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PubMed2006

[Values of color Doppler flow imaging and imaging changes of breast fascia and ligament in differential diagnosis of small breast neoplasms].

BACKGROUND & OBJECTIVE: Color Doppler flow imaging (CDFI) has been widely applied to the diagnosis of breast neoplasms. But combined use of CDFI and imaging changes of breast fascia and ligament (superficial and deep fascia, and Cooper's ligament) on the differential diagnosis of small breast neoplasms (< or =2 cm) has rarely been reported. This study was to explore the value of combined use of CDFI and imaging changes of breast fascia and ligament in differential diagnosis of small breast neoplasms. METHODS: CDFI was performed on 110 patients with small breast neoplasms. Among them, 52 cases were diagnosed to be benign by pathologic examination after surgery, while the rest 58 were malignant. The blood flow and Doppler image inside and around the breast lesions were analyzed. Four grades were classified according to blood flow imaging. The infiltration of breast fascia and ligament was also considered. The CDFI result was compared with that of pathologic examination. RESULTS: The correct diagnosis rates of CDFI in diagnosing benign and malignant small breast neoplasms were 90.4% and 84.5%, respectively. The false-positive and false-negative rates of CDFI were 9.6% and 15.5%, respectively. There were obvious differences in blood flow grading, systolic maximum velocity (V(max)), resistance index (RI), and imaging changes of superficial, deep fascia and Cooper's ligament between benign and malignant small breast neoplasms. CONCLUSION: Combination of CDFI with imaging changes of breast fascia and ligament is valuable in clinical diagnosis and differential diagnosis of small breast neoplasms.

Adolescent↗
PubMed1990

Anatomy of the orbital fasciae and the third eyelid in dogs.

The connective tissue structures commonly referred to as the periorbita, orbital septum, muscular fasciae, and vagina bulbi or collectively, as the orbital fasciae were dissected then illustrated and described. Two sheets (layers) of the periorbita (endorbita) were found in our dogs. The periorbita should be renamed endorbita because of its anatomic relations. The periorbita did not always fuse with the periosteum of frontal and sphenoid bones. Rather, the periorbita and the periosteum were often distinct and separate; only medioventrally did several fibrous bands unite the superficial sheet of the endorbita with the periosteum. Two layers of the endorbita fused with the periosteum of the margin of the bony orbit and with the orbital ligament. The muscular fasciae were divided into 3 layers. The superficial layer extended caudally from the orbital septum, was thick, and was pierced by arteries, veins, and nerves. The middle layer was attached to the sclerocorneal junction and, at the temporal canthus of the eye, was divided into superficial and deep sheets. The deep portion was attached to the lateral angle of the third eyelid, similar to a strong ligament. The deep layer of the muscular fasciae extended caudally from the sclerocorneal junction in intimate contact with recti and oblique muscles of the eyeball. The deep portion of the deep muscular fascia covered the deep surface of all recti muscles and separated them from the retractor bulbi muscle. Intermuscular septa were observed between middle and deep muscular fascia layers.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1979

[Fascia canals of the greater sciatic foramen and their practical importance].

Fasciae and fat tissue spaces in the gluteal region, topography of the suprapiriform and infrapiriform foramina have been studied by means of a complex anatomical experimental technique. The suprapiriform foramen should be considered as a fascialosseous canal, as it is 4-4.5 cm long and 0.6-1.0 cm wide. It is formed by the upper margin of the greater sciatic notch covered with a thin fascia, fasciae of the gluteal and piriform muscles and the parietal layer of the pelvic fascia. The proper fascial vaginae of the upper gluteal vessels and nerves are adhered to fascial walls of the canal. This peculiarity is used for the method of ligation of the superior gluteal artery within the limits of the suprapiriform canal. The infrapiriform foramen is either narrow or wide enough (up to 2.0 cm in diameter). Inferior gluteal vessels at the level of the sacrospinous ligament go from the parietal layer of the pelvic fascia into the duplicature of the deeper layer of musculus gluteus maximus. The inferior gluteal nerve, above the lower margin of the piriform muscle, ajoining the vessels gets into the fissure of the parietal layer of the pelvic fascia, under the lower margin neurovascular fasciculus also goes through the fissure of the pelvic fascial parietal layer, downward and parallel to the inferior gluteal vessels. The knowledge of possible ways of connections through the canals of the greater sciatic foramen, fat tissue spaces at the subperitoneal level of the small pelvis and the gluteal region is of great practical value.

