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PubMed1998

The anatomical organization of the rat fascia dentata: new aspects of laminar organization as revealed by anterograde tracing with Phaseolus vulgaris-Luecoagglutinin (PHAL).

The rat fascia dentata is characterized by a simple cytoarchitecture and characteristic lamination of afferents. Entorhinal afferents are believed to terminate exclusively in the outer two thirds of the molecular layer, whereas commissural fibers are believed to terminate exclusively in the inner molecular layer of the fascia dentata. A sharp border divides these two major afferent fiber systems and is regarded as the main boundary of the fascia dentata. This concept of a highly laminated brain structure has made the fascia dentata attractive for studies analyzing normal or pathological processes of the brain. Recently, entorhinal as well as commissural fibers have been identified which do not follow the classical lamination of the fascia dentata. Using anterograde tracing with Phaseolus vulgaris-Leucoagglutinin, an entorhino-dentate projection to the molecular layer, granule cell layer, and hilus of the fascia dentata was described. With the same technique, GABAergic commissural fibers to the outer molecular layer of the fascia dentata were revealed and a previously unknown heterogeneity of the commissural projection was demonstrated. These previously unknown fiber systems complicate the interpretation of lesion effects in this brain region and have to be taken into account as possible sources of sprouting fibers following the partial denervation of the fascia dentata.

Afferent Pathways↗
PubMed2005

Does the investing layer of the deep cervical fascia exist?

BACKGROUND: The placement of the superficial cervical plexus block has been the subject of controversy. Although the investing cervical fascia has been considered as an impenetrable barrier, clinically, the placement of the block deep or superficial to the fascia provides the same effective anesthesia. The underlying mechanism is unclear. The aim of this study was to investigate the three-dimensional organization of connective tissues in the anterior region of the neck. METHODS: Using a combination of dissection, E12 sheet plastination, and confocal microscopy, fascial structures in the anterior cervical triangle were examined in 10 adult human cadavers. RESULTS: In the upper cervical region, the fascia of strap muscles in the middle and the fasciae of the submandibular glands on both sides formed a dumbbell-like fascia sheet that had free lateral margins and did not continue with the sternocleidomastoid fascia. In the lower cervical region, no single connective tissue sheet extended directly between the sternocleidomastoid muscles. The fascial structure deep to platysma in the anterior cervical triangle comprised the strap fascia. CONCLUSIONS: This study provides anatomical evidence to indicate that the so-called investing cervical fascia does not exist in the anterior triangle of the neck. Taking the previous reports together, the authors' findings strongly suggest that deep potential spaces in the neck are directly continuous with the subcutaneous tissue.

Aged↗
PubMed1991

Nose and paranasal augmentation: autogenous, fascia, and cartilage.

The up-to-date plastic surgeon should consider using augmentation rhinoplasty with relative frequency. In selected cases, for improving the face integrally, it is desirable to augment the paranasal area. In the author's hands, grafts of cartilage and fascia are the preferred tissues, based on the experience of many years. Fascia can be used alone or combined, and in the last few years we have used it alone quite often. A temporoparietal fascia graft has great versatility in the correction of a number of nasal deformities. A depressed nasal dorsum can be augmented by utilizing fascia grafts. A depressed nasal radix can be corrected successfully by utilizing fascia grafts. Submucosal placement of strips of fascia has proved to be an effective method of reconstructing the roof of the middle cartilaginous vault. For augmenting the nasal dorsum when it is a case of primary rhinoplasty, the author prefers the use of fascia alone, but if the patient is having a secondary rhinoplasty, then the graft of fascia and cartilage combined is preferred.

Cartilage↗
PubMed1990

Functional construction of the superficial and deep fascia system of the lower limb in man.

