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PubMed1991

Clinical applications of the subgaleal fascia.

The anatomic boundaries and vascular supply of the subgaleal fascia have been described previously. The thin and malleable subgaleal fascia was selected for difficult reconstructive problems in seven patients. This flap has been based on either the supraorbital or the superficial temporal vascular leash. The subgaleal fascia is readily dissected from superficial galea and deep periosteum, leaving behind a well-vascularized scalp and a skin-graftable calvarium. The flap conforms to a cartilage framework for ear reconstruction. It takes a skin graft well. The subgaleal fascia can patch dural defects and fill sinus dead space. It has been used to augment facial contour. Free vascularized transfer of the subgaleal fascia has included the temporoparietal fascia, which was partially split from the subgaleal fascia for bilobed flap resurfacing of the hand. The subgaleal fascial flap should be considered when ultrathin, vascularized coverage is needed.

Adult↗

PubMed1994

Temporalis fascia grafts in open secondary rhinoplasty.

Parchment thin skin is a common problem associated with secondary rhinoplasty. When such skin is present, the underlying osseocartilaginous skeleton often becomes visible. Although many techniques have been used to treat the condition, we have found that an onlay graft of temporalis fascia is a most satisfactory method to cover the underlying osseocartilaginous framework or cartilage grafts. Temporalis fascia grafts have been advocated for this purpose in closed rhinoplasty; however, precise placement of the graft is difficult because the graft rolls. On the other hand, when used in open rhinoplasty, the graft may be placed accurately and secured under direct vision. This paper presents our experience with temporalis fascia grafts in open secondary rhinoplasties. Six female patients ages 31 to 57 underwent open secondary rhinoplasty. Five patients also had autologous cartilage grafts. Our average follow-up was 24 months; the minimum was 1 year, and the longest 7 years. All patients had excellent dorsal contours and osseocartilaginous irregularities were not observed. One patient developed a culture-proven nasal infection that responded successfully to antibiotics without removal of the fascia or cartilage graft, a result unlikely to occur when alloplastic materials are used. Biopsy of the temporalis fascia and cartilage grafts was obtained in one patient 12 months after placement. Microscopic examination confirms the long term viability of both grafted tissues, inasmuch as the temporalis fascia was vascularized and normal chondrocytes were present in the cartilage grafts. In summary, we have found that temporalis fascia grafts are a very satisfactory method for managing thin skin in open secondary rhinoplasty.

Adult↗

PubMed1997

The vertically based deep fascia turnover flap of the leg: anatomic studies and clinical applications.

Although fasciocutaneous turnover flaps are a simple and fast method for covering soft-tissue defects of the lower leg, many reconstructive surgeons have their doubts about them. They revolve around the lack of criteria for safely designing these random-pattern flaps and around the risk of donor site problems. A vertically based deep fascia turnover flap with a paratibial or parafibular pedicle is presented. Anatomic studies of 36 injected lower limbs showed the deep fascia to be supplied by a mean of 61 vessels. As musculofascial, septofascial, and periosteofascial branches, these contribute to a richly anastomosing vascular network within the deep fascia. Along the deep transverse septum at the medial tibial border, the anterior and posterior peroneal septa, and between the anterior tibial and extensor muscles, the fascia is supplied by segmental vessels in a clearly defined arrangement. Pedicled on these vessels, the deep fascia is a useful candidate tissue for transversely oriented turnover flaps. These are particularly well suited for covering pretibial or prefibular soft-tissue defects. Unlike adipofascial turnover flaps, the transversely oriented deep fascia turnover flap keeps its subcutaneous layer with its intact vascular plexus so that the overlying skin is adequately perfused even in patients with sizable flaps or an extremely thin skin. Clinical experience with the vertically based paratibial or parafibular deep fascia turnover flap in six patients confirmed its usefulness for covering small to medium-sized soft tissue defects of the lower leg.

Adult↗

PubMed2002

The vascular supply of the extended tensor fasciae latae flap: how far can the skin paddle extend?

