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At least 127 records · Page 7Linked to original sources
PubMed2005

Ramification pattern of the thenar branch of the median nerve entering the thenar fascia and the distribution of the terminal branches in the thenar musculature: Anatomic cadaver study in 144 hands.

Knowledge of the anatomy of the median nerve is important in surgery of the palmar aspect of the hand. The purpose of our study was to investigate the ramification pattern of the thenar branch before entering the thenar fascia and the distribution of the terminal branches in the thenar musculature. The observations were carried out on 144 hands of 74 dissecting room cadavers. According to the number of the thenar branches entering the thenar fascia we classified our specimens into four types. In 121 hands (84%, Group I) the thenar branch piercing the thenar fascia was a single trunk. In 19 hands (13.2%, Group II) two branches; in three (2.1%; Group III), three branches; and in one hand (0.7%; Group IV), four branches were identified entering the thenar fascia. Accessory thenar nerve was found in 8.3% of hands. The further division of each branch to its terminal branches was investigated in detail. Our results show that the more the number of thenar branches entering the thenar fascia, the less the terminal branching. Because more than one branch was seen in 16% of the specimens, meticulous dissection is required for preventing injury of the thenar branches before entering the thenar fascia.

Aged↗
PubMed2006

The influence of athletic activity on the plantar fascia in healthy young adults.

PURPOSE: Complaints deriving from the plantar fascia are relatively common in athletes. This study aimed to investigate the changes of thickness of plantar fascia via sonography in healthy young adults with different levels of activity. PATIENTS AND METHODS: One hundred ten adults with normal body mass index were separated into three groups according to activity level: sedentary (group 1, n = 50), athletic activity less than 7 hours per week (group 2, n = 30), and athletic activity 7 or more hours per week (group 3, n = 30). The thicknesses of the plantar fascia at origin and at a point 5 mm distal to origin were measured via sonography. RESULTS: The mean values of the thickness of the proximal plantar fascia (PFp) and the distal plantar fascia (PFd) in group 1 were similar to those of groups 2 and 3 (p > 0.05). The mean values of PFp and PFd were significantly higher in men than in women (p < 0.05). The mean values of PFp and PFd were similar in left and right feet (p > 0.05). There were moderate positive correlations between PFp and weight, height, and body mass index but no correlation between PFp and amount of athletic activity. CONCLUSIONS: The thickness of the plantar fascia at origin did not change with athletic activity at the amateur level.

Adult↗
PubMed1993

Anterolateral thoracic fascia: an anatomic and surgical entity.

This anatomic study, based on six subjects, is aimed at a better description of the anterolateral thoracic fascia, not previously studied in its entirety. The literature describes a fascia of the pectoralis major m. continuous with that of the serratus anterior m., starting at the lateral border of the pectoralis major or pre-pectoral. The upper limits have never been studied and the lower limits are ill-defined, the aponeurosis of the pectoralis major or the pre-pectoral fascia being continuous with that of the rectus abdominis m. It is shown that this fascia, from a retropectoral origin, extends to the base of the axilla above and is stretched as bridge between the pectoralis major and latissimus dorsi mm. and the muscles of the anterolateral wall of the abdomen. This fascia has some surgical importance as a plane of coverage in the protection of mammary implants. The lack of concordance with classical anatomic accounts, the histology and the vascularisation of this fascia call for complementary studies.

Dissection↗
PubMed1999

The surgical anatomy of the fasciae and the fascial spaces related to the rectum.

The perirectal fasciae and their vascular and neural relationships were studied based on the dissection of 46 fresh cadavers. The rectal fascia is a tubular sleeve, areolar in nature, which houses the superior rectal vessels and lymphatics. The nerves which supply fibres to the pelvic plexus run close to the rectum, contained in the urogenital and presacral fasciae. The rectum is attached to these two fasciae by the rectal stalks, which take a spiral course round the rectum, being posterolateral in the upper rectum, lateral in the mid-rectum and anterolateral in the lower rectum. During rectal resection the pelvic nn. may be preserved if the rectal dissection proceeds close to the rectal fascia. After cutting the rectal insertion of the presacral fascia, the lower rectal stalks (paraproctium) come into direct view and can be divided close to the rectal wall with no risk of damage to the pelvic plexus.

Fascia↗
PubMed2005

Morphology of the suburethral pubocervical fascia in women with stress urinary incontinence: a comparison of histologic and MRI findings.

