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PubMed2005

Temporalis fascia in the management of gold eyelid weight extrusion.

A patient with a traumatic facial nerve palsy and resulting paralytic lagophthalmos underwent surgical implantation of a gold weight load, which extruded 4 weeks after surgery. Cicatricial contraction of the anterior lamella developed, and a full-thickness skin graft was used to correct the cicatrix. A second gold weight loading procedure was then undertaken with a temporalis fascia drape added to reduce the risk of extrusion. One year after surgery, there is no sign of migration or extrusion. Gold weight loading has emerged as the standard in management of paralytic lagophthalmos, with extrusion cited as the most serious complication. We propose temporalis fascia draping as an adjuvant procedure in the reimplantation of an extruded gold weight.

Adult↗

PubMed2003

Changes in tensile strength of cadaveric human fascia lata after implantation in a rabbit vagina model.

PURPOSE: We determined changes in tensile properties after vaginal implantation of human cadaveric fascia lata. MATERIALS AND METHODS: Baseline tensile properties were determined for freeze-dried, gamma irradiated human cadaveric fascia lata from 3 separate lots. Fascial strips (2 x 0.5 cm.) from 2 lots were implanted between the rectovaginal membrane and vaginal mucosa in New Zealand white rabbits. The strips were excised en bloc 12 weeks after implantation. Tensile property measurements were repeated and compared with pre-implantation values. RESULTS: Pre-implantation interlot and intralot variability in baseline tensile properties was significant. After implantation there was an approximate 90% decrease in tensile strength from baseline values. There was no gross evidence of graft autolysis. CONCLUSIONS: The decrease in tensile strength of cadaveric fascial graft was significant after implantation in this model.

Animals↗

PubMed2005

Long-term urinary continence rates after simple sling incision for relief of urinary retention following fascia lata pubovaginal slings.

PURPOSE: We examined long-term urinary continence rates in patients after midline simple sling incision for urinary retention following suburethral fascia lata slings. MATERIALS AND METHODS: A retrospective review was completed of 13 women undergoing a simple sling incision for catheter dependent obstruction after suburethral sling surgery more than 4 years previously. Urinary continence was evaluated by use of the Groutz-Blaivas anti-incontinence surgery response score. The scores were statistically compared as binary categories at mean 111-day and 60.8-month followup. RESULTS: A total of 13 women underwent a simple sling incision for catheter dependent urinary retention after sling surgery, and 11 patients (mean age 73.4 years) were available for long-term followup (60.8 months). The simple sling incision procedure was completed an average of 65 days (range 36 to 235) after original sling placement. Mean post-void residual urine volume at least 1 month after sling surgery was 289 ml (range 75 to 500). At a mean followup of 60.8 months, no patient required catheterization. Of 11 patients 5 wore no pads. There was no statistical difference in leakage episodes per day (p = 1.0), pads per day (p = 0.3), or patient perceived condition (p = 0.3) during long-term followup. The mean Groutz-Blaivas score did not change statistically during the 5-year followup period (p = 0.6). CONCLUSIONS: Midline simple sling incision provides relief of catheter dependent obstruction following fascia lata sling surgery while preserving urinary continence in the majority of patients during a 5-year followup period.

Aged↗

PubMed2003

Reconstruction of combined defects of the Achilles tendon and the overlying soft tissue with a fascia lata graft and a free fasciocutaneous lateral arm flap.

A new approach to reconstruction of the Achilles tendon and overlying soft tissue is presented. A fascia lata graft is used to reconstruct the tendon and is enwrapped by the fascia that is included in a fasciocutaneous lateral arm flap. Five patients were treated with this technique; three of them after surgical Achilles tendon repair, rerupture, and consecutive infection, one after a full-thickness burn with loss of the tendon and one with a history of ochronosis and necrosis of the whole tendon and overlying soft tissue. There were no anastomotic complications and all flaps healed primarily. Functional evaluation with the Cybex II dynamometer was done at least 49 months after reconstruction. A good functional and cosmetic result was obtained in all patients and donor site morbidity was acceptable. These results are well within the results of other surgical treatment options reported in the literature.

Achilles Tendon↗

PubMed2004

Tensor fasciae latae combined with tangentially split vastus lateralis musculocutaneous flap for the reconstruction of pressure sores.