The muscular system, the connective tissue and the bones are the components of a biomechanical pelvis-lower extremity model. The occasional electrical events in the muscles were not taken into account, as they can only be measured by physiological methods. In this publication, the connective tissue of the lower extremities is examined. The connective tissue system of the thigh and leg was prepared; after removal of the muscles the so-called 'hollow' lower extremity could be studied. A topographical documentation followed, and the structure and directions of the fibers were observed with polarized light. The connective tissue systems of the lower extremities and bones form a biomechanical, effective and functional system, the bone-fascia-tendon system. The components of the connective tissue in such a system are the fascia lata, the crural fascia, the iliotibial tract, the femoral and crural intermuscular septa, and the membrana interossea. The iliotibial tract is not the sole part of this system having a tension band effect, other components--above all the lateral femoral intermuscular septum--also reduce the forces acting on the bones. Therefore, the tensile strength of the iliotibial tract has to be considered lower as supposed. The iliotibial tract is not a part of the fascia lata; it is an independent, vertically tightened tendon of the 'pelvic deltoid muscle' (gluteus maximus, tensor fasciae latae). The iliotibial tract passes over the greater trochanter like on a roller bearing. It is not attached directly to the greater trochanter and to the lateral femoral condyle, so that previous models have to be modified. The iliotibial tract glides in a fascia bag which is composed of oblique and horizontal fibers of the broad fascia. The iliotibial tract, as tendon of the pelvic deltoid muscle, continues in a lateral location into the leg where it is fixed to the lateral malleolus. The present report provides a new description of the structure of the connective tissue system of the lower extremities. The model reported complies with the laws of similarity mechanics by describing exactly the geometric, physical and functional conditions. This representation could facilitate the construction of a computer-aided, efficient, biomechanical model of the pelvis-lower extremity region considering also the complex functional circumstances, in contrast to previous models. In order to construct such a model, the data obtained by the examination of the connective tissue of the lower extremities have to be given into a data bank, which, however, has to be built up.

Biomechanical Phenomena↗
PubMed1987

Obtaining fascia lata.

The surgical procedure for obtaining fascia lata can be easily carried out by the ophthalmic surgeon. However, anatomy related to obtaining the tissue, as outlined in standard surgical textbooks, is not entirely accurate and should be clarified. The tissue necessary for strong frontalis slings should come from a thick band of fascia lata referred to as the "iliotibial tract." If one attempts to obtain fascia lata by directing a fascia stripper along an imaginary line directed from the head of the fibula to the anterior iliac spine, as suggested in most textbooks, an inadequate specimen may be obtained. The iliotibial tract of fascia lata actually runs from the lateral tibial condyle to the iliac crest. The fascia stripper, therefore, needs to be directed along an imaginary line from the lateral tibial condyle to the iliac crest to obtain the strongest fascia lata and avoid transecting the longitudinal fibers.

Fascia Lata↗
PubMed1991

The relationship between parotid and superficial fasciae.

The paper reports a study conducted on serial sections of subcutaneous neck and facial tissues taken from ten human fetuses with a craniocaudal distance of between 7 and 30 cms for the purpose of establishing the age at which various anatomical structures develop and interact. In particular, the study was aimed at investigating the relationship between the parotid and superficial fasciae. Findings, supported also by direct observations on humans, demonstrated that a parotid fascia proper does not exist. The study was also aimed at confirming or invalidating the contrasting opinions reported in recent literature. On the basis of our observations on the parotid gland, no parotid fascia as such seems to be present, but rather a superficial thickening of the connective tissue with muscle fibres which can be identified with the superficial fascia of the region and as a continuation of the platysma m., and with the septa subdividing the gland. Moreover, only a thin connective layer was detected in the deep surface of the fascia. These findings are in line with those reported by Jost who, like ourselves, conducted his research on both primates and humans. The anatomical and surgical implications of these findings are considerable as they entail a redefinition of the existence of a parotid fascia. In particular, this implies abandoning the expression introduced by Mitz who defines this structure as representing a "superficial muscular and aponeurotic system (SMAS)" which in fact can be considered to correspond to the superficial fascia as correctly described by Sterzi and subsequently confirmed by Bertelli.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗
PubMed2000

Extrafascial excision of the rectum: surgical anatomy of the fascia propria.