To correlate MRI with histologic findings of the suburethral pubocervical fascia in women with urodynamic stress incontinence. Thirty-one women with urodynamically proven stress urinary incontinence without relevant prolapse underwent preoperative MRI. Tissue specimens obtained from the pubocervical fascia were examined immunohistochemically (types I and III collagen, smooth muscle actin) and the results compared with the MRI findings. MRI demonstrated an intact pubocervical fascia in 61.3% of the cases and a fascial defect in 38.7%. A fascial defect demonstrated by MRI was associated with a decrease in actin (P<0.09) and an increase in collagen III (P<0.01) compared to an intact fascia. In women with stress urinary incontinence, smooth muscle actin in the pubocervical fascia is decreased, changed in structure, and replaced by type III collagen. MRI allows evaluation of the pubocervical fascia and its morphologic changes.

Actins↗
PubMed2007

Comparative analysis of urinary incontinence severity after autologous fascia pubovaginal sling, pubovaginal sling and tension-free vaginal tape.

PURPOSE: Autologous fascia, Pelvicol implant and polypropylene are common materials used in suburethral anti-incontinence procedures. We explored the relative effectiveness of the autologous fascia pubovaginal sling, Pelvicol pubovaginal sling and Gynecare TVT on self-reported postoperative urinary incontinence. MATERIALS AND METHODS: The study was a mailed cross-sectional survey of health related quality of life 1 to 3 years after suburethral anti-incontinence surgery performed at our institution. The Incontinence Symptom Index was used to assess the presence and severity of urinary incontinence symptoms and the Incontinence Impact Questionnaire-7 was used to assess impairment. Regression models were developed to identify factors with an independent effect on the presence, severity and impairment of urinary incontinence symptoms. RESULTS: The questionnaire was returned by 69% of eligible respondents (173 of 250). Those with previous incontinence surgery (OR 11.0, 95% CI 2.3-51.4) and medical comorbidities (OR 1.6, 95% CI 1.1-2.2) were more likely to report urinary incontinence symptoms, ie incontinence symptom index greater than 0. Symptom severity, which was analyzed only in respondents with urinary incontinence symptoms, was greater in the Pelvicol than in the autologous fascia pubovaginal sling and TVT groups (each p <0.01). No significant difference was observed between the TVT and autologous fascia pubovaginal sling groups (p = 0.15). Also associated with higher urinary incontinence symptom severity scores were body mass index (p = 0.03), a history of incontinence surgery (p = 0.01) and lower education (p <0.01). Impairment from urinary incontinence, as assessed by the Incontinence Impact Questionnaire-7, was associated with body mass index, severe depression and current smoking (each p = 0.01) but not with surgical treatment group. CONCLUSIONS: Women who received an autologous fascia pubovaginal sling or TVT reported lower symptom severity scores than those who had a Pelvicol pubovaginal sling. Impairment was not associated with procedure type. These findings suggest better outcomes with autologous fascia pubovaginal sling and TVT. Randomized, controlled trials are needed to confirm these findings.

Cross-Sectional Studies↗
PubMed2002

Reconstruction of diaphragm using autologous fascia lata: an experimental study in dogs.

BACKGROUND: We investigated whether fascia lata is an appropriate material for reconstruction of the diaphragm. METHODS: A diaphragmatic defect (2 cm by 5 cm) was reconstructed with a patch of autologous fascia lata in the experimental group (n = 12) and with expanded polytetrafluoroethylene in the control group (n = 12). Maximal tensile strength at the sutured region was measured serially. RESULTS: The maximal tensile strength at the sutured region reconstructed with the fascia lata was 1.14 +/- 0.50 kgf 15 days and 2.04 +/- 0.94 kgf 30 days after operation. The values were higher than those of expanded polytetrafluoroethylene (p < 0.0001). These values of fascia lata were close to the original maximal tensile strength of the muscular region of the diaphragm (1.52 to 1.66 kgf). CONCLUSIONS: Reconstruction of diaphragm using autologous fascia lata is safe, easy, and inexpensive, and provides smooth wound healing. The only disadvantage is the necessity of a femoral incision for harvest; nevertheless, it may be worthwhile to use fascia lata in clinical trials to further assess its suitability as a reconstruction material.

Animals↗
PubMed2002

Stress analysis of the standing foot following surgical plantar fascia release.

