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Use of temporalis fascia in eyelid reconstruction.

Full-thickness eyelid defects resulting from trauma, tumor destruction, surgical excision, or congenital anomalies present a dilemma to the reconstructive surgeon. Full-thickness eyelid replacement requires composite grafting of skin, muscle, tarsal support or its substitute, and mucosa. A temporalis fascia sling hammock can be used to support the reconstructed eyelid. This static suspension assists in maintaining proper globe apposition to the eyelid and in preventing sagging of the reconstructed structures.

Basal Cell Carcinoma↗

Blood supply of the tensor fasciae latae muscle.

The tensor fasciae latae (TFL) muscle has been successfully harvested as a myocutaneous flap in reconstructive surgery. Reports on the vascular supply of this muscle, however, are incomplete or inconclusive. Therefore the arterial pattern was examined by dissection in 100 injected human cadaveric specimens. It was observed that whereas 67 muscles were supplied exclusively by a single vessel derived from the ascending branch of the lateral circumflex femoral (LCF) artery, 13 were supplied by a secondary vessel derived from the same branch, while 20 muscles were supplied by two vessels, the larger one arising as before and the smaller from the descending branch of the LCF. Our observations reveal that although the majority of TFL muscles are clinically Type I (one vascular pedicle) according to the classification of Mathes and Nahai (1981), 20% are actually Type II (major and minor vascular pedicles).

Aged↗

The role of biomechanical factors and HLA-B27 in magnetic resonance imaging-determined bone changes in plantar fascia enthesopathy.

OBJECTIVE: To study the role of biomechanical factors and HLA-B27 in plantar fasciitis. METHODS: T1-weighted and T2 spectral presaturation with inversion recovery (fat suppressed) magnetic resonance imaging (MRI) sequences of the plantar fascia insertion and adjacent bone were performed on 28 patients with plantar fasciitis; 17 had spondylarthropathy (SpA)-associated disease, and 11 had mechanically induced disease. The relationship between the degree of bone edema, scored on a semiquantitative scale (from absent to severe), and the patient's HLA-B27 status was determined. RESULTS: On MRI, edema within the soft tissue at the enthesis was evident in both groups. Bone edema in the adjacent calcaneum was evident in 64.7% (11 of 17) of patients with SpA and in 45% (5 of 11) of those with mechanically induced disease (P = 0.441). HLA-B27 was identified in 9 (53%) of the patients with SpA but in none (0%) of those with mechanically induced disease. All 6 of the SpA patients with extensive bone edema but none of the 5 SpA patients with mild bone edema were HLA-B27 positive (P = 0.002). CONCLUSION: The association of HLA-B27 with bone pathology in early enthesitis may have implications for a better understanding of the pathogenesis of SpA.

Achilles Tendon↗

Unusual insertion of the coracobrachialis muscle to the brachial fascia associated with high division of brachial artery.

Anatomical variations of the coracobrachialis muscle (CBM) are common. We detected an abnormal form of the CBM of the left arm during human cadaver dissection. The CBM originated from the tip of the coracoid process of the scapula and divided into muscular and musculo-aponeurotic bellies. The muscular belly inserted into the middle of the anteromedial surface of the humerus, which is the normal anatomic insertion point of the CBM. The musculo-aponeurotic belly inserted into the medial intermuscular septum as well as the brachial fascia, creating a tunnel for the passage of the brachial artery. Inside the tunnel, the brachial artery bifurcated into the radial and ulnar arteries. No abnormality of the CBM, the brachial artery, or the median nerve was detected in the contralateral arm. The phylogenic, ontogenic, functional, and clinical importance of this variant muscle is described. Knowledge of such variations is of considerable importance during invasive and non-invasive investigative procedures or orthopedic, reconstructive, or surgical procedures.

Arm↗

Of fat and fascia: clinical conundrum corner.

A case report involving a 76-year-old male is presented. The signs and symptoms represent a difficult diagnostic problem. The physical signs are dependent on a knowledge of the distribution of fat and fascia in the region involved. The importance of this distribution, both physiologic and pathologic, is the subject of a brief commentary.

Adipose Tissue↗

Incarcerated trocar-wound hernia after laparoscopic hysterectomy. Is closure of large trocar fascia defects after laparoscopy necessary?

An incarcerated hernia through a 12-mm laparoscopic trocar wound, causing small bowel subobstruction, was diagnosed in a 50-year-old female patient following a laparoscopic hysterectomy 1 month earlier. Trocar-wound hernias causing early postoperative bowel obstruction are very rare. Insertion of trocars at a narrow angle to the abdominal wall may cause larger fascia defects than the actual size of the trocar. Manual examination and closure of large defects, if possible, may prevent such complications.

Fascia↗

Contribution of imaging to the understanding of the female pelvic fasciae.