PURPOSE: It is now agreed that it is of vital importance to maintain the fascia propria as an intact envelope around the mesorectum to prevent tumor spillage while performing rectal excision for cancer. There are several surgical techniques described to achieve an intact fascial envelope, each arising from differing descriptions of the fascia propria of the rectum. The aim of this study was to describe the detailed surgical anatomy of the fascia propria. METHODS: Thirteen rectal specimens surgically removed by the technique of extrafascial excision were subjected to gross inspection, dissection, and histologic and electron microscopic examination. The attachments, thickness, and composition of the fascia propria were determined. RESULTS: The fascia propria is a continuous fascial sleeve surrounding the rectum and mesorectum that can be dissected as a complete "sock" off a fresh extrafascial specimen. It is 154 (+/- 1 standard deviation = 61-391) microm thick, is thinner anteriorly than posteriorly (P < 0.05), and is composed predominantly of collagen. It can be identified surgically at the pelvic brim as a shiny membrane and lies inside the hypogastric nerves and the pelvic plexuses. CONCLUSION: The fascia propria forms a sleeve around the mesorectum, offering a surface against which to dissect, enabling safe removal of the rectum with its intact mesorectum while preserving the autonomic nerves of the pelvis. The term "extrafascial excision" highlights the importance of the fascia propria in this operation.

Adult↗
PubMed1986

The anatomical basis for retrorenal extensions of pancreatic effusions: the role of the renal fasciae.

Retrorenal extension of pancreatic inflammatory processes are considered to involve invasion of the posterior pararenal space. Analysis of computed tomographic (CT) images demonstrates preservation of posterior pararenal fat in most patients, implicating some other mechanism. We have examined the anatomical basis for these retrorenal extensions in static and functional studies of 12 cadavers using CT imaging, dissection and histological techniques. We observed that the posterior renal fascia was thicker than the anterior, that it could be easily separated into two layers by manual dissection and injections of liquid latex, that the inner (anterior) layer of the posterior fascia was continuous with the anterior fascia and the outer layer continuous with the lateroconal fascia. The point at which the two layers of the posterior fascia separated laterally and the medial extent of the posterior fascia varied considerably in CT scans of 100 patients. These data are interpreted to mean that pancreatic effusions extend posterior to the kidney by separating the two layers of the posterior renal fascia.

Fascia↗
PubMed2003

Three-layer reconstruction with fascia lata and vascularized pericranium for anterior skull base defects.

BACKGROUND: We report an assessment of the efficiacy of a triple layer graft composed of fascia lata and vascularized pericranium for anterior skull base reconstruction. This technique is based on the concept that vascularized tissue over a free flap may promote vascularization and rapid wound healing. METHOD: A large fascial graft is prepared from the fascia lata and divided in two pieces and trimmed to a size larger than the bone and dural defect. Vascularized pericranium is harvested after bicoronal incision and elevating the bifrontal scalp flap down to the supraorbital rims. First is dural repair, which is performed with fascia lata placed between the brain and remaining dura. Second, fascia lata is placed over the skull base defect and secured with mini titanium screws over the cranial surface of the orbital ridges. Third, vascularized pericranium is laid between the two layers of fascia lata. FINDINGS: We studied 17 patients of whom 2 had malignancy, 6 had olfactory groove meningioma, 6 had skull base fracture and rhinorrhea, 1 case had orbital meningioma, 1 had invasive pituitary adenoma and 1 had basal encephalocele. The transbasal approach was used as a single procedure in 13 cases. The extended transbasal approach combined with a transfacial approach was used in 3 cases and with a pterional approach in 1 case. In each patient, reconstruction of the cranial base was performed with triple layer graft of fascia lata and vascularized pericranium. The patients were followed-up 2 months to 5 years. None of the patients experienced postoperative cerebrospinal fluid leakage, meningitis, abscess, brain herniation and tension pneumocephalus. INTERPRETATION: Fascia lata with vascularized pericranium is highly reliable, tensile and well suited for reconstruction of the anterior skull base.

Adolescent↗
PubMed1990

Medial extent of the posterior renal fascia. An anatomic and computed tomography study.