Buttocks↗
PubMed1981

Biochemical changes in the collagen of the palmar fascia in patients with Dupuytren's disease.

The palmar fascial tissues of more than 400 patients with Dupuytren's disease were studied biochemically and compared with normal tissue obtained from more than 100 patients who were undergoing hand surgery for other reasons. No alterations of the molecular structure or the state of macromolecular aggregation of the collagen in Dupuytren's disease were detected by wide or low-angle x-ray diffraction studies or by transmission electron microscopy. Major biochemical changes in the palmar fascia affected by Dupuytren's disease included increased collagen and hexosamine contents and the presence of galactosamine in the most severely involved tissue. Type-III collagen, which is virtually absent from normal adult palmar fascia, was abundant in the tissue of patients with Dupuytren's disease. Post-translational modifications included a very elevated hydroxylysine content, an increase in the total number of reducible cross-links, and the appearance of hydroxylysinohydroxynorleucine (virtually absent from normal palmar fascia) as the major reducible cross-link. Even palmar fascia from patients with Dupuytren's disease that appeared grossly and histologically normal showed the same biochemical changes, albeit to a lesser extent. All of these biochemical changes are similar to those that occur during the active stages of connective-tissue wound repair. This includes the rapid synthesis and turnover of collagen which leads to newly synthesized, immature collagen being more abundant in the involved tissue than in normal tissue. There is no evidence that the gross, macroscopic contracture of the palmar fascia in Dupuytren's disease is due to shortening, plication, or contraction of the collagen fibrils or fibers present in the tissue at the onset of the disease or synthesized during its development. Instead, we propose that the gross contracture (shortening) of the palmar fascia in Dupuytren's disease is due to an active cellular process that progressively draws the distal extremities of the affected tissue closer together at the same time that the original tissue is being replaced. The result of these two processes is simply a shorter, smaller piece of tissue fabric containing collagen molecules, fibrils, and fibers of normal length and organization, but with pretranslational and posttranslational modifications similar to those observed in collagens during the active stages of connective-tissue repair in general.

Adult↗
PubMed1975

Crossed pathways from the entorhinal area to the fascia dentata. II. Provokable in rats.

In the rat thhe perforant pathways from the entorhinal area normally innervate the fascia dentata only ipsilaterally. However, unilateral ablation of the entorhinal area (deentorhination) induces the formation of an anomalous crossed projection from the intact contralateral entorhinal area to the septal portion of the deafferented fascia dentata. After deentorhination of rats aged 1-30 days the organization of this projection was analyzed (a) by producing secondary lesions in the intact entorhinal area of perforant paths and observing the results anterograde degeneration with Fink-Heimer silver impregnation techniques, and (b) by staining with Timm's sulfide silver method whichmakes the terminal fields of afferent systems stand out in different tones of colors. Both methods showed the crossed entorhino-dentate projection to consist of two separable components. They were named the crossed medial perforant path and the crossed lateral perforant path, corresponding to their similarity in origin, dendritic localization of termination and Timm stainability to the ordinary, uncrossed medial and the lateral perforant pathways (MPP and LPP) which arise in the medial and lateral parts of the entorhinal cortex, respectively. Similarly induced crossed projections were demonstrated to the subcallosal continuation of fascia dentata, the fasciola cinerea. The heaviest terminal field of the crossed entorhino-dentate projection which was found in the most rostral and medial parts of the deafferented fascia dentata correlated with a lack of expected aberrant extension into theMPP and LPP terminal zones of commissural and ipsilateral hippocampodentate fibers. In Fink-Heimer preparations there was little variation in the distribution of the aberrant crossed sustems over the range of ages studied although the chronic operations performed earliest postnatally (5 days) tended to produce the heaviest representation. This latter observation appeared consistent with changes in the Timm staining pattern of the deafferented fascia dentata, since with an increase in age at the primary lesion from 5 to 14 days there was no increase in the spread into the fascia dentata of Timm stainable axon ter minals from CA3, interpreted as a sign of fewer crossed entorhinal afferents succeeding in a presumable competition with the CA3-derived system for available terminal space.