Plantar fascia release is a surgical alternative for patients who suffer chronic heel pain due to plantar fasciitis and are unaffected by conservative treatment. A computational (finite element) model for analysis of the structural behavior of the human foot during standing was utilized to investigate the biomechanical effects of releasing the plantar fascia. The model integrates a system of five planar structures in the directions of the foot rays. It was built according to accurate geometric data of MRI, and includes linear and non-linear elements that represent bony, cartilaginous, ligamentous and fatty tissues. The model was successfully validated by comparing its resultant ground reactions with foot-ground pressure measurements and its predicted displacements with those observed in radiological tests. Simulation of plantar fascia release (partial or total) was accomplished by gradually removing parts of the fascia in the model. The results showed that total fascia release causes extensive arch deformation during standing, which is greater than normal deformation by more than 2.5mm. Tension stresses carried by the long plantar ligaments increased significantly, and may exceed the normal average stress by more than 200%. Since the contribution of the plantar fascia to the foot's load-bearing ability is of major importance, its release must be very carefully considered, and the present model may be used to help surgeons decide upon the desired degree of release.

Computer Simulation↗
PubMed1998

Pubovaginal sling using cadaveric allograft fascia for the treatment of intrinsic sphincter deficiency.

PURPOSE: Pubovaginal sling is the definitive management of female stress urinary incontinence due to intrinsic sphincter deficiency. Customarily, autologous fascia has been used, although synthetic material has its proponents. Harvesting autologous fascia at surgery is associated with postoperative discomfort, and synthetic material has a history of infection and erosion. To assess whether allograft fascia is free from these drawbacks, we retrospectively compared the outcome of women undergoing pubovaginal sling using either autologous or cadaveric allograft fascia. MATERIALS AND METHODS: We reviewed our experience during the last 28 months with patients treated with the pubovaginal sling for intrinsic sphincter deficiency. All patients underwent preoperative video urodynamics. The outcome was assessed using the SEAPI scoring system. Special attention was devoted to local sling tolerance. Operative time and length of hospital stay were compared between patients with allograft and autograft pubovaginal sling. RESULTS: A total of 92 women (mean age 60 years) underwent allograft (59) or autograft (33) pubovaginal sling. Preoperative parameters, such as percent of patients who had had previous incontinence surgery, mean leak point pressure and SEAPI incontinence score, were similar in both populations. Mean followup was 11.5 months (range 1 to 28) for the overall population. The SEAPI scoring system showed that patients were markedly improved, with no significant difference between the allograft and autograft groups. Allograft and autograft pubovaginal slings were equally well tolerated, and no infection or erosion was encountered. Mean operative time and hospital stay were significantly shorter when using allograft compared to autograft fascia. CONCLUSIONS: The success rates of allograft and autograft pubovaginal sling were equally high, and no complications related to the cadaveric origin of the allograft fascia were observed. Allograft pubovaginal sling was well tolerated, and its use significantly shortened operative time and hospital stay.

Adolescent↗
PubMed2001

Histologic examination of "fascia" used in colporrhaphy.

OBJECTIVE: To perform a histologic examination of tissue identified as fascia and used during colporrhaphy. METHODS: In patients undergoing primary anterior and posterior colporrhaphy, biopsies were taken from three surgically distinct vaginal tissues types: the wall, the "fascia," and areolar tissue. The biopsies were placed in formalin, identified numerically, and sent to pathology for staining with hematoxylin-eosin, Masson trichrome for collagen, Movat for elastin, and immunoperoxidase stain for actin in smooth muscle. Simultaneous photographs were taken of the biopsy sites. The histologic diagnosis was compared with the surgical diagnosis. RESULTS: A total of 60 samples were taken from five women. The specimens from two of these patients were disqualified. The pathologist made the following histologic diagnosis for each type of surgical specimen: vaginal wall, mucosa and underlying connective tissue; fascia, moderately dense connective tissue with smooth muscle; areolar tissue, loose connective tissue. The histologic appearance of the "fascia" was indistinguishable from the deeper aspects of the vaginal wall. It was composed of the same proportions of smooth muscle, elastin, and collagen. Using the histologic appearance as the "gold standard," the accuracy of the surgical diagnosis was: "vaginal wall," 12 of 12 (100%); "fascia," seven of 12 (58%); and "areolar tissue," eight of 12 (67%). CONCLUSIONS: The surgical "fascia" used during colporrhaphy consists of moderately dense connective tissue with smooth muscle similar to the deep aspects of the vaginal wall, is the same in both the anterior and posterior compartments, and is an artifact of the surgical dissection used to separate the vaginal wall from the underlying organs.

Biopsy↗
PubMed1997

High leg incision fascia lata harvesting.

