Fascia Research Papers - Academia.edu (original) (raw)

- by
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- Complementary and Alternative Medicine, Skeletal muscle biology, Fascia, Electromyography

We have studied the human thoracolumbar fascia by sulated mechanoreceptors (Ruffini's and Vater-Pacini using antiserum against neurofilament protein (NFP) corpuscles) were identified. These findings support and S-1 00 protein to identify sensory nerve fibers and the hypothesis that the thoracolumbar fascia may their endings. Seven surgical specimens from 7 play a neurosensory role in the lumbar spine patients were studied with light microscopy. In mechanism. addition to free nerve endings, two types of encap-

- by L'Hocine Yahia
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- Biomedical Engineering, Immunohistochemistry, Fascia, Clinical Sciences

Background: Chronic paralytic lagophthalmos is a condition that is often conservatively treated with ophthalmic ointments and eye drops, but usually requires definitive surgical correction. Purpose: An effective modification of the gold lid loading technique is described, which we have found to be the simplest and most reliable method for lid reanimation. Material: After empiric evaluations with lead fisherman's weights 'glued' to the eyelid, a custom-made gold lid weight is made by a jeweller on the basis of the tarsal dimensions of the individual patient, and then sutured to the tarsus under local anaesthesia and covered with a fine sheet of temporal galea. Other ancillary procedures (lower lid suspension, lateral tarsal strip, lateral tarsoplasty) are added as required. Methods: Between 1990 and 1996, 27 patients underwent this type of surgery, of whom 24 were re-evaluated after a mean follow-up period of 73.2 months (range 36-96 months), 14 of these for a minimum of 5 years. Results: None of the gold weights was extruded, all 24 patients experienced marked improvement of their dry-eye symptoms and expressed a high degree of satisfaction. Six patients underwent further minor surgery (lateral McLaughlin tarsorrhaphy) in order to improve relative underaction. Two patients had ptosis (less than 2 mm of asymmetry) of the affected side but refused further correction. Conclusion: The use of custom-made gold lid weights and a protective galeal layer is a simple, reliable and successful means for permanently rehabilitating paralysed eyelids.

- by Ornella D'orto
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- Dentistry, Facial Paralysis, Medicine, Complication

Background: Damage control and decompressive laparotomies salvage severely injured patients who would have previously died. Unfortunately, many of these patients develop open abdomens. A variety of management strategies exist. The end result in many cases, however, is a large ventral hernia that requires a complex repair 6 to 12 months after discharge. We instituted vacuum-assisted wound closure (VAWC) to achieve early fascial closure and eliminate the need for delayed procedures. Methods: For 12 months ending June 2000, 14 of 698 trauma intensive care unit admissions developed open abdomens and were managed with VAWC dressing. This was changed every 48 hours in the operating room with serial fascial approximation until complete closure. Results: Fascial closure was achieved in 13 patients (92%) in 9.9 Ϯ 1.9 days, and 2.8 Ϯ 0.6 VAWC dressing changes were performed. There were 2 wound infections, no eviscerations, and no enteric fistulas. Conclusions: Use of VAWC can safely achieve early fascial closure in more than 90% of trauma patients with open abdomens.

- by Frederick A Moore
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- Operating Room, Fascia, Abdominal Muscles, Clinical Sciences
- by mesut tez
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- Stem Cell, Fascia, Inguinal Hernia, Tensile Strength
- by Dr. Juan Asensio
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- Medicine, Fascia, Risk factors, Clinical Sciences

The battlefield surgeon is faced with challenges in the management of leg and foot compartment syndrome because the condition's pathophysiology, diagnostic modalities, and treatment methods all involve controversy. Blast injury, high-velocity gunshot wounds, and blunt trauma associated with combat operations cause injuries that may induce compartment syndrome. If untreated, muscle and nerve necrosis may occur. Subsequent myoneural fibrosis, contracture, infection, amputation, and systemic complications are all possible. However, compartment syndrome and its sequelae can be prevented or mitigated by prompt intervention to maintain adequate tissue oxygenation. At present, recommendations for a low threshold for fasciotomy are maintained to avoid missing the diagnosis; however, this exposes casualties to the risks of fasciotomy in false-positive cases. The incidence of compartment syndrome and limbs at risk in combat casualties requiring evacuation is estimated to be 15%. 1 In recent United States' conflicts, severe extremity trauma caused by blast injuries has been a common presentation resulting in more than 71% of the total number of extremity injuries and accounts for 86% of those requiring fasciotomy. 1-4 Exploding ordnance causes significant