Age Factors↗
PubMed2006

Operating behind Denonvilliers' fascia for reliable preservation of urogenital autonomic nerves in total mesorectal excision: a histologic study using cadaveric specimens, including a surgical experiment using fresh cadaveric models.

PURPOSE: Little is known about which urogenital nerves are liable to be injured along surgical planes in front of or behind Denonvilliers' fascia. METHODS AND RESULTS: Using semiserial histology for five fixed male pelves, we demonstrated that: 1) left/right communicating branches of bilateral pelvic plexuses run immediately in front of Denonvilliers' fascia; and 2) a lateral continuation of Denonvilliers' fascia separates the urogenital neurovascular bundle from the mesorectum. Notably, the mesorectum contains no or few extramural ganglion cells. At the level of the seminal vesicles, incision in front of Denonvilliers' fascia seems likely to injure superior parts of the pelvic plexus and the left/right communication. Moreover, at the prostate level, this incision misleads the surgical plane into the neurovascular bundle. Fresh cadaveric dissections of five unfixed male pelves confirmed that the surgical plane in front of Denonvilliers' fascia continues to a fascial space for the pelvic plexus containing ganglion cell clusters lateral and/or inferior to the seminal vesicles. CONCLUSIONS: To preserve all autonomic nerves for urogenital function, optimal total mesorectal excision for rectal cancer requires dissection behind Denonvilliers' fascia.

Aged↗
PubMed1980

Trajectory of contralateral entorhinal axons which reinnervate the fascia dentata of the rat following ipsilateral entorhinal lesions.

Unilateral destruction of the entorhinal area in the rat results in the proliferation of a pathway from the surviving contralateral entorhinal area to the fascia dentata denervated by the lesions (the crossed temporodentate pathway). The present study analyzes the point of entry of these reinnervating fibers into the fascia dentata, and their trajectory within the reinnervated zones utilizing orthograde transport of tritiated proline or horseradish peroxidase (HRP). Following injections of tritiated proline or HRP into the surviving entorhinal area in animals with long standing unilateral entorhinal lesions labeled axons could be visualized entering the contralateral fascia dentata via two routes. Labeled fibers could be traced from the dorsal hippocampal commissure (the dorsal psalterium) into the rostral tip of the fascia dentata (the fasciola cinerea) and from the terminal field of the crossed temporo-ammonic tract in regio superior into adjacent portions of the stratum moleculare of the fascia dentata. Within the stratum moleculare, most of the labeled axons had predominantly a caudal and lateral orientation. Exceptions to this predominant trajectory were found in the case of some of the axons which entered the ventral blade of the rostral fascia dentata, and coursed laterally from their point of entry. Comparisons of the trajectory of the crossed temporodentate projections with that of the normal ipsilateral pathway indicated that while the predominant trajectory of the fibers was roughly comparable, the polarity of the projections was in part opposite. Specifically, the normal ipsilateral pathway travels in a caudorostral direction, while the majority of fibers of the crossed temporodentate pathway apparently project rostrocaudally. The significance of this difference in the pattern of innervation is discussed with respect to the normal functioning of the temporodentate circuitry.

Animals↗
PubMed2006

Consequences of partial and total plantar fascia release: a finite element study.