To study the medial extent of the posterior renal fascia and the perirenal space, the authors dissected two cadavers and reviewed 50 computed tomographic (CT) abdominal scans. The results demonstrated that the medial extent of the posterior renal fascia depends on the level in a vertical direction and its relationship to the kidney which varies at different levels. At the renal hilus, the fascia inserts posteromedially to the fascia of the quadratus lumborum along its lateral margin; more cranially, the line of insertion is more lateral, onto the diaphragmatic fascia; more caudally, the line of insertion is more medial, inserting onto the anterior surface of the quadratus lumborum. Therefore the posteromedial insertion of the posterior renal fascia extends medially, from the more laterally placed diaphragmatic fascia, to the lateral margin of the quadratus lumborum and then to the anterior surface of the quadratus lumborum, depending on the anatomic level. The clinical implication of these findings are discussed.

Cadaver↗
PubMed2005

Effect of Achilles tendon loading on plantar fascia tension in the standing foot.

BACKGROUND: The plantar fascia, which is one of the major arch-supporting structures of the human foot, sustains high tensions during weight-bearing. A positive correlation between Achilles tendon loading and plantar fascia tension has been reported. Excessive stretching and tightness of the Achilles tendon are thought to be the risk factors of plantar fasciitis but their biomechanical effects on the plantar fascia have not been fully addressed. METHODS: A three-dimensional finite element model of the human foot and ankle, incorporating geometrical and material nonlinearity, was employed to investigate the loading response of the plantar fascia in the standing foot with different magnitudes of Achilles tendon loading. FINDINGS: With the total ground reaction forces of one foot maintained at 350 N to represent half body weight, an increase in Achilles tendon load from (0-700 N) resulted in a general increase in total force and peak plantar pressure at the forefoot of up to about 250%. There was a lateral and anterior shift of the centre of pressure and a reduction in the arch height with an increasing Achilles tendon load as a result of the plantar flexion moment on the calcaneus. From the finite element predictions of simulated balanced standing, Achilles tendon forces of 75% of the total weight on the foot (350 N) were found to provide the closest match of the measured centre of pressure of the subject during balanced standing. Both the weight on the foot and Achilles tendon loading resulted in an increase in tension of the plantar fascia with the latter showing a two-times larger straining effect. INTERPRETATION: Increasing tension on the Achilles tendon is coupled with an increasing strain on the plantar fascia. Overstretching of the Achilles tendon resulting from intense muscle contraction and passive stretching of tight Achilles tendon are plausible mechanical factors for overstraining of the plantar fascia.

Achilles Tendon↗
PubMed2001

Anatomic study of arcus tendineus fasciae pelvis.

OBJECTIVE: To describe the anatomy of the arcus tendineus fasciae pelvis. MATERIAL AND METHODS: Two fixed female cadaver pelvises (88 and 66 years old) were dissected. RESULTS: The arcus tendineus fasciae pelvis is a 10-cm-long fibrous thickening of the pelvic fascia which is medial to the obturator internus muscle and lateral to the peritoneum. It is inserted on the ischiatic spine and courses downward and anteriorly to the pubovesical ligament. The posterior third of the arcus tendineus fasciae pelvis is fused with the posterior third of the arcus tendineus musculus levatoris ani, forming a curve with upward and anterior concavity. This portion of the arcus tendineus is thick and easy to recognise upon palpation. It is located 1cm slightly above and anterior to the ischiatic spine and 2 cm from of the pudendal vessels, which course around the posterior inferior margin of the ischiatic spine. The superior margin of the median part of the arcus tendineus fasciae pelvis is crossed laterally by vessels for the obturator internus muscle arising from the internal iliac vessels. CONCLUSION: In genital prolapse cure, sutures must be placed through the anterior or median parts of the arcus tendineus fasciae pelvis. In any case, they must remain anterior to the posterior part of the arcus tendineus fasciae pelvis to avoid injury to the pudendal vessels.

Aged↗
PubMed2000

The antigenicity of fascia lata allografts.

