Human fascia lata in rat calvarial bone defects Amer, Mariano; Rodriguez, Pablo; Renou, Sandra
Clinical oral implants research,
October 2018, 2018-10-00, 20181001, Volume:
29, Issue:
S17
Journal Article
Peer reviewed
Open access
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BFBNIB, CMK, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Due to varying descriptions and terminology of fascias of the neck, medical advice relying on this basic knowledge is insufficient. Our goal was to provide a precise anatomical description of ...cervical fascias and spaces with special focus on the intercarotid fascia, or the alar fascia. One hundred bodies donated to science embalmed with Thiel's method were investigated, cervical fascias were dissected layer by layer, and the results were documented by photography, with a focus on the intercarotid fascia. In addition, we performed a review of recent literature concerning cervical surgical interventions, radiological diagnostic pathways, and basic anatomical works focusing on core information on anatomical relations of cervical fascias and spaces. In another 10 bodies donated to science, the spaces of the neck were injected with coloured latex under ultrasound guidance, dissected, and documented by photography. The intercarotid fascia was a constantly developed connective tissue interconnecting the carotid sheath of both sides. In 52 of 100 specimens (52%) it crossed to the opposite side without any fusion to the ventrally situated visceral fascia. Fusion with the visceral fascia was found in 48%, either at the lateral border of the pharynx or on its dorsal side. The results of our dissections strengthen the precise description of the cervical fascias provided by Grodinsky and Holyoke in 1938. Spaces can be confirmed as described by Hafferl in 1969. The international anatomical and ENT societies should codify a unified anatomical terminology of the cervical spaces and fascias to prevent varying interpretations in the future.
The precise description of fascias and spaces on the neck in this manuscript shows an important topography concering regional anaesthetic block techniques and surgical approaches.
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Although fasciae have long interested clinicians in a multitude of different clinical and paramedical disciplines, there have been few attempts to unite the ensuing diverse literature into a single ...review. The current article gives an anatomical perspective that extends from the gross to the molecular level. For expediency, it deals only with fascia in the limbs and back. Particular focus is directed towards deep fascia and thus consideration is given to structures such as the fascia lata, thoracolumbar fascia, plantar and palmar fascia, along with regional specializations of deep fascia such as retinacula and fibrous pulleys. However, equal emphasis is placed on general aspects of fascial structure and function, including its innervation and cellular composition. Among the many functions of fascia considered in detail are its ectoskeletal role (as a soft tissue skeleton for muscle attachments), its importance for creating osteofascial compartments for muscles, encouraging venous return in the lower limb, dissipating stress concentration at entheses and acting as a protective sheet for underlying structures. Emphasis is placed on recognizing the continuity of fascia between regions and appreciating its key role in coordinating muscular activity and acting as a body‐wide proprioceptive organ. Such considerations far outweigh the significance of viewing fascia in a regional context alone.
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Introduction
The alar fascia remains one of the most variably described fascial structure in the human body. Much disagreement persists in the literature and mainstream anatomical texts about its ...anatomy, function, and clinical significance. It is generally described as a coronally oriented fascial sheet separating the retropharyngeal space anteriorly from the danger space posteriorly. The current study aimed to confirm the presence of the alar fascia and delineate its anatomical characteristics, connections, and potential function through gross dissection and microscopic analysis. Possible clinical and surgical implications are considered.
Methods
Twelve (12) cadaveric necks were dissected and examined histologically. Smooth muscle (αSMA), nerve (S100 protein), and myosin proteins were identified immunohistologically to characterize the composition and possible functions of the alar fascia.
Results
The alar fascia was found in all specimens spanning between the carotid sheaths. Morphologically, it was not a delamination or derivative of the prevertebral fascia. It extended from the base of the skull to the upper thoracic level (T2) where it fused with the visceral fascia. No midsagittal connection was found between the alar and visceral fasciae. Immunohistochemically, the alar fascia was positive in focal areas for αSMA and S100 proteins but negative for fast and slow myosin.
Conclusion
The alar fascia is an independent and constant coronal fascial layer between the carotid sheaths. It contains neurovasculature and may limit the spread of retropharyngeal infections into the thorax as well as facilitate normal physiological functions of the cervical viscera.
