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At least 577 records · Page 32Linked to original sources
PubMed1995

Levator scapulae transfer and fascia lata fasciodesis for chronic spinal accessory nerve palsy.

A retrospective evaluation of the functional results after reconstructive treatment with levator scapulae transfer and scapulo-spinal fasciodesis by fascia lata slings for complete chronic trapezius palsy is presented. Five patients (ages 6 to 40 years) were operated on between 1988 and 1991 because of incapacitating pain and/or functional limitations. Treatment was recommended after failure to alleviate symptoms by a shoulder-girdle muscle-strengthening program or after unsuccessful nerve graft. The descriptions of the results are drawn from the last follow-up evaluation available for each patient (minimum: 14 months post-operative). They are expressed in terms of functional recovery, residual pain, and patient satisfaction. Three patients had an excellent result, with at least 80 percent of normal abduction and forward elevation of the arm, no residual pain, and a high satisfaction rate. One patient showed good improvement in function, with 90 percent of normal shoulder function, but complained of some residual pain. The last patient was not improved by the surgery. Levator scapulae transfer and scapulo-spinal fasciodesis by fascia lata slings, substitute for the function of the upper trapezius and enhance the function of the serratus anterior, thus helping to relieve pain and to improve shoulder function after chronic trapezius palsy. The procedure warrants consideration in patients who are not candidates for nerve repair and reconstruction.

Accessory Nerve↗
PubMed2001

Harvesting autologous fascia lata for pelvic reconstructive surgery: techniques and morbidity.

OBJECTIVE: To determine donor site morbidity associated with harvesting of fascia lata. STUDY DESIGN: We reviewed medical records and evaluated responses to mailed questionnaires from all patients who underwent fascia lata harvesting during a 54-month period. Data were collected about immediate complications and long-term morbidity related to the donor site. RESULTS: The study comprised 71 patients. Immediate postoperative complications were limited to 1 (1%) hematoma that required drainage, 2 (3%) seromas, and 5 (7%) cases of cellulitis that required oral antibiotics. Questionnaire response rate was 77%, with a mean follow-up of 25 months. Of the responders, 22 (40%) reported mild symptoms, 3 (5%) reported clinically significant symptoms related to the donor leg, and 7 (13%) expressed dissatisfaction because of unacceptable cosmesis (n = 5), leg discomfort (n = 5), or both. CONCLUSION: There was little immediate postoperative morbidity. Although many patients may be expected to report long-term symptoms related to the donor leg, these symptoms are generally mild, and the incidence of patient dissatisfaction is relatively low.

Adult↗
PubMedDate not supplied

Experimental fascial autografting for the supraspinatus tendon defect: remodeling process of the grafted fascia and the insertion into bone.

To elucidate the postoperative histologic changes of fascial autografting, tendinous defects (1.5 x 1.5 cm) were created close to the supraspinatus insertion and were covered by fascial autografts in 21 rabbits. Shoulders harvested on the fourth day and 1, 2, 3, 4, 6, and 8 weeks after surgery were examined histologically and immunohistochemically. At the fascia-bone junction, chondrocytes started to appear at 2 weeks after surgery and increased rapidly thereafter. Although a tidemark was not seen, remodeling of direct insertion with fibrocartilage was almost complete by 8 weeks. The distribution of collagen types II and III represented a pattern similar to that of a normal supraspinatus tendon insertion. In the grafted fascia, the cellular density showed a marked increase over time (r2 = 0.74, P <.0001). Our study revealed that both the tendinous tissue and its insertion were reformed after this procedure. Fascial autografting might be useful for repairing a supraspinatus tendon defect.

Animals↗
PubMed2006

Transvaginal repair of enterocele and vaginal vault prolapse using autologous fascia lata graft.

BACKGROUND: The aim was to describe the operative technique of transvaginal repair of enterocele and apical prolapse using autologous fascia lata and report intra- and postoperative complications and long-term outcome. METHODS: A retrospective chart review of 74 consecutive patients who had repair of a symptomatic enterocele and vaginal vault prolapse or uterine prolapse from January 1987 to August 1999. All patients were followed for a minimum of 3 months and 61 were available for long-term evaluation at 18-106 months (median 52 months). RESULTS: Intra- and postoperative complications were few. Pelvic examination at long-term follow-up disclosed a recurrence rate for enterocele of 1.7%, vaginal vault prolapse of 8.3%, and cystocele of 15%. Ninety-one per cent were subjectively satisfied with the relief of mechanical vaginal symptoms. Only 35% (6/17) were cured of constipation. Out of the 22 women who were sexually active after the procedure, 12 (54%) experienced improved quality. CONCLUSION: Repair of the posterior compartment defect and suspension of the vaginal vault using autologous fascia lata graft provides acceptable intra- and postoperative complication and long-term results.