OBJECTIVE: The traditional method of harvesting fascia lata has been through an incision above the lateral knee. Problems with this method include a conspicuous scar, herniation of the muscle belly, and hematoma formation. The authors describe a new method of harvesting fascia lata in the region of the hip to minimize these complications. DESIGN: Cohort study. PARTICIPANTS: Twenty-three patients underwent harvesting of fascia lata by the technique described by the authors. Twenty-one patients had ptosis with poor levator function. In two patients, the fascia lata was used to wrap a hydroxyapatite implant. INTERVENTION: The technique for harvesting fascia lata through an incision between the greater trochanter and anterior iliac crest is described. Long-term results were collected from chart reviews and patient interviews after surgery. MAIN OUTCOME MEASURES: The patients were evaluated to determine whether any complications resulted from the new incision site. RESULTS: No permanent complications were noted at the incision site. CONCLUSIONS: Fascia lata can be harvested safely in the region of the iliac crest with an inconspicuous scar and with fewer complications than with the more traditional site slightly above the lateral knee.

Adolescent↗
PubMed2001

Mersilene mesh sling as an alternative to autogenous fascia lata in the management of ptosis.

PURPOSE: To evaluate the use of Mersilene mesh as a brow suspensory material and to compare it clinically against autogenous fascia lata. METHODS: A prospective study was carried out in which 80 eyes of 56 patients with ptosis and absent, poor or abnormal levator function were operated on. The patients were divided into two groups. In 46 eyes of 32 patients Mersilene mesh was used and in 34 eyes of 24 patients autogenous fascia lata was used. The results were recorded and analysed. RESULTS: The age range for the Mersilene group was larger than for the fascia lata group and female patients preferred Mersilene over fascia lata. The improvement in lid height was significant in all cases in both groups. The complication rates were similar in the two groups and the mesh was well tolerated by the patients. No cases of infection, sling exposure or extrusion occurred with the use of Mersilene. Lid lag and lagophthalmos occurred as a complication of the procedure itself and not the type of the sling material. The mean follow-up period was 33.8 months for both groups. CONCLUSION: We believe that Mersilene mesh is an effective alternative to autogenous fascia lata when the use of fascia lata is felt inappropriate.

Adolescent↗
PubMed1999

Preserved particulate fascia lata for injection: a new alternative.

BACKGROUND: Preserved particulate fascia lata, derived from screened human cadavers, has recently become available. This injectable form of the material can be injected when soft tissue augmentation is desired. Historically, preserved fascia grafts have proven efficacy and an excellent safety record over the past 73 years. OBJECTIVE: To examine the clinical response to preserved fascia lata injections in human subjects. METHODS: Clinical subjects (N = 81; 74 women, 7 men, age range 19-56 years) requiring deep, soft tissue augmentation to repair various cosmetic deficiencies were injected with a total of 109 syringes of preserved particulate fascia lata. Three different preparations-<2.0 mm, <0.5 mm, and <0.25 mm particle sizes-were hydrated in 3-5 cc of 0.3% lidocaine solution and injected with needles ranging in size from 16 to 25 gauge. RESULTS: The patients were followed for 6-9 months after implantation without incidence of infections, allergic reactions, or acute rejection. After the treatment day, patients experienced no further discomfort. No dermal inflammation was evident and the local echymosis associated with injections was typically minor. Soft tissue augmentation was evident 3-4 months after grafting or longer in most cases. CONCLUSIONS: This patient series indicates that injectable preparations of preserved fascia lata have the same high biocompatibility as experienced with whole-tissue implants. The safety record of preserved fascia lata implants is reviewed.

Adult↗
PubMed2002

MR imaging of abnormalities of the plantar fascia.

Foot pain and disability may curtail the performance of simple routine tasks, work-related duties, and athletic activities. Disorders of the plantar fascia are commonly encountered in the diagnostic evaluation of subcalcaneal heel pain. The approach to imaging the ankle and foot has undergone significant amendment with the introduction of magnetic resonance (MR) imaging. MR imaging allows direct visualization of the plantar fascia and permits a comprehensive evaluation of a wide spectrum of disorders involving the fascia and perifascial structures, including bones, ligaments, musculotendinous units, and intrinsic muscles of the foot. The objectives of our cadaveric and clinical study are to describe the normal MR imaging appearance of the plantar fascia and analyze the signal intensity changes in the fascia and perifascial tissue with conventional MR imaging in symptomatic patients. We present a brief overview of common disease processes involving the plantar fascia that may prove practical for routine imaging evaluation of patients with suspected pathology.