BACKGROUND: Plantar fasciotomy, a common operative procedure to relieve chronic heel pain, has been suggested to decrease foot arch stability. A systematic evaluation of the biomechanical consequences of partial or total plantar fascia release is essential to the understanding of the biomechanical rationale behind these operative procedures. METHODS: A geometrical detailed three-dimensional (3-D) finite element (FE) model of the human foot and ankle, incorporating geometrical and contact nonlinearities, was constructed by 3-D reconstruction of MR images. Partial and complete plantar fascia releases were simulated to evaluate the corresponding biomechanical effects on load distribution of the bony, ligamentous, and encapsulated soft-tissue structures. RESULTS: Partial and total plantar fascia release may decrease arch height but did not necessarily cause total collapse of the foot arch even with additional dissection of the long plantar ligament. Operative release of the plantar fascia was compromised by increased strains of the plantar ligaments and intensified stress in the midfoot and metatarsal bones. Load redistribution among the centralized metatarsal bones and focal stress relief at the calcaneal insertion were predicted with different types of fasciotomy. CONCLUSIONS: The FE model suggested that plantar fascia release may provide relief of focal stress and therefore could relieve associated heel pain. However, these operative procedures may pose a risk to arch stability and clinically may produce dorsolateral midfoot pain. The initial strategy for treating plantar fasciitis should be nonoperative. If surgery is necessary, partial release of less than 40% of the fascia is recommended to minimize the effect on arch instability and maintain normal foot biomechanics.

Adult↗
PubMed1981

A biochemical dissection of the cardiac intercalated disk: isolation of subcellular fractions containing fascia adherentes and gap junctions.

In view of our limited knowledge of the biochemical composition of intercellular junctions, a method was developed for the preparation from rats and mice of plasma membranes containing cardiac intercalated disks. When these membranes were extracted with detergents, e.g. N-lauryl sarcosinate or deoxycholate, the detergent-insoluble material contained structures derived mainly from fascia adherentes junctions, but a few gap junctions and maculae adherentes were also present. When the detergent extraction was carried out at an alkaline pH, the maculae adherentes junctions were dissolved. Fractionation of the detergent-insoluble extract on a sucrose gradient yielded a fraction containing fascia adherentes junction of density 1.20-1.26 g/cm3. Gap junctions banded at a lower density, 1.16-1.20 g/cm3. Polyacrylamide gel electrophoresis showed that the major polypeptide bands in the fascia adherentes-enriched fraction were of molecular weights 134000, 108000, 62-64000, 58000, 47000 and 43000. Although fractions with the gap junctions were contaminated by fascia adherentes junctions, the major polypeptides were calculated by subtraction to be of mol. wt 37000, 26000 and 19000. Two glycoproteins corresponding to minor polypeptides visualized by Coomassie Blue staining were present in the fascia adherentes fraction. Comparison of the fascia adherentes-enriched fraction with a Z-disc fraction prepared from rabbit hearts indicated a different morphology and polypeptide composition.

Animals↗
PubMed2006

Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up.

BACKGROUND: In a previous investigation, eighty-two patients with chronic proximal plantar fasciitis for a duration of more than ten months completed a randomized, prospective clinical trial. The patients received instructions for either a plantar fascia-stretching protocol or an Achilles tendon-stretching protocol and were evaluated after eight weeks. Substantial differences were noted in favor of the group managed with the plantar fascia-stretching program. The goal of this two-year follow-up study was to evaluate the long-term outcomes of the plantar fascia-stretching protocol in patients with chronic plantar fasciitis. METHODS: Phase one of the clinical trial concluded at eight weeks. At the eight-week follow-up evaluation, all patients were instructed in the plantar fascia-stretching protocol. At the two-year follow-up evaluation, a questionnaire consisting of the pain subscale of the Foot Function Index and an outcome survey related to pain, function, and satisfaction with treatment was mailed to the eighty-two subjects who had completed the initial clinical trial. Data were analyzed with use of a mixed-model analysis of covariance for each outcome of interest. RESULTS: Complete data sets were obtained from sixty-six patients. The two-year follow-up results showed marked improvement for all patients after implementation of the plantar fascia-stretching exercises, with an especially high rate of improvement for those in the original group treated with the Achilles tendon-stretching program. In contrast to the eight-week results, the two-year results showed no significant differences between the groups with regard to the worst pain or pain with first steps in the morning. Descriptive analysis of the data showed that 92% (sixty-one) of the sixty-six patients reported total satisfaction or satisfaction with minor reservations. Fifty-one patients (77%) reported no limitation in recreational activities, and sixty-two (94%) reported a decrease in pain. Only sixteen of the sixty-six patients reported the need to seek treatment by a clinician. CONCLUSIONS: This study supports the use of the tissue-specific plantar fascia-stretching protocol as the key component of treatment for chronic plantar fasciitis. Long-term benefits of the stretch include a marked decrease in pain and functional limitations and a high rate of satisfaction. This approach can provide the health-care practitioner with an effective, inexpensive, and straightforward treatment protocol.