The vascular supply of the tensor fasciae latae flap and of the lateral thigh skin was studied in 10 cadavers to evaluate whether the lateral thigh skin toward the knee could be incorporated into an extended tensor fasciae latae flap. Within each cadaver, vascular injection of radiopaque material preceded flap elevation in one limb and followed flap elevation in the contralateral limb. Flaps raised after vascular injection were examined radiographically to evaluate the vascular anatomy of the lateral thigh skin independent of flap elevation. When vascular injection was made into the profunda femoris, the upper two-thirds of the flaps was better visualized than the distal third. When the injection was made into the popliteal artery, the vasculature of the distal third of the flaps was better visualized. Flaps raised before vascular injection were examined radiographically to delineate the anatomical territory of the vascular pedicle that had been injected. In these flaps, consistent cutaneous vascular supply was only seen in the skin overlying the tensor fasciae latae muscle, confirming that musculocutaneous perforators are the predominant means by which the pedicle of the tensor fasciae latae flap supplies the skin of the lateral thigh. Extended tensor fasciae latae flaps were elevated bilaterally in one cadaver, and selective methylene blue injections were made into the lateral circumflex femoral artery on one side and into the superior lateral genicular artery on the contralateral side. Methylene blue was observed in the proximal and distal thirds of the skin paddles, respectively, leaving unstained midzones. The vascular network of the lateral thigh skin could be divided into three zones. The lateral circumflex femoral artery and the third perforating branches of the profunda femoris artery perfuse the proximal and middle zones of the lateral thigh skin, respectively. The superior lateral genicular artery branch of the popliteal artery perfuses the distal zone. The middle and distal zones meet 8 to 10 cm above the knee joint, where the skin paddle of the tensor fasciae latae flap becomes unreliable. These data indicate that if the aim is to incorporate the skin over the distal thigh in an extended tensor fasciae latae flap without resorting to free-tissue transfer, then either a carefully planned delay procedure or an additional anastomosis to the superior lateral genicular artery is required.

Adult↗

PubMed1998

Effect of calcaneal osteotomy and lateral column lengthening on the plantar fascia: a biomechanical investigation.

Medial calcaneal displacement osteotomy or lateral column lengthening fusion has been advocated to augment tendon transfer in planovalgus foot deformity associated with chronic posterior tibial tendon insufficiency. It is hypothesized that plantar fascia tightening occurs with these procedures, helping to restore a more normal longitudinal arch. To investigate this further, nine fresh-frozen cadaver below-knee specimens were used. A flatfoot model was created by sectioning of the posterior tibial tendon, spring ligament, talonavicular capsule, and deltoid ligament. A liquid-metal strain gauge, calibrated to measure fractional changes in length, was sutured proximally to the origin and distally into the thickest portion of the medial band of the plantar fascia. Specimens were axially loaded to 400 N and plantar fascia strain was measured. Fractional length changes in the plantar fascia were then measured after a medial displacement calcaneal osteotomy and after a lateral column lengthening through the calcaneocuboid joint. Tightening of the plantar fascia did not occur with either medial calcaneal displacement or lateral column lengthening. The plantar fascia became significantly less taut with both medial displacement and lateral column lengthening. We found that lateral column lengthening produced significantly looser plantar fascia than did medial displacement of the calcaneal tuberosity.

Biomechanical Phenomena↗

PubMed2024

Proteomics analysis of deep fascia in acute compartment syndrome.

Acute compartment syndrome (ACS) is a syndrome in which local circulation is affected due to increased pressure within the compartment. We previously found in patients with calf fractures, the pressure of fascial compartment could be sharply reduced upon the appearance of tension blisters. Deep fascia, as the important structure for compartment, might play key role in this process. Therefore, the aim of the present study was to examine the differences in gene profile in deep fascia tissue in fracture patients of the calf with or without tension blisters, and to explore the role of fascia in pressure improvement in ACS. Patients with lower leg fracture were enrolled and divided into control group (CON group, n = 10) without tension blister, and tension blister group (TB group, n = 10). Deep fascia tissues were collected and LC-MS/MS label-free quantitative proteomics were performed. Genes involved in fascia structure and fibroblast function were further validated by Western blot. The differentially expressed proteins were found to be mainly enriched in pathways related to protein synthesis and processing, stress fiber assembly, cell-substrate adhesion, leukocyte mediated cytotoxicity, and cellular response to stress. Compared with the CON group, the expression of Peroxidasin homolog (PXDN), which promotes the function of fibroblasts, and Leukocyte differentiation antigen 74 (CD74), which enhances the proliferation of fibroblasts, were significantly upregulated (p all <0.05), while the expression of Matrix metalloproteinase-9 (MMP9), which is involved in collagen hydrolysis, and Neutrophil elastase (ELANE), which is involved in elastin hydrolysis, were significantly reduced in the TB group (p all <0.05), indicating fascia tissue underwent microenvironment reconstruction during ACS. In summary, the ACS accompanied by blisters is associated with the enhanced function and proliferation of fibroblasts and reduced hydrolysis of collagen and elastin. The adaptive alterations in the stiffness and elasticity of the deep fascia might be crucial for pressure release of ACS.