OBJECTIVE: To determine whether commercially available fascia lata allograft material contains donor antigens. MATERIALS AND METHODS: Human leukocyte antigens (HLA) class I and II were assessed in: (i) freeze-dried fascia lata allografts; (ii) a Tutoplast fascia lata graft (Mentor Urology, Santa Barbara, CA, USA); (iii) an acellular dermal graft; and (iv) a successful donor fascia sacrocolpopexy graft one year after implantation, using a polymerase chain reaction sequence-specific primer-based assay. RESULTS: The donor for both the freeze-dried fascia lata and Tutoplast fascia lata was fully HLA-typed. At one year after implantation, antigens from the implanted sacrocolpopexy graft matched the host blood antigens. The antigenicity of the acellular dermal graft could not be ascertained because this material interfered with the assay. CONCLUSION: Donor fascia lata grafts prepared by freeze-drying or by the Tutoplast technique retain donor antigens. The significance of this antigenicity is unknown. All donor antigens are replaced by host antigens after implantation.

Fascia Lata↗
PubMed1999

Experimental vascular graft using small-caliber fascia-wrapped fibrocollagenous tube: short-term evaluation.

This study was undertaken to evaluate the application of autogenous fascia as a framework for a fibrocollagen tube for small-caliber vascular prostheses in Japanese white rabbits (n = 15). The fascia, measuring 10 x 40 mm, was harvested from the dorsal fascia and was carefully wrapped around a silicone rod of 1.5 mm in diameter. Then, the fascia-wrapped silicone rod was implanted into a subcutaneous pocket on the medial thigh. Four weeks later, the fascia-wrapped silicone rod was removed from the subcutaneous pocket. The rod was removed from the material, and the fascia-wrapped fibrocollagen tube was treated to make it antithrombogenic. Subsequently, the 1.5 x 10-mm fascia-wrapped tube was prepared as an arterial conduit. Using microvascular techniques, the tube was interposed into the divided femoral artery. Eleven of 15 grafts maintained patency over the follow-up period and no aneurysmal formation was found at any graft site. Microscopically, there was an ingrowth of endothelium with fibroblast proliferation from each end of the recipient vessel at 2 weeks after interposition; however, no neointima was found to line the center of the conduit. At 5 weeks after interposition, the neointimal growth rate was 70 percent. There was an ingrowth of endothelium with fibroblast proliferation from each end onto the entire internal surface of the conduit at 8 weeks after interposition. Further study is required before any long-term conclusions can be drawn.

Animals↗
PubMed1999

Transversalis fascia: historical aspects and its place in contemporary inguinal herniorrhaphy.

Since the introduction of the term "fascia transversalis" by Sir Ashley Cooper in 1840, this thin layer of tissue has been discovered, denied, and redefined. The transversalis fascia was originally described as a bilaminar membrane. Although most subsequent descriptions do not reflect this analysis, some authors, especially in the surgical literature, believe that a posterior lamina of the transversalis fascia exists. Others believe that the posterior lamina of the transversalis fascia is, in fact, part of the preperitoneal fascia. The usefulness of the transversalis fascia and its derivatives or analogues; e.g., the crura of the deep inguinal ring, have also been extensively discussed. The aim of this paper is to provide a brief survey of the historical literature concerning the transversalis fascia and a discussion of some of the contemporary views on its morphology and significance in current laparoscopic hernia repair.

Anatomy↗
PubMed1999

Attachment of the deep temporal fascia to the zygomatic arch: an anatomic study.