- by Kevin Kirk
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- Wound Healing, Treatment Outcome, Risk assessment, Medicine

Background The treatment of hernia, independent of anatomical site and technique utilized, generally involves using prostheses, which may cause complications, despite their unarguable advantage in allowing safe reinforcement. An example of this is possible retraction, which causes discomfort and hernia recurrence. Polypropylene is still the most often used biomaterial of the great number available. The purpose of this study is to evaluate the amount of retraction of the polypropylene mesh, as well as the histological reactions that accompany this phenomenon. Methods Polypropylene meshes (Marlex Ò ) were inserted in an anterior position to the whole abdominal aponeurosis of 25 Wistar rats (Rattus norvegicus albinus). The animals were divided into groups and another intervention was performed 7, 28, and 90 days later to measure the dimensions of the prostheses and to calculate the final area. Histological analysis was performed with hematoxylineosin to evaluate neutrophils, macrophages, giant cells, and lymphocytes surrounding the mesh threads in ten random fields of each slide. Results Seven days after the mesh was inserted, the mean rate of retraction was 1.75% (P = 0.64); at 28 days, it was 3.75% (P = 0.02); and at 90 days, it was 2.5% (P = 0.01). As to the histological analysis, there was a total decline of neutrophils and a progressive increase of macrophages, giant cells, and lymphocytes proportional to the postimplant time of the mesh (P \ 0.05). Conclusion There was a statistically significant retraction of 3.75% at 28 days and 2.5% at 90 days after the prosthesis was inserted. There is a well-established sequence of cellular events which aim at synthesizing new connective tissue to reinforce the mesh.

- by Eva Trindade
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- Wound Healing, Statistical Significance, Fascia, Connective tissue

OBJECT Surgical transposition of the ulnar nerve to alleviate entrapment may cause otherwise normal structures to become new sources of nerve compression. Recurrent or persistent neuropathy after anterior transposition is commonly attributable to a new distal compression. The authors sought to clarify the anatomical relationship of the ulnar nerve to the common aponeurosis of the humeral head of the flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS) muscles following anterior transposition of the nerve. METHODS The intermuscular septa of the proximal forearm were explored in 26 fresh cadaveric specimens. The fibrous septa and common aponeurotic insertions of the flexor-pronator muscle mass were evaluated in relation to the ulnar nerve, with particular attention to the effect of transposition upon the nerve in this region. RESULTS An intermuscular aponeurosis associated with the FCU and FDS muscles was present in all specimens. Transposition consistently resulted in ...

- by Jaime Gasco
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- Neurosurgery, Skeletal muscle biology, Medicine, Anatomy

The presacral venous plexus results from anastomoses between the lateral and median sacral veins, and courses into the pelvic fascia covering the anterior aspect of the body of the sacrum. The presacral venous plexus is not directly visible during rectal surgery, and injuries to this plexus may be life-threatening. Dissection of the retrorectal plane or anchoring of the rectum to the sacral promontory as in rectal prolapse surgery exposes the patient to the risk of injury to the presacral venous plexus. The aim of this study was to identify some avascular areas in the anterior aspect of the sacrum in order to lower the occurrence of such injuries during rectal surgery. The pelvis of 10 fresh cadavers was dissected after injection of a colored resin into the inferior vena cava, and the presacral venous plexus was studied. Four avascular tetragonal areas were common to all the specimens. The corners of a square with a side of 3 cm, centered on the anterior aspect of the body of sacrum, were always contained in the avascular areas. The upper side of this square was parallel to a line passing through the sacral promontory, at a 3 cm distance from it. Staples or sutures should be placed in the avascular areas to avoid injuries to the presacral venous plexus.