Humans↗

PubMed1983

Visualization of the renal fascia: a normal finding in urography.

A previous study indicated that visualization of renal fascia adjacent to radiographically normal kidneys may suggest undetected renal disease. To determine the clinical significance of visualized renal fascia during excretory urography of radiographically normal kidneys, 110 normal excretory urograms were analyzed prospectively. Renal fascia was seen in 23 cases (21%). It was usually identified in short segments; average thickness of visualized fascia was 1.5 mm. The renal fascia was identified with anteroposterior nephrotomography in 17 (74%) of 23 cases. It is known that retroperitoneal inflammation or neoplasia may thicken the renal fascia but the visibility of this structure in patients without renal or retroperitoneal abnormalities has not been emphasized. Visualization of renal fascia adjacent to kidneys judged radiographically normal should not imply unrecognized renal pathology.

Adolescent↗

PubMedDate not supplied

Comparison of silastic and banked fascia lata in pediatric frontalis suspension.

PURPOSE: To compare the use of Silastic and banked fascia lata in pediatric frontalis suspension surgery for functional success, ptosis recurrence, and infection and granuloma rates. METHODS: This retrospective study analyzed the medical records of 72 patients who underwent 131 frontalis suspension operations using either Silastic or banked fascia lata during the past 12 years at Children's Hospital at Westmead, Sydney, Australia. RESULTS: Functional success rates for primary frontalis suspension procedures were not significantly different for banked fascia lata and Silastic (60% versus 67.2%, respectively; P = .4666). Infection and granuloma rates also were not significantly different (7.1% for banked fascia lata versus 15.2% for Silastic; P = .1381). There was, however, a statistically significant difference between the two materials in ptosis recurrence (35.3% for banked fascia lata versus 13% for Silastic; P = .0062). CONCLUSIONS: Silastic was significantly better than banked fascia lata in terms of ptosis recurrence. Both materials were comparable in terms of functional success after one procedure and in infection and granuloma rates. Given the conflicting evidence presented in the literature, large prospective studies are needed to compare the use of the most common synthetic materials with banked fascia lata in pediatric frontalis suspension.

Adolescent↗

PubMed2000

Cadaveric versus autologous fascia lata for the pubovaginal sling: surgical outcome and patient satisfaction.

PURPOSE: We report our initial experience with cadaveric fascia lata in pubovaginal sling procedures. MATERIALS AND METHODS: We compared 121 consecutive women who underwent a sling procedure using cadaveric fascia lata from February 1997 through June 1999 (group 1) with 46 consecutive women who underwent a sling procedure using autologous fascia lata from May 1994 through July 1997 (group 2). RESULTS: Mean followup was longer in group 2 (44 versus 12 months). A total of 104 of the 121 group 1 patients (86%) responded to the questionnaire, of whom 85% were cured of stress incontinence, 83% reported overall improvement in urinary control and 74% had no or minimal leakage not requiring pads. Median catheterization time was 9 days (range 4 to 120). Overall 89% of the women were satisfied with the results and 83% would recommend this surgery. A total of 30 of the 46 group 2 patients (65%) responded to the questionnaire, of whom 90% were cured of stress incontinence, 90% reported overall improvement in urinary control and 73% had no or minimal leakage not requiring pads. Median catheterization time was 14 days (range 6 to 180). Overall 90% of the women were satisfied with the results and 83% would recommend this surgery. CONCLUSIONS: Cadaveric fascia lata pubovaginal slings appear to be safe. Early experience suggests that cadaveric fascia lata may be considered an alternative to autologous fascia. Cadaveric and autologous fascia lata appear to have a high success rate.