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Although the number of Ultrasound (US) imaging studies investigating the fascial layers are becoming more numerous, the majority tend to use different reference points and terminology to describe ...their findings. The current work set out to compare macroscopic and microscopic data of specimens of the fascial layers of the thigh with US imaging findings. Specimens of the different fascial layers of various regions of the thigh were collected for macroscopic and histological analyses from three fresh cadavers and compared with in vivo US images of the thighs of 20 healthy volunteers. The specimens showed that the subcutaneous tissue of the thigh is made up of three layers: a superficial adipose layer, a membranous layer/superficial fascia, and a deep adipose layer. The deep fascia is composed of an aponeurotic fascia, which envelops all the thigh muscles and is laterally reinforced by the iliotibial tract and an epimysial fascia, which is specific for each muscle. The morphometric measurements of the thickness of the superficial fascia were different (anterior: 153.2 ± 39.3 µm; medial: 128.4 ± 24.7 µm; lateral: 154 ± 28.9 µm; and posterior: 148.8 ± 33.2 µm) as were those of the deep fascia (anterior: 556.8 ± 176.2 µm; medial: 820.4 ± 201 µm; lateral: 1112 ± 237.9 µm; and posterior: 730.4 ± 186.5 µm). The US scans showed a clear picture of the superficial adipose tissue, the superficial fascia, and the deep adipose tissue, as well as the deep fasciae. The epimysial and aponeurotic fasciae of only some topographic areas could be independently identified. The US imaging findings confirmed that the superficial and deep fascia have different thicknesses, and they showed that the US measurements were always larger with respect to those produced by histological analysis (p < 0.001) probably due to shrinkage during the processing. The posterior region (level 1) of the superficial fascia had, for example, a mean thickness of 0.56 ± 0.12 mm at US, while the histological analysis showed that it was 148.8 ± 33.2 µm. Showing a similar pattern, the thickness of the deep fascia was as follows: 1.64 ± 0.85 mm versus 730.4 ± 186.5 µm. Study results have confirmed that US can be considered a valid, non‐invasive instrument to evaluate the fascial layers. In any event, there is a clear need for a set of standardised protocols since the thickness of the fascial layers of different parts of the human body varies and the data obtained using inaccurate reference points are not reproducible or comparable. Given the inconsistent terminology used to describe the fascial system, it would also be important to standardise the terminology used to define its parts. The difficulty in distinguishing between the epimysial and aponeurotic/deep fascia can also impede data interpretation.
Although the number of Ultrasound (US) imaging studies investigating the fascial layers are becoming more numerous, the majority tend to use different reference points and terminology to describe their findings. The current work set out to compare macroscopic and microscopic data of specimens of the fascial layers of the thigh with US imaging findings. Specimens of the different fascial layers of various regions of the thigh were collected for macroscopic and histological analyses from three fresh cadavers and compared with in vivo US images of the thighs of 20 healthy volunteers.
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6.
The fascial connections of the pectineal ligament Steinke, Hanno; Wiersbicki, Dina; Völker, Anna ...
Clinical anatomy (New York, N.Y.),
October 2019, 2019-Oct, 2019-10-00, 20191001, Volume:
32, Issue:
7
Journal Article
In this overview, new and existent material on the organization and composition of the thoracolumbar fascia (TLF) will be evaluated in respect to its anatomy, innervation biomechanics and clinical ...relevance. The integration of the passive connective tissues of the TLF and active muscular structures surrounding this structure are discussed, and the relevance of their mutual interactions in relation to low back and pelvic pain reviewed. The TLF is a girdling structure consisting of several aponeurotic and fascial layers that separates the paraspinal muscles from the muscles of the posterior abdominal wall. The superficial lamina of the posterior layer of the TLF (PLF) is dominated by the aponeuroses of the latissimus dorsi and the serratus posterior inferior. The deeper lamina of the PLF forms an encapsulating retinacular sheath around the paraspinal muscles. The middle layer of the TLF (MLF) appears to derive from an intermuscular septum that developmentally separates the epaxial from the hypaxial musculature. This septum forms during the fifth and sixth weeks of gestation. The paraspinal retinacular sheath (PRS) is in a key position to act as a ‘hydraulic amplifier’, assisting the paraspinal muscles in supporting the lumbosacral spine. This sheath forms a lumbar interfascial triangle (LIFT) with the MLF and PLF. Along the lateral border of the PRS, a raphe forms where the sheath meets the aponeurosis of the transversus abdominis. This lateral raphe is a thickened complex of dense connective tissue marked by the presence of the LIFT, and represents the junction of the hypaxial myofascial compartment (the abdominal muscles) with the paraspinal sheath of the epaxial muscles. The lateral raphe is in a position to distribute tension from the surrounding hypaxial and extremity muscles into the layers of the TLF. At the base of the lumbar spine all of the layers of the TLF fuse together into a thick composite that attaches firmly to the posterior superior iliac spine and the sacrotuberous ligament. This thoracolumbar composite (TLC) is in a position to assist in maintaining the integrity of the lower lumbar spine and the sacroiliac joint. The three‐dimensional structure of the TLF and its caudally positioned composite will be analyzed in light of recent studies concerning the cellular organization of fascia, as well as its innervation. Finally, the concept of a TLC will be used to reassess biomechanical models of lumbopelvic stability, static posture and movement.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Abstract
Purpose
To investigate the urogenital fascia (UGF) anatomy in the inguinal region, to provide anatomical guidance for laparoscopic inguinal hernia repair (LIHR).