Adult↗
PubMed1999

Areolar temporalis fascia: a reliable graft for tympanoplasty.

OBJECTIVE: This study examines the success rate of areolar temporalis fascia (fool's fascia) as a graft material for tympanoplasty. DESIGN: This study is a retrospective review of surgical cases. SETTING: This study was conducted at Kaiser Permanente Medical Center, San Diego, a tertiary referral center for otologic surgery within Southern California Permanente Medical Group. PATIENTS: Four hundred six patients having undergone tympanoplasty (with and without mastoidectomy) from September 1992 to December 1997 were observed. Medial graft (underlay) techniques were used in all cases, including total drum replacement procedures. Sixty-three percent (256/406) of the cases were revision surgeries. Seventy-three percent (296/406) of the cases were for total drum replacement. In 342 (84%) cases, areolar temporalis fascia was used as the graft material. OUTCOME MEASURE: Successful tympanic membrane healing. Failure of a graft was considered to be reperforation during the entire period of follow-up (range 6 months-5 years). RESULTS: Tympanic membrane healing was successful in 98.54% (337/342) of the cases in which areolar temporalis fascia was used as the graft material. Graft failure for other graft materials was slightly higher. Overall success rate for all 406 cases was 97.5%. CONCLUSIONS: Areolar temporalis fascia is an effective and reliable graft material for primary and revision tympanoplasty. Areolar fascia is readily found in most revision surgeries. Revision tympanoplasty achieved a success rate better than 95%.

Adolescent↗
PubMed1992

[Interposition arthroplasty with pedicled island fascia flap. Experimental study and clinical application].

Interposition arthroplasty of knee joint, using island fascia flap, was performed on 90 rabbits. The fascia flap was vessel pedicled in 54 rabbits and not vessel pedicled in 36 for control. Results of the vessel pedicled island fascia flaps showed that clinically, the range of joint motion was 142.5 degrees on the average. Histologically, the transplanted fascia showed good vascularity and elasticity. There were no signs of adhesion or degeneration. Analogous cartilage appeared in 12 to 15 months. In the control group, the average joint motion was 83.61 degrees and the transplanted fascia showed degeneration of varying degree in each cases. On the basis of these experimental findings, we performed interposition arthroplasty with vessel-pedicled island fascia flap on 20 patients suffering from different joint diseases. The joints were 14 hips, 3 knees, and 3 elbows. Follow-up for 9 to 48 months after arthroplasty revealed clear-up of previous troubles with satisfactory function.

Adolescent↗
PubMed1989

[The fasciae of the pterygomandibular space].

After a rapid description of the pterygomandibular space, the authors describe the anatomy of the interpterygoid fasciae. The interpterygoid fasciae divide the pterygomandibular region into two compartments. The interpterygoid fascia is the most important layer; its limits are defined with precision. The individuality of the pterygotemporomaxillary fascia is less well defined. The authors then report their own study about the functional anatomy of these fasciae by means of frozen sections of color-injected fresh anatomical specimens. The results confirm the importance of the interpterygoid fasciae in guiding the anesthetic solution to the mandibular foramen in mandibular nerve block.

Adolescent↗
PubMed1981

Freeze-dried fascia lata allografts: a review of 47 cases.

Fascia lata used to connect bony structures can provide stability while maintaining mobility. Experience with reconstituted freeze-dried allogeneic fascia used in 56 patients was reviewed, including ankle, hip, and shoulder suspensions, plus ligament and tendon repairs. Follow-up was available in 47 patients with 51 fascial grafts whose ages ranged from 2 to 58 years (mean, 19.2 years). Follow-up ranged from 6 months to 16 years with a mean of 7.2 years. Results were good in 72%, fair in 20%, and poor in 8%. Allograft fascia did not stretch out with time in these cases. Preserved fascia can provide satisfactory clinical results, thus eliminating the need for collecting autogenous fascia.