Cadaver↗

PubMed2000

[Arcus tendineus fascia pelvis: anatomical study].

OBJECTIVE: To reveal the anatomy of arcus tendineus fascia pelvis. MATERIAL: and methods. 2 fixed female cadaver pelvises (88 and 66 years old) were dissected. RESULTS: The arcus tendineus fascia pelvis is a fibrous recess of the pelvic fascia which is 10 cm long, laterally to the obturator internus muscle and medially to the peritoneum. It reaches the ischial spine lower and anteriorly to the pubo-vesical ligament. The third posterior part of the arcus tendineus of the pelvic fascia is commun with the posterior part of the arcus tendineus of the levator ani. This third posterior part is like a curve concave anteriorly. This curve is thick and easy to recognize by the palpation. This third posterior curve is 1cm in front of the ischial spine and 2cm in front of the pudendal vessel which took place behind the ischial spine. The vessels of the obturator internus muscle originated from the internal iliac vessel and crossed laterally the median part of the arcus tendineus of the pelvic fascia. CONCLUSION: Sutures must be placed through the anterior and median part of the arcus tendineus fascia pelvis, in front of the posterior part of the arcus tendineus fascia pelvis to avoid any injury to the pudendal vessels.

Aged↗

PubMed2005

[Duraplasty with Neuropatch versus autologous fascia lata for Chiari I malformation with syringomyelia: a comparative study].

OBJECTIVE: To evaluate the outcome and postoperative reaction of dural substitute (Neuropatch) applying in the treatment of Chiari I malformation(CMI) associated with syringomyelia(SM). METHODS: Forty patients of CMI associated with SM were operated in our department from Jul. 2002 to Jul. 2004. All patients underwent posterior cranial fossa decompression and duraplasty. They were divided into two groups, 20 patients being repaired with Neuropatch (Neuropatch group), and the others with autologous fascia lata (fascia group). There were 6 males and 14 females in Neuropatch group and 10 males and 10 females in fascia group. The operations were performed under general anesthesia via suboccipital approach and the extent of posterior cranial fossa decompression ranged from 20 cm(2) (5 cmx4 cm) to 35 cm(2) (5 cmx7 cm). The removal of posterior arch of atlas depended on the extent of tonsillar herniation, and the dura was opened in Y shape. The Neuropatch was cut into triangular shape, and the same sized autologous fascia lata was used in fascia group. The patches were sutured tightly to the dura matter in each group. The incision was closed layer by layer and drainage was used, if necessary. Antibiotics and hormone were routinely used. The duration of operation, postoperative fever were evaluated, the outcome of the operation was evaluated by Tator scale, and the data were analyzed with statistic software SPSS 10.0. RESULTS: There were12 patients (60%) who suffered from postoperative fever in the Neuropatch group, and 9 patients (45%) in the fascia group(chi(2)=0.902,P=0.342). Seventeen patients in each group were improved postoperatively. The duration of operation, postoperative fever and antibiotics used were compared between the two groups. No significant difference was found, but the duration of postoperative fever and the time of hormone used were different. There were no postoperative infections that occurred after the follow up for 1 to 2 years, except for one patient in fascia group who developed infective granuloma and recovered later by treatment. CONCLUSION: Neuropatch is a useful dural substitute for the repair of dural defects in the treatment of CMI associated with syringomyelia.

Arnold-Chiari Malformation↗

PubMed1995

The posterior layer of the thoracolumbar fascia. Its function in load transfer from spine to legs.