Methods
The anatomy was ...performed on 10 formalin-fixed cadavers. The peritoneum and its deeper fascial tissues were carefully dissected.
Results
The UGF’s bilateral superficial layer extended and ended in front of the abdominal aorta. At the posterior axillary line, the superficial layer medially reversed, with extension represented the UGF's deep layer. The UGF's bilateral deep layer medially extended beside the vertebral body and then continued with the transversalis fascia. The ureters, genital vessels, and superior hypogastric plexus moved between both layers. The vas deferens and spermatic vessels, ensheathed by both layers, moved through the deep inguinal ring. From the deep inguinal ring to the midline, the superficial layer extended to the urinary bladder’s posterior wall, whereas the deep layer extended to its anterior wall. Both layers ensheathed the urinary bladder and extended along the medial umbilical ligament to the umbilicus and in the sacral promontory, extended along the sacrum, forming the presacral fascia. The superficial layer formed the rectosacral fascia at S4 sacral vertebra, and the deep layer extended to the pelvic diaphragm, terminating at the levator ani muscle.
Conclusion
The UGF ensheaths the kidneys, ureters, vas deferens, genital vessels, superior hypogastric plexus, seminal vesicles, prostate, and urinary bladder. This knowledge of the UGF’s anatomy in the inguinal region will help find correct LIHR targets and reduce bleeding and other complications.
Scars are more severe when the subcutaneous fascia beneath the dermis is injured upon surgical or traumatic wounding. Here, we present a detailed analysis of fascia cell mobilisation by using deep ...tissue intravital live imaging of acute surgical wounds, fibroblast lineage-specific transgenic mice, and skin-fascia explants (scar-like tissue in a dish - SCAD). We observe that injury triggers a swarming-like collective cell migration of fascia fibroblasts that progressively contracts the skin and form scars. Swarming is exclusive to fascia fibroblasts, and requires the upregulation of N-cadherin. Both swarming and N-cadherin expression are absent from fibroblasts in the upper skin layers and the oral mucosa, tissues that repair wounds with minimal scar. Impeding N-cadherin binding inhibits swarming and skin contraction, and leads to reduced scarring in SCADs and in animals. Fibroblast swarming and N-cadherin thus provide therapeutic avenues to curtail fascia mobilisation and pathological fibrotic responses across a range of medical settings.
ZusammenfassungHintergrundRegionalanästhesiologische Verfahren (RA) wie der N.-femoralis-Block (NFB) oder Fascia-iliaca-Kompartment-Block (FIKB) sind effektive Analgesieverfahren bei proximalen ...Femurfrakturen (PFF). Während diese in Großbritannien (GB) bereits häufig in der Notaufnahme zur präoperativen Analgesie eingesetzt werden, scheint dies im deutschsprachigen D‑A-CH-Raum (Deutschland, Österreich und die Schweiz) weniger verbreitet zu sein. Das Ziel der Arbeit ist es daher, die Art und Häufigkeit der Anwendung von RA-Verfahren zu erheben und international zu vergleichen.Material und MethodenIm D‑A-CH-Raum sowie in GB wurden registrierte Notaufnahmen kontaktiert und zur Teilnahme an einer Online-Umfrage eingeladen. Die Umfrage umfasste Fragen zu Häufigkeit und Art von RA-Verfahren, Gründen der Nichtanwendung, verwendeten Hilfsmitteln, der durchführenden Person und zu verwendeten Medikamenten.ErgebnisseDie Teilnahmequote lag bei 17,4 % (142/818 Notaufnahmen). RA-Verfahren zur präoperativen Analgesie bei hüftgelenknahen Femurfrakturen wurden im D‑A-CH-Raum bei 18,3 % (21/115), in GB bei 96,3 % (26/27) der Kliniken eingesetzt. Der am häufigsten verwendete Block war in GB der FIKB mit 96,2 % (25/26) und in Deutschland der NFB mit 66,7 % (14/21). Im D‑A-CH-Raum werden die RA-Verfahren vorrangig von anästhesiologischen Fachärzten 71,4 % (15/21), in GB von Assistenzärzten der Notaufnahme 65,4 % (17/26) durchgeführt.DiskussionIn Notaufnahmen des D‑A-CH-Raums werden RA-Verfahren bei PFF zu selten durchgeführt. Im internationalen Vergleich mit GB besteht noch Verbesserungspotenzial.Graphic abstract
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