Adolescent↗
PubMed1990

[Histologic changes in fascia lata transplants in the replacement of the anterior cruciate ligament of the knee in dogs].

Lesions of the anterior cruciate ligament of the knee are very frequent misfortune and the results of their suture being insufficient yet, made us to explore the possibility to replace the damaged ligament with the fascia lata as an autologous transplant. Surgical operation was performed on dogs. Instead of the anterior cruciate ligament removed, we used a piece of a rolled fascia lata. Six months after transplantation being performed, samples of the fascia lata were extracted for histological analysis to assess their structure and to evaluate the transplant as a neoligament, on the basis of its similarity with the normal structure of the ligament. After degeneration of a part of transplant because of the insufficient supply of nutrients, the invasion of the synovial blood vessels into the fascia lata was established and the young granulation tissue formed on the account of the nondifferentiated adventitial cells. In the mosaic of the transplant structure there were present parts of a more mature, dense connective tissue with longitudinal orientation of the cells, the fibers and the vascular elements, which partially made structure similar to that in ligaments. In the attachment region fibrocartilage was noticed, gradually passing into the hyaline one, to merge with the hyaline cartilage of the joint surface. After the histological analysis follows the conclusion that fascia lata functionally could replace the anterior cruciate ligament if a role was supplied with sufficient collagenic fibers on the cross-section. Time is of a high importance, too.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

HIV and banked fascia lata.

Banked irradiated fascia lata is used in many ophthalmic procedures. Along with its increased popularity has come concern over protection from the AIDS virus. Banked fascia lata is protected against the AIDS virus by donor selection, antibody testing and irradiation sterilization. With the knowledge that fascia may also be heated as additional protection, this study was performed to determine if heat treatment weakens the fascia. Results suggest that heat treatment does not clinically or statistically weaken banked homogenous fascia lata.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Dupuytren's disease and the relationship between the transverse and longitudinal fibers of the palmar fascia: a dissection study.

Dupuytren's disease is characterized clinically by a proliferative fibrous contracture of the palmar or digital fascia. A logical approach to the assessment and treatment of this complex condition requires a precise knowledge of the anatomy of the palmar fascia. This dissection study was carried out on ten cadaveric hands to determine the relationship between the longitudinal and transverse fibers of the palmar fascia. We found that the deepest layer of the three longitudinal layers of the palmar fascia (layer 3) divided at the transverse fibers into two sub-layers. Fibers of the deeper sub-layer passed dorsally, proximal to the transverse fibers of the palmar fascia, whereas the more superficial fibers of layer 3 passed dorsally distal to the transverse fibers. The literature is reviewed and the significance of these findings is discussed in relation to the surgical treatment of Dupuytren's disease.

Anatomy, Artistic↗
PubMed2004

Anatomy and blood supply of the subgaleal fascia flap.

The subgaleal fascia (SGF) is a distinct layer in the temporal fossa situated between the superficial fascia and galea aponeurotica and the temporal fascia covering the superficial surface of the temporal muscle. The SGF is used most frequently for otologic reconstruction. Reviewing the literature, however, showed many contradictory findings about dissection of an independent SGF layer, its blood supply, and the possibility of harvesting it as part of a combined flap. Our study, carried out on ten fresh cadavers, presents a detailed view of the blood supply of the SGF to develop a safe method of harvesting an inferior-based SGF. Our systematic plane-by-plane approach, associated with a transparent grid applied on each dissection, allowed us to quantify the branches from each plane and to localize precisely their entering sites from a reference "zygomatic point." The SGF had no ascending axial vascular supply entering from its base; according to our results, therefore, the SGF could not be harvested alone as an inferior pedicled flap down to the zygomatic arch. It may be feasible, however, to harvest a SGF flap when a strip of the superficial fascia is associated with its middle third. Therefore, we suggest that an average height of 5.4 cm of superficial fascia should be included in an inferior-based pedicle of a SGF.

Aged↗