STUDY DESIGN: The superficial and deep lamina of the posterior layer of the thoracolumbar fascia have been studied anatomically and biomechanically. In embalmed human specimens, the posterior layer has been loaded by simulating the action of various muscles. The effect has been studied using raster photography. OBJECTIVES: To study the role of the posterior layer of the thoracolumbar fascia in load transfer between spine, pelvis, legs, and arms. SUMMARY OF BACKGROUND DATA: It has been determined whether muscles such as the gluteus maximus, latissimus dorsi, erector muscle, and biceps femoris are functionally coupled via the thoracolumbar fascia. The caudal relations of the posterior layer of the thoracolumbar fascia have not been previously studied. METHODS: Dissection was directed to the bilaminar posterior layer of the thoracolumbar fascia of 10 human specimens. The superficial and deep lamina were studied using visual inspection and raster photography. Tension to the posterior layer of the fascia was simulated by traction to various muscles and measured by studying the displacement in the posterior layer. RESULTS: Traction to a variety of muscles caused displacement of the posterior layer. This implies that in vivo, the superficial lamina will be tensed by contraction of various muscles, such as the latissimus dorsi, gluteus maximus and erector muscle, and the deep lamina by contraction of the biceps femoris. Caudal to the level of L4 (in some specimens, L2-L3), tension in the posterior layer was transmitted to the contralateral side. CONCLUSIONS: Anatomic structures normally described as hip, pelvic, and leg muscles interact with so-called arm and spinal muscles via the thoracolumbar fascia. This allows for effective load transfer between spine, pelvis, legs, and arms--an integrated system. Specific electromyographic studies should reveal whether the gluteus maximus muscle and contralateral latissimus dorsi muscle are functionally coupled, especially during rotation of the trunk. In that case, the combined action of these muscles assists in rotating the trunk, while simultaneously stabilizing the lower lumbar spine and sacroiliac joints.

Aged↗

PubMed1993

[Surgical treatment of rupture of the plantar fascia].

Among the various lesions of the hindfoot in athletes, plantar fascia ruptures are not well documented and their surgical treatment is not often reported in the literature. The purpose of the current work was to more precisely define therapeutic indications and to evaluate the results of the surgical treatment based on the excision-release of the plantar fascia. Between 1986 and 1991, 19 patients (5 females, 14 males, average age 32 years) were operated on by one surgeon. All patients were either recreational or competitive athletes. The plantar fascia rupture occurred 18 times during sports activity. Surgical treatment was indicated when pain persisted despite a well conducted conservative treatment. In 17 cases, MRI allowed to plan the operative strategy by showing the fascia lesion. The patients were operated after an average of 8 months following the initial injury (6-16 months). One patient was lost for follow-up, 2 had a follow-up below 6 months, thus 16 patients were available for analysis. The clinical outcome was evaluated through persistence of pain, return to sports, and functional activity. With a 16-month average follow-up (6-51 months) it was observed that pain constantly disappeared and that 11 patients over 16 returned to the same level of sports activity after 6 months with a time-stable result. After failure of a well conducted conservative treatment, surgical treatment of plantar fascia rupture must be proposed. Surgical technique is based not only on fascia release but also on the excision of the pathological scar tissue in order to avoid the restoration of the continuity of the fascia with the calcaneus.

Adult↗

PubMed1994

The use of autogenous fat, fascia, and nonvascularized muscle grafts in the head and neck.

We have reviewed the transplantation of autogenous fat, fascia, and nonvascularized muscle. Although none of these tissues satisfies all of the requirements for an ideal transplantation material, understanding the indications and each material's limitations will broaden the surgeon's armamentarium when soft-tissue grafting is desired. Although the use of autogenous fat grafts in head and neck surgery has been associated with some unpredictability, fat remains an excellent choice for obliteration of frontal sinuses, for myringoplasty, and for limited soft-tissue augmentation. In most applications, significant resorption of the transplanted fat can be expected, and it should be compensated for accordingly by initial overcorrection. Future research endeavors, including development of preadipocyte transplants and hormonal manipulation of fat grafts, will perhaps improve results of transplantation. The grafting of fascia has been shown to be a very reliable technique, especially when tensile strength is required of the transplant material. In grafts, fascia is much more predictable than fat, in that the majority of the fascia survives as living tissue that retains its original characteristics. A relative lack of three-dimensional bulk, however, limits the use of fascia in soft-tissue augmentation. The transplantation of nonvascularized muscle, because of its enormous metabolic requirements, almost always results in death of the muscle cells and subsequent partial replacement by fibrous tissue. Free muscle grafts therefore have very limited application, except in circumstances in which fibrous tissue obliteration of small defects (such as the nasofrontal duct or eustachian tube) is the desired result. In clinical situations in which maintenance of the substance or bulk of the transplanted material is of paramount importance, consideration should be given instead to the transfer of vascularized tissue. For this purpose, numerous simple and composite flaps of fascia, fat, muscle, and other tissues are now available. Vascularized tissue transfers are certainly not the solution to every reconstructive problem, however. When properly selected and applied, the transplantation of fat, fascia, and occasionally muscle remains an important option for soft-tissue replacement in head and neck surgery.