Adult↗
PubMed1998

Use of the subgaleal fascia to construct the auditory canal in microtia associated with aural atresia. A preliminary report.

In this paper we introduce the use of a subgaleal flap to construct the auditory canal in cases of microtia associated with aural atresia. The anatomy, the vascularisation, and the nomenclature of the different planes that constitute the temporal region are wellknown. The subgaleal fascia, also referred to as the loose areolar fascia has been until now the less surgically exploited of these planes. Nevertheless, it has a structure and a vascularisation that enables it to be dissected and used surgically. The subgaleal flap used to line the neoauditory canal drilled into the bone provides a vascular bed that greatly improves the quality of the skin graft and supports the tympanoplasty. The procedure is done while the ear is being raised, which constitutes the second stage of the two-stage ear reconstruction. This new approach has been used on 22 ears. A preliminary analysis of the results shows that construction of the auditory canal has been improved.

Adolescent↗
PubMed1990

Assessment and treatment of TMJ muscles, fascia, ligaments, and associated structures.

The primary goal of temporomandibular joint therapy is to establish normal physiologic tension of the muscles, fascia, ligaments, and associated soft tissue structures. Because of pathologic sprain and strain patterns in the TMJ structures, the patient may exhibit pain and dysfunction due to tissue tightness, disk displacement, and occlusal discrepancies. This article presents an effective clinical technique to assess and relieve the sprain and strain in the TMJ muscles, fascia, ligaments, and associated structures to restore normal physiology.

Fascia↗
PubMed1987

Recontouring of the middle third of the face with onlay cartilage plus free fascia graft.

The onlay fascia-cartilage graft technique for malar or maxillary projections can be used for recontouring the middle third of the face. Covering onlay grafts with fascia achieves a smoother contour, concealing the edges in addition to obtaining a more natural anatomical look for the face. The technique has provided a predictable and permanent method of augmenting malar or maxillary projections, and it has produced good aesthetic results.

Adolescent↗
PubMed1993

Banked fascia lata as an orbital floor implant.

Synthetic orbital floor implants carry the risk of infection, rejection, anterior migration with prolapse, and posterior migration with optic nerve compression. Banked irradiated homologous fascia lata has been used as an orbital floor implant in the repair of 18 patients with surgically indicated orbital floor fractures. All patients had improvement in diplopia. There was no infection, anterior migration, or posterior migration of the implant. There was no reported transmission of communicable diseases. Early results suggest that banked irradiated fascia can be used effectively and safely as an orbital floor implant in selected cases.

Adolescent↗
PubMed1998

Use of temporalis fascia for exposed hydroxyapatite orbital implants.

The hydroxyapatite implant (Bio-Eye, Intergrated Orbital Implant, Inc., San Diego, CA, U.S.A.) has gained increasing popularity as an orbital implant in recent years. Several complications may occur, including infection, exposure, extrusion, and various peg problems. Exposure of the implant appears to be the most common complication, ranging up to 21.6%. Many techniques, including nonsurgical and surgical approaches, have been described to manage these exposures. When surgery is indicated, a patch graft may be required to cover the defect. We report our experience and technique with autogenous temporalis fascia as a patch graft. Autografts such as temporalis fascia are easily obtained, bring about no immunological reaction, and have no risk of infectious transmission.

Adult↗
PubMed1999

Voice acoustics after autologous fascia injection for vocal fold paralysis.

OBJECTIVES: The present study was carried out to assess the impact of fascial injection on voice acoustics Preliminary results had suggested that voice, as rated by a panel of listeners, was significantly improved after autologous fascia augmentation of a paralyzed vocal fold. STUDY DESIGN: A prospective study among patients with unilateral vocal fold paralysis was carried out. Eighteen subjects were analyzed 9 months (mean) after the procedure. METHODS: The preoperative and postoperative samples of vowel /a/ were analyzed by Key Elemetrics (Lincoln Park, NJ). Computerized Speech Lab. RESULTS: There was a significant improvement (P<.05) in all parameters measured, including jitter, shimmer, noise-to-harmonic ratio, and maximum phonation time. No laryngeal complications were seen. CONCLUSIONS: According to these preliminary results, vocal fold augmentation by an injection of autologous fascia seems a simple, inexpensive, reliable and safe method to restore voice quality after unilateral vocal fold paralysis.