Pressure sores in the ischial and the trochanteric regions are usually encountered in long-term bedridden and wheelchair-dependent patients. A number of techniques have been developed for the reconstruction of pressure sores. Tensor fasciae latae musculocutaneous flap has been extensively employed to close the trochanteric defect. Despite its utility of having a constant pedicle and proximal bulky muscle, the relative shortness of the flap and insufficient padding in the distal portion limit the applications for distant locations of pressure sores. From January 2001 to December 2003, 8 patients with ischial and trochanteric pressure sores underwent tensor fasciae latae reconstruction in combination with tangentially split vastus lateralis muscle. The descending branches of the lateral circumflex femoral arteries were also included in these flaps. All of the procedures have been successful, and no flap necrosis has been observed. Sufficient bulk of the flap and reliable distal skin paddle constitute the advantages of this flap.

Adult↗

PubMedDate not supplied

An electron microscopic study of the fascia from the medial and lateral sides of clubfoot.

Two cell types were observed in fascia from the lateral side of the clubfoot: a cell resembling the fibroblast of hypertrophic scar and a fibroblast-like cell with dilated rough endoplasmic reticulum. Three cell types were observed in fascia from the medial side of the clubfoot: typical fibroblasts, cells resembling myofibroblasts, and mast cells. The contracture of the medial side may be due to the myofibroblast-like cells, and this contracture may be enhanced by histamine released from the mast cells. The stretching of the lateral side is probably due to a compensatory fibrosis that maintains the tissue density.

Child↗

PubMed2006

Plaque incision and fascia lata grafting in the surgical management of Peyronie's disease.

OBJECTIVE: To assess the outcome of using modified human fascia lata (Tutoplast, Mentor Corp, Santa Barbara, CA, USA) in the surgical management of Peyronie's disease (PD), as the penile deformity associated with PD can be corrected by plaque incision and saphenous vein grafting (Lue procedure). PATIENTS AND METHODS: In all, 14 patients (mean age 51 years, range 34-59) with PD had their penile deformity corrected by plaque incision and Tutoplast grafting. Three patients had a previous unsuccessful Nesbit operation. The mean (range) penile deformity before surgery was 67.2 (20-90) degrees and the mean follow-up was 31 (17-37) months. RESULTS: Using set criteria, 13 patients were satisfied (excellent or satisfactory) with the results of surgery. The penis was completely straight in 11 of 14 patients. One patient developed de novo erectile dysfunction after surgery. In 10 patients there was no penile shortening, whereas four reported penile shortening of >1 cm. CONCLUSION: Fascia lata Tutoplast grafts provide a reliable and well tolerated biomaterial for penile reconstruction in PD. The outcome of using Tutoplast is similar to that from saphenous vein but without the morbidity associated with the donor site. However, there remains a significant risk of penile shortening and development of erectile dysfunction.

Adult↗

PubMed2000

Tears of the palmar superficial fascia in five racing greyhounds and a Labrador retriever.

Tears of the palmar superficial fascia over the palmar extremity of the accessory carpal bone were identified as the cause of lameness in five racing greyhounds and as a coincidental finding in a Labrador retriever with an avulsion of the insertion of the flexor carpi ulnaris tendon. The lameness in the greyhounds was mild and transient, although racing performance was affected. The Labrador retriever was severely lame. In all cases there was a marked soft tissue swelling and a palpable defect in the superficial fascia. One case was managed conservatively and surgical repair was performed in the remaining five cases. The greyhounds returned to successful racing and the Labrador retriever made a complete recovery.

Animals↗

PubMed1999

Late repair of simultaneous bilateral distal biceps brachii tendon avulsion with fascia lata graft.

A 50 year old rock climber sustained a bilateral rupture of the distal biceps brachii tendons. He retained some flexion power in both arms but minimal supination, being weaker on the non-dominant right side. As the patient presented late, with retraction and shortening of the biceps muscle bellies, reconstruction was carried out using fascia lata grafts on both sides. Because of residual weakness on the left (dominant) side, three further surgical procedures had to be carried out to correct for elongation of the graft. A functionally satisfactory outcome, comparable with that on the right side, was eventually obtained. In summary, bilateral fascia lata grafts to bridge the gap between the retracted biceps bellies and the radial tuberosities were successful in restoring function and flexion power to the elbow. Despite being the stronger side, the dominant arm did not respond as well to the initial surgery. This may be due to overuse of this arm after the operation.

Arm Injuries↗

PubMed1976

Renal fascia in urinary tract disease.

The renal fascia is rarely detected on excretory urograms. When seen, it is usually associated with disease processes such as focal renal scarring, acute renal infection, renal calculi, and intrarenal and perirenal masses. In all cases of normal appearing kidneys with visualization of the renal fascia, undetected renal disease should be suspected.