Adipose Tissue↗

PubMed1996

Myringoplasty: is molded collagen xenograft a valid alternative for fresh temporalis fascia?

Seventy four simple myringoplasties, 53 with xenograft and 21 with fresh temporalis fascia were reviewed. Closure rate for all cases was 90.5%. There were 3 surgical failures in xenografts and none in the fascia graft. Fifty two myringoplasties, 37 using xenograft and 15 using fascia graft, had a mean follow-up of 20 months and late perforations were seen in 4 of these cases. Three of the late reperforations occurred in xenografts, one in the fascia graft. Postoperative air bone gap was within 15 dB in 83.3% of the xenografts and in 66.7% of the fascia grafts. Recurring bouts of granular myringitis after 6 months were seen in 4 xenografts and in one fascia graft. Based on these results xenograft can be considered as an alternative for fresh fascia in easy to reach perforations operated "in speculo" when there is no need for an external incision.

Adolescent↗

PubMed1997

[Historical notes on anatomy of the transversalis fascia].

In the early 19th century, the tissue of the peritoneum was regarded as the duplicature of membrane. In the middle of the century, however, it was considered to be one of serous membranes, because histology had been developed. Between the peritoneum and the abdominal muscles, there are two fasciae, the subperitoneal and the transversalis fascia. But, Sir Astley Cooper reported that there was only the transversalis fascia, because he considered the subperitoneal fascia to be a double covering of the peritoneum, that is, a part of the duplicature of the peritoneum. In this century, Cooper's report has been interpreted through histology. Consequently, it is the general opinion that there is no other fascia than the transversalis fascia between the peritoneum and the abdominal muscles, in a view which disregards the subperitoneal fascia.

Anatomy↗

PubMed1982

Excision of underlying fascia with a primary malignant melanoma: effect on recurrence and survival rates.

Patients with stages O and I malignant melanomas of the trunk and proximal limbs, having had wide excisions only without lymph node dissections, were reviewed to determine whether the presence or absence of muscle fasciae correlated with prognosis. Prior to 1969 most patients seen at The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston with primary melanomas underwent wide excision of their lesions including muscle fasciae; however, after 1969 the fasciae were not resected in most patients. Records of 107 patients in whom fasciae were excised and 95 patients in whom fasciae were preserved, all with 5-year follow-up, were analyzed. Although a trend was present in favor of the patients in whom the fascia was removed (20% regional recurrence rate versus 25%), the incidence of subsequent recurrence, site of recurrence, and survival were not statistically different between the two groups. This review has not confirmed the hypothesis that the excision of muscle fasciae correlates with recurrence or survival in patients treated for primary malignant melanoma.

Adolescent↗

PubMed1983

[Experiences with solvent-dried fascia lata in surgical interventions in otorhinolaryngology].

Basing on our good experiences with dehydrated solvent-dried human dura we applied, during the last two years, dehydrated solvent-dried fascia lata in our clinic. Fascia lata is more flexible in comparison to the stiff dura. In 225 cases we collected experience with the new dehydrated solvent-dried human fascia lata: 103 patients with frontobasal fractures and rhinoliquorrhoea 83 patients with tympanoplastics for mastoid lining 5 patients with laterobasal fractures 11 patients with septum perforations 21 patients with blow-out fractures 2 patients with facial paralysis. Fascia lata was fixated by human fibrin adhesive. The dehydrated human solvent-dried fascia lata showed the same good results as the group of patients where we used autologous fascia lata.

Dura Mater↗