Adult↗
PubMed1995

Pharyngoesophageal reconstruction with a tensor fasciae latae free flap.

This report describes our experience with the use of a tensor fasciae latae flap in total reconstructions of the hypopharynx and cervical esophagus. This flap is durable, reliable, and easy to elevate. Moreover, it is possible to obtain a tight two-layer closure of the circumferential suture lines by means of the vascularized fascia. We think this flap will be one of the methods of choice in reconstructions of the hypopharynx and cervical esophagus.

Carcinoma, Squamous Cell↗
PubMed1997

The microvenous valvular anatomy of the human dorsal thoracic fascia.

The use of free scapular fasciocutaneous flaps for reconstruction of recalcitrant grade 6 venous stasis ulcers has shown excellent early success rates. Venous refilling times measured postoperatively over the flaps by photoplethysmography have noted improvements to normal levels. Preliminary anatomic studies have demonstrated valves in the circumflex scapular veins of flaps used in reconstruction. The purpose of this study was to investigate and document the number, morphology, size, and location of valves in the human dorsal thoracic fascia. Ten scapular flaps were obtained from unembalmed cadavers and injected with methyl methacrylate. Each flap cast was divided into four parts: proximal, right and left, and distal, right and left. We reduced the size of specimens (the largest being 24 x 11 mm) and studied them in a scanning electron microscope. We identified all valves, estimated the diameter of the corresponding vein, calculated the depth of the valvular sinus, and related it to the corresponding venous size. Light microscopy and transmission electron microscopy were used as assisting tools applied to glutaraldehyde-fixed specimens. Analysis of injected specimens showed that valves were most abundant in veins with a luminal diameter of 30 to 120 microns (59.3 percent of 905 valves). The depth of valves became larger with increasing venous diameter. The sizes of valve sinuses were not different for individual valves. Except for veins larger than 1000 microns in diameter, there was no significant difference between the number of valves in different parts of an individual flap, nor were there significant differences between the valve numbers in different flaps. Most valves were bicuspid; only in the vein category of 30 to 120 microns were unicuspid valves encountered. Valves sometimes were located in series in a short segment of a vein; occasionally, they were found at the merging site of two veins. Transmission electron microscopy showed that valve leaflets had collagen fibers that ascended toward the tip of the leaflet and occasionally were accompanied by elastic fibers. Myofibroblasts were regularly present in the valve leaflets. These data show that fasciocutaneous flaps from the scapular region have numerous valves (90 valves on average in each flap) in the venous microcirculation. The microvenous valves in the dorsal thoracic fascia appear to be structurally similar to valves in larger veins. These valves may play a role in the improved hemodynamics and promising clinical outcome of patients with chronic venous insufficiency who have undergone free scapular flap reconstruction.

Fascia↗
PubMed1998

Reconstruction of the extremity with the dorsal thoracic fascia free flap.

The dorsal thoracic fascia is the anatomic layer that contains the blood supply to the scapular and parascapular fasciocutaneous flaps. The cutaneous vascular territory of the circumflex scapular artery and its parascapular branches is well known. During the past 8 years, the authors have employed the dorsal thoracic fascia free flap for extremity reconstruction in 17 patients (upper extremity, n = 9; lower extremity, n = 8). The indications for using this free flap included primary coverage after trauma (n = 10), resurfacing of "unstable" scar (n = 3), coverage of plantar foot ulceration (n = 3), and coverage of an exposed lower extremity distal arterial bypass graft (n = 1). The large anatomic boundaries of this flap, the consistent vascular anatomy, and the thin yet durable quality of the tissue make this flap an excellent choice for the reconstruction of upper and lower extremity defects.

Adult↗
PubMed1998

Clinical experience and indications of the free serratus fascia flap: a report of 21 cases.