Adolescent↗

PubMed2002

Female urinary genuine stress incontinence: anatomic considerations at MR imaging of the paravaginal fascia and urethra initial observations.

PURPOSE: To compare, on high-spatial-resolution magnetic resonance (MR) images, the presence and distribution of the paravaginal fascia in continent women and in those with genuine stress incontinence (GSI) to establish its role in the pathophysiology of GSI. MATERIALS AND METHODS: Eleven continent reference subjects and 10 GSI patients underwent MR imaging with a specifically designed endovaginal receiver coil. A urinary continence questionnaire and urogynecologic clinical examination had been completed. GSI was diagnosed with urodynamic tests. Paravaginal fascial tissue distribution was determined, and the paravaginal fascial volume (PFV) anteriorly associated with the urethra was measured. Retropubic urethral length (UL) in the supine position at rest was compared with its total length and expressed as a percentage ratio. Comparisons of urethral PFV and retropubic UL between reference subjects and the GSI patients were performed by means of two-sample t tests with unequal variances because data were parametric by means of the Shapiro-Francia W' test for normal data. RESULTS: The paravaginal fascia (connective tissue that contained venous plexus) was a consistent MR imaging feature in all women. Mean urethral PFV was 5.3 cm(3) +/- 0.6 (SD) in reference subjects compared with 3.5 cm(3) +/- 2.0 in GSI patients (P =.017). The ratio of the retropubic UL to its total length was 82.6% +/- 7.4 in reference subjects compared with 57.4% +/- 9.8 in GSI patients (P <.001). There was a weak correlation between urethral PFV and retropubic UL (r = 0.46). CONCLUSION: There is a significant association between urethral PFV and continence status. GSI patients have a reduced urethral PFV, and greater than 40% of their urethral length lies below the pubis in the supine position at rest. However, the effects of age and hormonal status on urethral PFV remain to be evaluated.

Adult↗

PubMed1983

The perirectal fascia: morphology and use in staging of rectal carcinoma.

A revised anatomy of the perirectal fascia is proposed based on more than 2,000 CT examinations of the lower pelvis. CT examination showed that the perirectal fascia completely encloses the "capsula adipose rectalis" within the subperitoneal space and separates the perirectal compartment from the "pararectal connective tissue." The accuracy of CT in preoperative staging of rectal carcinoma was also demonstrated. It is concluded on the basis of 155 preoperative CT examinations of rectal carcinoma that CT staging is superior to Mason's clinical staging scheme, although routine staging by CT is not justified because slight perirectal tumor spread and lymph node metastasis cannot be predicted accurately.

Carcinoma↗

PubMedDate not supplied

Dermal-fat-fascia grafts.

Free dermal-fat-fascia grafts are used for subdermal augmentation in soft tissue or bony deficiencies resulting from surgical extirpation of cancer, congenitally arrested development, and trauma. The most important determinant for graft survival is the health of the recipient area and the volume of the graft. At least 70% resorption of these large grafts must be anticipated. Imitial overcorrection has some justification but may be self-defeating. Calcification of dermal-fat-fascia grafts, common in other areas of the body, does not appear to be a problem in the head and neck region. When possible, other types of augmentation procedures should be considered.

Absorption↗

PubMed2000

Reconstruction of the lateral ligaments of the ankle using solvent-dried and gamma-irradiated allogeneic fascia lata.

We have described a method of anatomical reconstruction of the lateral ligaments of the ankles with instability using allogeneic fascia lata dried with solvents and sterilised with gamma irradiation. Twenty ankles of 20 patients were assessed objectively and subjectively after a mean follow-up of 4.2 years (3.1 to 10). The result was excellent in 12 (60%), good in seven (35%) and fair in one (5%); none had a poor result. Stress radiography showed that the angle of talar tilt improved from 12.3+/-4.2 degrees (mean +/- SD) to 5.9+/-3.0 degrees and that the anterior drawer distance decreased from 9.2+/-3.9 mm to 4.4+/-2.5 mm. Neither infection nor limitation of movement occurred after operation. Fascia lata allografts provide a good alternative to autogenous grafts such as the peroneus brevis tendon.

Adolescent↗

PubMed1981

A comparative study of the activity of lysosomal and main metabolic pathway enzymes in tissue biopsies and cultured fibroblasts from Dupuytren's disease and palmar fascia. On the pathobiochemistry of connective tissue proliferation, I.