Adult↗
PubMed2003

Experimental fascial flap model in the dog: free flap of the dorsal thoracic fascia.

For years, various types of fascial flaps have been used in clinical practice; however, there are many unanswered questions regarding their basic physiology, anatomy and histopathologic changes occurring after transfer. Simple and reliable flap models are needed to investigate these questions, but very few of these flap models have been described in experimental animals to date. The purpose of this study was to describe a new reliable fascia flap model in the dog-the dorsal thoracic fascia flap. This fascia is defined as the anatomic layer that contains the blood supply to the scapular and parascapular fasciocutaneous flaps. Fourteen adult dogs were used in this experiment. The vascular anatomy of the dorsal thoracic fascia was studied by anatomic dissection and microangiography. Anatomic dissection revealed that the main axial vessel supplying the dorsal thoracic fascia was the superficial branch of the thoracodorsal vessel. Based on the vascular pedicle, fascia flaps generally measuring 15 x 24 cm were created. At gross observation, all of these large flaps based solely on the vascular pedicle were observed to be well-perfused. Microangiographic examination revealed the intense vascularity of the superficial branches of the thoracodorsal vessels in the whole area of all flaps. It was concluded that this is a simple and reliable fascial flap model which can be prepared as a free or pedicled flap. It has a consistent, long vascular pedicle with large vessel diameters supporting a large fascial flap.

Animals↗
PubMed2000

The fate of rectus fascia suburethral slings.

OBJECTIVE: Autologous rectus fascia is commonly used to construct suburethral slings for the treatment of genuine stress incontinence. This fascia performs well and has not been associated with clinical problems related to its choice as a sling material. However, the histologic appearance of such slings after implantation has not been documented. STUDY DESIGN: At the time of revision of autologous rectus fascia suburethral slings in 5 patients, biopsy specimens of the slings were obtained and submitted for histologic examination. A specimen of rectus fascia before implantation was also obtained from a sixth patient who had no symptoms. RESULTS: After implantation autologous rectus fascia slings remain viable. There is fibroblast proliferation, neovascularization, and remodeling of the graft. No evidence of inflammatory reaction or of graft degeneration was detected. A linear orientation of connective tissue and fibroblasts was seen in some areas, whereas other areas had remodeled to form tissue similar to noninflammatory scar. CONCLUSION: Autologous rectus fascia slings undergo extensive remodeling after implantation.

Aged↗
PubMed1984

Surgical anatomy of the upper eyelid fascia.

There is a network of fascia in the upper eyelid that serves to transmit and distribute the motor power of the levator palpebrae muscle to the superficial tissues. The architecture of this network was studied intraoperatively. The results demonstrate that there is a superficial fascia under the orbicularis muscle which fuses with the levator aponeurosis at the level of the lid fold. Below the fold, these fascia remain fused or "conjoined." Thus, the fold in the upper eyelid reflects the union of fascia occurring internally and dose not result simply from the levator aponeurosis inserting into the skin. This article describes the anatomy and surgical identification of the upper eyelid fascia. I contend that the fascia constitutes an important internal framework for the upper eyelid, shaping the lid fold while elevating the tarsal plate in perfect synchrony. For the surgeon, visualizing the fascial architecture is a great aid in the correction of a variety of difficult eyelid deformities.

Asian People↗
PubMed1992

Characteristics of prosthetic mesh and autogenous fascia in abdominal wall reconstruction after prolonged implantation.

This study evaluated two types of prosthetic mesh and autogenous fascia in long-term abdominal wall reconstruction for rats. Marlex mesh, Gore-Tex patch, and autogenous fascia were implanted and left in place for 1 year. Materials were removed and evaluated using tensile strength of the material, tensile strength of the suture line, and adhesions. No change in the tensile strength of any of the materials were found at 1 year follow-up. Tensile strengths were significantly greater for Gore-Tex patch and Marlex mesh than the autogenous fascia. The Marlex mesh, however, had a weak and a strong tensile strength direction. These were significantly different (p < 0.05). Suture line tensile strength was greater for autogenous fascia and Marlex mesh than it was for the Gore-Tex patch, which was significantly weaker (p < 0.05). The greatest number of adhesions were seen in the Marlex mesh group. No significant difference was present in adhesions between Gore-Tex patch and autogenous fascia. In summary, autogenous fascia showed virtually no adhesions and good suture line strength. While it was the weakest of the three materials examined, the strength was still within the normal range and adequate for abdominal wall reconstruction.

Abdominal Muscles↗