFAA. The draft recommendations of FCAT on fascia and the reasons for them are given. Problems associated with the use, or lack of use, of international terminologies are illustrated. For the advancement of medical knowledge and understanding, the cooperation of authors, editors and publishers in using the current terminology in the right way remains of critical importance. It is suggested that, after adopting a terminology, IFAA has a responsibility to arrange for technical back-up.

Fascia↗

PubMed2005

[PET-CT studies of the support system and continence function of pelvic organs. The pivotal importance of Denonvilliers' fascia for surgical procedures].

Like all other organs in the chest or abdominal cavities, pelvic organs are not suspended by specialized ligaments such as those in the skeletomuscular system. In spite of this, the organs of the pelvis remain well suspended within their cavity even during evacuation. This support system for these organs consists of inconspicuous smooth muscle elements scattered throughout pelvic structural fat tissue and fascial structures, in particular Denonvilliers' fascia. We used PET-CT studies to identify spontaneous muscle activity in the pelvis, which is strongest at Denonvilliers' fascia. We were able to correlate continence function, filling, and evacuation of pelvic organs with this spontaneous muscle activity that leads to stiffening and relaxation of the muscular walls of these organs. During the course of different disease processes such as visceral prolapse, these pelvic support structures are prone to fail gradually. Surgical interventions should take the pelvic support system into account to avoid therapeutic errors.

Aged↗

PubMed2004

[Late reconstruction of distal biceps tendon rupture with fascia lata graft and Mitek anchors].

Ruptures of the distal biceps tendon are rare but well documented. A technique for reinserting the distal biceps tendon into the radial tuberosity with two Mitek anchors and a fascia lata graft is presented and illustrated by a case report. Ectopic ossification as a complication after the procedure is discussed as well as the final outcome. It could be concluded that late reconstruction of the distal biceps tendon rupture with fascia lata and Mitek anchors is a safe procedure that can be advocated in a restricted number of cases where acute injury has been overlooked.

Adult↗

PubMedDate not supplied

Medium-term follow-up on use of freeze-dried, irradiated donor fascia for sacrocolpopexy and sling procedures.

The aim of this study was to document longer-term follow-up of patients in a previously reported series who underwent either sacrocolpopexy (SCP) or suburethral sling procedures utilizing freeze-dried, irradiated donor fascia. Subjects from the initial series of 67 SCPs and 35 slings were included in this retrospective chart review of postoperative follow-up where surgical follow-up longer than 3 months from the procedure was available. Subjects undergoing SCP were examined at the time of any clinical visit and their pelvic organ support evaluated utilizing the POP-Q system. The SCP procedure was considered to be unsuccessful if any anterior vaginal wall point (Aa or Ba) was at the hymen or beyond, or if the vaginal apical point (C or D) descended to a point at least halfway to the hymen from a position of perfect apical support. Subjects who did not return for clinical examination after their 3-month postoperative visit but who had been in telephone contact with the clinic stating that they had experienced symptomatic recurrence of their POP were also included as having unsuccessful SCP procedures. Those similarly in contact with the office by telephone, but not clinically examined, who indicated no subjective return of their POP, were coded as successful. The outcome of the sling procedure was primarily evaluated subjectively, with the patient indicating that stress incontinence symptoms were present or absent. Follow-up was available for 75 patients, who had undergone 54 SCP and 27 sling procedures (6 patients had undergone both SCP and sling procedures). When failure was defined according to any of the criteria listed in the methods section, 45 (83%) patients experienced SCP failure at a median of 12 months after surgery. A total of 14 (52%) sling procedures were failures, with recurrent SUI symptoms experienced from 2 weeks to 24 months (median 3 months) after the procedure. One year after surgery, 23 (43%) SCPs were known to be failures, and 11 (41%) slings were known to be failures. The remaining 13 (48%) slings were subjectively successful when last seen 7-51 months after surgery. We reoperated on 21 (40%) patients. At the time of repeat SCP (chosen by 16 patients) we found graft between the sacrum and vagina in just 3 patients (19%). The use of freeze-dried, irradiated donor fascia for both SCP and sling procedures was associated with an unacceptably high failure rate in our series.

Aged↗

PubMed2005

Visualization of the endopelvic fascia by transrectal three-dimensional ultrasound.

The aim of our pilot study was to explore the feasibility of visualizing the endopelvic fascia by transrectal three-dimensional (3D) ultrasound. Transrectal 3D ultrasound was performed in 12 nulliparous women and 11 women with a history of vaginal delivery. A 6-10 MHz volume probe was used to examine the suburethral anterior vaginal wall. In all women, an echogenic layer was identified at an average of 3-5 mm from the vaginal surface. This echogenic layer was found to be contiguous to the lateral pelvic sidewall and uninterrupted in 10 of 12 nulliparous women, whereas gaps in this layer were identified in all 11 parous women. We hypothesize that this echogenic layer may represent the suburethral component of the endopelvic fascia. Depending on the number and localization of the interruptions in this echogenic layer, the mechanical support of the pelvic floor seems to be weakened corresponding to a higher incidence of descensus of the anterior vaginal wall, which frequently was associated with urinary incontinence.

Adolescent↗