Activities of ten main metabolic pathway enzymes and seven lysosomal enzymes were determined in specimens from human normal palmar fascia and Dupuytren's contracture. The activities of the enzymes tested are 2-3 times higher in fresh specimens of Dupuytren's contracture. There are no differences in the activity distribution patterns of both these specimens, or in the absolute activities calculated in relation of the glyceraldehyde-3-phosphate dehydrogenase activities. With the exception of adenylate kinase and pyruvate kinase, the activities of main metabolic pathway enzymes based on the DNA content showed significantly lower activities in Dupuytren's contracture tissue than in palmar fascia. Lysosomal enzymes exhibit no significant differences of activity in the respective specimens. However, the lysosomal enzyme activities of cultured fibroblasts are lower than the corresponding activities from tissue specimens. The enzyme activities per DNA content in cultured fibroblasts are 10-50 times higher than in tissue specimens. The enzyme activities in cultured fibroblasts decrease with age or density of the cells in culture. The increased metabolic activity of the diseased tissues in Dupuytren's contracture is due to the higher cell content of the afflicted portions of the tissue, but individual enzymes show no qualitative changes in activity and there are no increases of enzyme activity per cell (DNA).

Acid Phosphatase↗

PubMed1983

Metabolism and proliferation of cultured fibroblasts from specimens of human palmar fascia and Dupuytren's contracture. The pathobiochemistry of connective tissue proliferation, II.

Cell Cultures from 11 Dupuytren's contracture and 6 normal palmar fascia specimens were established. The rates of sulphated glycosaminoglycan, collagen and DNA synthesis by means of incorporation of labelled precursors ([35S]sulphate, [3H]proline, [3]thymidine) as well as the growth characteristics of the cell lines of both healthy and diseased were compared. The incorporation rates of [35S]sulphate and [3H]proline were found to be significantly higher in Dupuytren than in healthy palmar fascia-deriving cell lines. In contrast, no differences in cell growth or DNA synthesis could be demonstrated. The abnormal capacity to synthesize sulphated glycosaminoglycans and collagen is attributed to a permanent modulation of cell characteristics which can be propagated into cell culture.

Adult↗

PubMed1988

The distribution of unsulphated and sulphated glycosaminoglycans in palmar fascia from patients with Dupuytren's disease and healthy subjects.

Eighty specimens from 20 patients with Dupuytren's disease and 7 biopsies of healthy palmar fascia were analysed for their glycosaminoglycan isomer patterns with a combined enzymatic/HPLC method. The diseased portions of palmar fascia tissue were characterized by elevated total glycosaminoglycans together with a relative increase in the sulphated fractions. The macroscopic stages of nodules, bands and unaffected tissue could be classified very well by multivariate statistical analysis on the basis of their glycosaminoglycan patterns. The biochemical analysis provided evidence of the pathological process even in those specimens that did not yet show any clinical symptoms of the disease.

Adult↗

PubMedDate not supplied

[Peritoneal-fascia-muscle autologous graft in the inguinal canal of rats].

PURPOSE: To study the fragment of the autologous tissue, built by a peritoneum-fascia-muscle, implanted on the level of the wall of inguinal canal and the spermatic cord of rats aiming to verify the histological behavior of the survive and the tissue incorporation. METHODS: Thirty-six rats were distributed into four groups. The rats of the group A, B, C and D were submitted to the median laparotomy to obtain the species to be implanted. On the group A, was implanted a tissue compounded by peritoneum and transversal fascia on the wall of the inguinal canal. On the B, the tissue implanted was added a part of rectum muscle of the abdomen and implanted on the wall of the inguinal canal. On the C, the tissue grafted was similar to the groupA, now grafted into the spermatic cord. On the D, the tissue was similar to the group B, now grafted into the spermatic cord. RESULTS: After 21 days of implant, these tissues presented the following histological alteration: the group A and C, fibroadipous tissue with dilated vessel, Focus of fibrosis' and limphoplasmocitary infiltrated and the groups B and D, fibroadipous tissue with dilated vessels, skeletal muscle and focus of fibrosis. The fibrosis displayed on the groups B and D was more intensive. On the group B, we almost always find the skeletal muscle, while on the group D this tissue was presented in six animals, almost replaced by fibrosis in two and not present in one. CONCLUSION: All the implanted grafts displayed survive and local incorporation, what could be useful on the correction of defects on the inguinal canal, on situations when the autologous tissue was indicated.

Animals↗