According to the ultrasound and MRI findings, supported by planned dissections, the female perineum is organised around the musculofascial system converging towards the fibrous structure of the central perineal tendon (CPT). Behind the CPT the fascial layers form part of a fibrous assembly extending from the ventral surface of the sacrum to the anal complex, prolonging the direction of the sacral concavity downwards and forwards. On the other hand, in front of the CPT the fasciae fuse to form two aponeurotic bands circumscribing the urogenital fossa. The fascial system is reinforced cranially by the structures of the hypogastric sheath and the uterosacral ligaments. The weak point of the urogenital fossa is partly filled by the urethral-clitoridal-vulvar complex. The perineum so formed plays a cardinal role in stabilising the pelvic viscera. Stress is placed on the firmness of the posterior perineum, a key element in pelvic stability. The posterior perineum is often involved in pathological conditions and a good acquaintance with these structures is essential in defining therapeutic indications.

Adult↗

Fascia lata sling cystourethropexy for the management of female urinary incontinence.

Pubovaginal sling cystourethropexy has rapidly become one of the primary surgical treatment options for women with urinary incontinence. The procedure has evolved over time with regard to clinical indications, patient selection criteria and surgical techniques. This article reviews the historical development of pubovaginal sling cystourethropexy, including recent technical advances. The selection of graft materials is considered and the utility of fascia lata emphasized. Clinical results and potential complications of the procedure are also reviewed.

Fascia Lata↗

Gerota's fascia flap: an alternative for aortic graft coverage.

The greater omentum is commonly used when there is a surgical indication for a barrier between an aortic graft and the abdominal contents. There are few other options when the omentum is not available. A novel approach is described for this purpose-Gerota's fascia flap. It is a simple, durable technique that can readily be used to provide extra tissue in the retroperitoneum for coverage of an aortic graft or possibly an aortic stump.

Aged↗

Diaphragm reconstruction with autologous fascia lata: report of a case.

When the diaphragm is excised so widely that the defect cannot be closed directly during an operation on either thoracic or epigastric tumors, a reconstruction of the defect is necessary. We used harvested autologous fascia lata to reconstruct the diaphragm in a patient undergoing a pleuropneumonectomy with a partial diaphragmatic resection for malignant mesothelioma.

Adult↗

[Eosinophilic cellulitis (Wells syndrome) with involvement of para-articular muscles and fascia].

A 62-year-old woman developed eosinophilic cellulitis of her right arm, accompanied by systemic signs (fever, leucocytosis) and massive restriction of the motility of her right shoulder joint. Sonography and computed tomography revealed massive cutaneous and subcutaneous oedema, and accumulations of fluid around the deep muscular fasciae, interstices and (less severe) within the joint. High-dose systemic corticosteroid treatment led to rapid clearing of the skin lesions, and joint motility was restored several weeks later. This is the first case of eosinophilic cellulitis in which involvement of deep structures adjacent to joints has been demonstrated by modern imaging techniques.

Administration, Oral↗

Sonographic findings of tensor fascia lata tendinopathy: another cause of anterior groin pain.

OBJECTIVE: To describe the sonographic appearances of the normal tensor fascia lata (TFL) origin and to describe the sonographic changes that were present in the TFL of a group of athletes presenting with anterior groin pain. DESIGN: The sonographic appearances of the TFLs of 40 healthy asymptomatic volunteers were evaluated. The TFLs of approximately 200 patients aged between 16 and 55 years presenting with anterior groin pain were evaluated in the course of routine sonographic assessment of the hip. Twelve abnormal TFLs were identified in 12 patients aged between 16 and 53 years. A retrospective review of the appearance of the normal and abnormal tendon with respect to its overall size and echotexture was made. RESULTS: The normal TFL has a thin ribbon-like appearance with a clearly defined fibrillar pattern and a mean anteroposterior (AP) size of 2.1 mm (range 1.5-3.1 mm). In the patient cohort the TFL typically appeared enlarged and contained a cone-shaped area of hypoechogenicity based on the iliac crest within the deep fibers of the origin. The TFL origin was enlarged up to 2 1/2 times its normal size. The mean AP size of the abnormal TFL was 4.7 mm (range 3.1-7.0 mm). CONCLUSION: Tendinopathy of the TFL is a cause of anterior groin pain. Sonography can be used to depict changes in the TFL, confirming the diagnosis and assessing the severity of the tendinopathy.

Adolescent↗

Unilateral hypertrophy of tensor fascia lata: a soft tissue tumor simulator.

OBJECTIVE: To describe the imaging findings in eight cases of unilateral tensor fascia lata (TFL) hypertrophy presenting as soft tissue masses. DESIGN: Imaging studies and medical charts of eight patients were reviewed retrospectively. The imaging studies included five radiographs, five computed tomography (CT) and six magnetic resonance imaging (MRI) examinations. RESULTS: The majority of patients (seven of eight) presented with a palpable proximal anterior thigh mass. One patient was asymptomatic and incidentally diagnosed. There were six females and two males. Ages ranged from 27 to 86 years old (mean 61). MRI and CT showed unilateral enlargement of the TFL muscle in all cases. CONCLUSION: TFL muscle hypertrophy is an uncommon clinical entity, which can simulate a soft tissue tumor. The characteristic appearance on CT or MRI allows a confident diagnosis of muscle hypertrophy to be made, avoiding unnecessary biopsy or surgical intervention.