The free "serratus fascia" flap as a free flap was first described by Wintsch and named a free fascia flap of gliding tissue; however, it has not yet been given a distinct name. The particular advantages of this flap consist of an easy access and a low donor-site morbidity without functional deficit. Additionally, it may be designed very variably and molded even three-dimensionally as a tendon wraparound flap or folded to fill up cavities. In our clinic, we used this flap in 21 patients for distinct indications and in 7 patients as a vascular graft in fingers or great toe with a minimal adjacent layer of gliding tissue around the vessels for the treatment of cold intolerance after finger replantation or severe finger or toe trauma. In the other cases, this versatile flap served for the coverage of traumatically exposed tendons or bones at the extremities, covered with a skin graft. Eighteen flaps survived completely, whereas 3 flaps developed partial or superficial necrosis. Only once did a major complication by unintentional sacrification of the long thoracic nerve during flap harvesting occur, resulting in a wing scapula. We recommend this flap for defect cover at sites where a thin vascularized gliding layer for defect cover is needed, especially in distal extremities with exposed tendons or nerves, and present the current indications in discussing our experiences.

Adolescent↗
PubMed2000

Facial autologous soft-tissue contouring by adjunction of tissue cocktail injection (micrograft and minigraft mixture of dermis, fascia, and fat).

Facial aging is both a physiologic and anatomic process characterized by changes in the skin and supporting tissues. The aging process produces an outer envelope that gradually expands while its contents gradually involute and the underlying structure weakens. This process results in an excess of skin that tends to create folds, grooves, and deepening furrows. Contour augmentation and filling depressions with autologous tissue or heterogeneous materials are widely used in face rejuvenation as an adjunctive procedure. There is unanimous agreement on the advantages of autogenous tissue grafts over alloplastic materials and heterogeneous transplants. It is also well known that the revascularization of a small graft (fat, dermis, and/or composite graft) is better than a large graft. For this reason, fat injections consisting of small particles have recently become popular. According to different authors, a graft take may vary from 30 to 50 percent. Nevertheless, it has been thoroughly documented that a graft consisting of dermis or fascia is superior to a fat graft in both the graft take rate and quality of the tissue. Strips of dermal graft have been used successfully for several years to fill lip contour and nasolabial folds. However, the main disadvantage of this technique is that utilization is restricted only to certain areas where there is a need for a small incision. To overcome this obstacle, the author developed a simple technique to obtain an injectable mass from a mixture of dermis, muscle strips, fat tissue, and fascia to use in body contouring (especially in the facial region) in large areas. The author describes the use of the technique in 450 patients. Follow-up in these patients from 6 months to 10 years showed that the application of the "tissue cocktail" procedure in select patients improved the author's results and created a marked increase in the number of satisfied patients with no complaints. The take and durability of this kind of graft were superior to the author's results using fat grafts. The tissue cocktail graft remained stable for several years, as effectively seen in the chin region. The sole complication from the procedure was some bruising, which was resolved in several days. No single infection or inclusion cyst was observed in this series.

Adipose Tissue↗
PubMed1984

The applied anatomy of the thoracolumbar fascia.

The thoracolumbar fascia was studied by dissection in ten adult human cadavers. The posterior layer of this fascia was found to consist of two laminae. The superficial lamina is formed by the aponeurosis of latissimus dorsi. The deep lamina consists of bands of fibers passing caudolaterally from the midline. Both laminae form a retinaculum over the back muscles, and the deep lamina constitutes a series of accessory posterior ligaments that anchor the L2 to L5 spinous processes to the ilium and resist flexion of the lumbar spine. The function of these ligaments is enhanced by the contraction of the back muscles and the action of certain, restricted portions of the abdominal muscles.

Adult↗
PubMed1995

Observations on the pathomorphology of the thoracolumbar fascia in chronic mechanical back pain. A microscopic study.

STUDY DESIGN: Human tissue specimens were examined for the presence of neural end-organs under light and electron microscopy. OBJECTIVES: To define the innervation of the thoracolumbar fascia in problem back pain patients who have articular abnormality defined through pain-provocation discography or facet blocks. SUMMARY OF BACKGROUND DATA: Previous investigators have defined the presence of innervation in control (no back pain) tissue specimens. METHODS: Tissue specimens were harvested during surgery from 24 back pain patients who had not undergone previous lumbar surgery. Specimens were fixed immediately in the operating room and later processed and studied under light and electron microscopy. RESULTS: Structural and ultrastructural studies failed to identify specific neural end-organs in any of the specimens. Serendipidously, microscopic changes suggestive of ischemia or inflammation in this tissue were found. CONCLUSIONS: These findings suggest that the thoracolumbar fascia may be deficiently innervated in problem back pain patients.

Back Pain↗