It is generally acknowledged that the superficial layer of the deep temporal fascia attaches to the lateral surface and its deep layer along the medial surface of the zygomatic arch. However, Ramírez asserts that the superficial and the deep layer of the deep temporal fascia fuse consistently approximately 1 cm above the upper ridge of the arch and attach to the outer surface of the arch, blending with the superficial fascia of the masseter muscle. In this study the authors clarify the precise anatomic relations between the fascia and the zygomatic arch. Coronal sections crossing the midpoint between the zygomaticotemporal suture and the tubercle of zygoma were observed grossly and histologically in 32 hemifaces from 16 Korean adult cadavers. This study demonstrates that the superficial and the deep layers of the deep temporal fascial fuse and insert onto the superior margin of the arch in 18 dissections (56%) and insert onto the superolateral surface in 14 dissections (44%). The contacting surface of the fused deep temporal fascia to the periosteum of the zygomatic arch is less than 2 mm. The following route is safer and is recommended for reaching the zygomatic arch region: Just above the split of the deep temporal fascia, a dissection is carried through the deep temporal fasica, continuing downward to the superior margin of the arch along the undersurface of the fascia. At this spot the periosteum of the arch is dissected.

Adult↗
PubMed2000

Utility of both muscle and fascia flaps in severe lower extremity trauma.

BACKGROUND: The evolving technology in trauma management today permits salvage of many severe lower extremity injuries previously even considered to be lethal. An essential component for any such treatment protocol must be adequate soft tissue coverage that often will use vascularized flaps. Traditionally, calf muscles have been used proximally and free flaps for the distal leg and foot. The reintroduction of reliable local fascia flaps has challenged this dictum, proving to be a simpler and yet versatile option. MATERIALS AND METHOD: The role of both muscle and fascia flaps in lower extremity injuries has been retrospectively reviewed from a 2-decade experience. Soft tissue deficits requiring some form of vascularized flap occurred in 160 limbs in 155 patients. The frequency of use of flap types, specific complications and benefits, effect of timing of wound closure, and rate of limb salvage were compared. RESULTS: Initial coverage after significant lower extremity trauma in these 160 limbs required 60 local muscle flaps, 50 local fascia flaps, and 74 free flaps. These flaps had been selected on a nonrandom basis according to wound location, its severity, and flap availability. Complications were directly related to the severity of injury, and for free flaps as a group (39%), although these were not independent variables. Local muscle (27%) or fascia flaps (30%) were similar with regard to this morbidity. Healing was more likely to be uneventful if coverage were accomplished during the acute period after injury, regardless of flap type. Muscle flaps were still used in two thirds of all cases, with the soleus muscle used as often for the distal leg as the mid-leg. Local fascia flaps were most valuable for smaller defects, especially in the distal leg or foot, and often as a reasonable alternative to a free flap. CONCLUSION: The traditional role of the gastrocnemius muscles for flap coverage of knee and proximal leg defects and the soleus muscle for the middle third of the leg was reaffirmed. The soleus muscle often also reached distal leg defects as could local fascia flaps, where classically, otherwise, a free flap would have been necessary. The largest or most severe wounds, irrespective of limb location, required free flap coverage. Local fascia flaps proved to be a valuable alternative.

Algorithms↗
PubMed2000

Histological study of injected autologous fascia in the paralyzed canine vocal fold.

OBJECTIVE: Several methods have been used for the treatment of the unilateral paralyzed vocal fold. Teflon injections have been used extensively but not without complications. The ideal substance for injection is yet to be determined. Injected autologous fascia has been reported as a means of achieving glottic closure. In review of the literature, there are no long-term results described using autologous fascia in this way. The purpose of this study was to examine the histological changes of the larynx after injection of autologous fascia into a paralyzed vocal fold. STUDY DESIGN: A prospective study with the contralateral side of the larynx used as the control. METHODS: Six adult dogs underwent severing of one of their recurrent laryngeal nerves. After the vocal folds were confirmed to be paralyzed by direct laryngoscopy, fascia lata that was harvested from the animal was minced and injected into the paralyzed vocal fold. The dogs were then killed at intervals ranging from 3 to 12 months and their larynges reviewed histologically. RESULTS: The larynges revealed muscle atrophy of the vocal fold, which is consistent with denervation, but there was no evidence of persistent fascia. In addition, there was no evidence of reaction to the injected fascia. Special stains for collagen were also performed which showed no significant change from the non-injected vocal fold. CONCLUSION: From this model, it is concluded that injected autologous minced fascia is not a good short- or long-term substance for vocal fold augmentation. Further study is warranted to confirm this observation.

Animals↗