Adult↗

Tendinous arch of the pelvic fascia: application to the technique of paravaginal colposuspension.

The authors give a description of the anatomy and topography of the tendinous arch of the pelvic fascia (TAPF), in order to facilitate its location during surgery. 35 TAPF in 25 female cadavers were dissected. The reproducibility of the landmarks was then verified at laparotomy. The TAPF can be easily identified and its resistance remains constant, even when the pelvic floor is hypotrophic. Its anterior extremity (d2) is at about 46 mm on a line perpendicular to the anterior edge of the pectineal ligament (35-55 mm), next to the pubovesical ligament. Its median part (dl) is perpendicular to the obturator foramen at a site located at an average of 30 mm below the obturator foramen (25-50 mm). Its posterior end is located at the ischial spine. These anterior landmarks, the only ones useful during surgery, allow its very easy location with the palmar surface of the finger. Testard and Delancey demonstrated the major role of the TAPF in stabilising the urethra submitted to strain. Richardson described a technique of paravaginal suspension for curing paravaginal fascial defect. The TAPF has never been well described, but his work allows its easy location during surgery. The suture of the vagina to the TAPF allows a more physiologic and stronger suspension of the bladder neck than other classical techniques.

Cadaver↗

Histopathological evaluation of the connective tissue of the vaginal fascia and the uterine ligaments in women with and without pelvic relaxation.

This study aimed to compare connective tissue components within the uterine ligaments histopathologically in women with and without pelvic relaxation. The tissue samples obtained from the histopathologic specimens of 24 patients with uterine descensus who underwent vaginal hysterectomy and from twenty-one patients with no pelvic relaxation, in whom total abdominal hysterectomies were performed for benign reasons, were used as the study and control groups, respectively. From each hysterectomy material, samples for histological examination were taken from the vaginal fascia and from the cardinal, the uterosacral and the round ligaments (4 samples for each patient). The amount of collagen, cellularity and elastic fibers within the connective tissue were evaluated and scored by the co-author pathologist. Mann-Whitney U and Student t tests were used for the statistical analysis. The patients with pelvic relaxation had significantly higher scores of collagen and fewer scores of cellularity within the connective tissue samples, compared with the ones without relaxation (p < 0.01, p < 0.01). It was concluded that decreased fibroblasts and increased collagen content might be the key factors associated with pelvic support disorders.

Adult↗

Segmentation of fascias, fat and muscle from magnetic resonance images in humans: the DISPIMAG software.

Segmentation of human limb MR images into muscle, fat and fascias remains a cumbersome task. We have developed a new software (DISPIMAG) that allows automatic and highly reproducible segmentation of lower-limb MR images. Based on a pixel intensity analysis, this software does not need any previous mathematical or statistical assumptions. It displays a histogram with two main signals corresponding to fat and muscle, and permits an accurate quantification of their relative spatial distribution. To allow a systematic discrimination between muscle and fat in any subject, fixed boundaries were first determined manually in a group of 24 patients. Secondly, an entirely automatic process using these boundaries was tested by three operators on four patients and compared to the manual approach, showing a high concordance.

Adipose Tissue↗

Artificial midline-fascia of the human abdominal wall for testing suture strength.

To reduce testing of human abdominal wall closure-modalities in test animals, a fibre reinforced rubber with identical mechanical properties compared to the human midline fascia (linea alba: LA) was developed. The microscopic structure of the human LA, stress-strain behaviour, maximum tensile force and macroscopic failure mechanism in tensile tests with human LA were defined as indicators for the required properties of the fibre reinforced rubber. A composite consisting of latex rubber and cotton fibres was developed that shows mechanical properties comparable to the human abdominal wall. The results of the tensile tests on sutured artificial LA were highly similar to those performed on sutured human LA. The material presented in this study is proposed as a substitute for human and animal tissues presently used to test suture techniques. A protocol for an approach to develop artificial fibrous soft tissue like fascie and tendon was drawn up.

Abdominal Muscles↗

Surgical significance of the endothoracic fascia. The anatomic basis for empyemectomy and other extrapleural technics.

Attention if directed to explanation of the endothoracic fascia in several operations described by pioneer thoracic surgeons. The extrapleural plane was extensively and successfully employed in a number of these operations. Re-emphasis of its use seems advisable even today when open thoracotomy is the rule rather than the exception. In selected cases the extrapleural plane can and should be dissected in the aggressive management of relatively localized empyema, with complete enucleation of the infected sac (empyemectomy). This operation can reduce morbidity and prevent prolonged external drainage. The surgical advantage of the extrapleural plane is also apparent in complete parietal pleurectomy for effective palliation of repeated fluid formation. Other instances of intrathoracic disease are mentioned for which dissection in the extrapleural plane can be a safe and time-saving method of treatment. The anatomic considerations relating to the rapid, safe, and effective dissection of the major hilar vessels are also emphasized.

Adult↗