- by Eric Sejor
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- Medical errors, Fascia, Medical Physiology, Forensic Illustration and Medical Art

Dupuytren's disease (DD) is a fibromatosis characterized by non-malignant transformation of palmar fascia leading to permanent contraction of one or more fingers. Despite the extensive knowledge of its clinical pathogenesis, the aetiology of this disease remains obscure. In the present paper, we report for the first time on the proteomic profiling of diseased versus unaffected patient-matched palmar fasciae tissues from DD patients using two-dimensional gel electrophoresis coupled with mass spectrometry analysis. The herein identified proteins were then used to create the protein-protein interaction network (interactome). Such an integrated approach revealed the involvement of several different molecular processes related to DD progression, including extra-and intra-cellular signalling, oxidative stress, cytoskeletal changes, and alterations in cellular metabolism. In particular, autocrine regulation through ERBB-2 and IGF-1R receptors and the Akt signalling pathway have emerged as novel components of pro-survival signalling in Dupuytren's fibroblasts and thus might provide a basis for a new therapeutic strategy in Dupuytren's disease.

- by G. Peter and +3
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- Pathology, Computational Biology, Immunohistochemistry, Oxidative Stress

Whiplash associated disorders commonly affect people after a motor vehicle accident, causing a variety of disabling manifestations. Some manual and physical approaches have been proposed to improve myofascial function after traumatic injuries, in order to effectively reduce pain and functional limitation. To evaluate whether the application of the Fascial Manipulation© technique could be more effective than a conventional approach to improve cervical range of motion in patients with subacute whiplash associated disorders. Pilot randomized clinical trial. Eighteen patients with subacute whiplash associated disorders were randomized into two groups. Group A (N.=9) received three, 30-minute sessions, (every five days during a two week period) of neck Fascial Manipulation©. Group B (N.=9) received ten, 30-minute sessions (five days a week for two consecutive weeks) of neck exercises plus mobilization. Patients were evaluated before, immediately after and two weeks post-treatment. cervic...

- by A. Picelli
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- Nonparametric Statistics, Italy, Neck Pain, Fascia

Background The coracoclavicular joint has been described as an articulation found inconstantly between the coracoid process and clavicle. We often observe a small space bordered by the fascia which covers the anterior surface of the subclavius muscle and the coracoclavicular ligament. The aim of this study was to observe the space in detail and to discuss the functional role of the coracoclavicular joint. Materials and methods Sixteen shoulder girdles from eight Japanese cadavers were used in this study. The scapula, clavicle, and anterior half of the Wrst rib were extracted en bloc together with the subclavius muscle and the surrounding fascia. After observing the motion of the scapula and clavicle, we investigated macroscopically the attachments of the coracoclavicular ligaments and the subclavius muscle, and the extension of the fascia. Results The fascia divided laterally into two sheets: the anterior sheet attached to the trapezoid ligament and the posterior to the conoid ligament. Among the two sheets, the coracoclavicular ligaments, coracoid process, and clavicle, a small space was observed. This small space can be recognized as a part of the coracoclavicular joint. When manually moving the inferior angle of the scapula with the sternal end of the clavicle Wxed, we observed that the clavicle collided with the trapezoid ligament on the superior surface of the coracoid process within the space and that the scapular motion was restricted by this collision. Conclusion The coracoclavicular joint could be much more recognizable than in previous papers and play an important role in the normal function of the shoulder joint. Level of evidence Basic science study.

- by Keiichi Akita
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- Surgery, Skeletal muscle biology, Treatment, Medicine

BACKGROUND: Despite advances in surgical technique and materials, abdominal fascial closure has remained a procedure that often reflects a surgeon's personal preference with a reliance on tradition and anecdotal experience. The value of a particular abdominal fascial closure technique may be measured by the incidence of early and late wound complications, and the best abdominal closure technique should be fast, easy, and costeffective, while preventing both early and late complications. This study addresses the closure of the vertical midline laparotomy incision. DATA SOURCES: A MEDLINE (National Library of Medicine, Bethesda, Maryland) search was performed. All articles related to abdominal fascia closure published from 1966 to 2003 were included in the review. CONCLUSIONS: Careful analysis of the current surgical literature, including 4 recently published meta-analyses, indicates that a consistent conclusion can be made regarding an optimal technique. That technique involves mass closure, incorporating all of the layers of the abdominal wall (except skin) as 1 structure, in a simple running technique, using #1 or #2 absorbable monofilament suture material with a suture length to wound length ratio of 4 to 1. (Curr Surg 62:220-225. © 2005 by the Association of Program Directors in Surgery.) KEY WORDS: abdominal closure, suture material, suture size, layered closure, mass closure, continuous closure, interrupted closure CURRENT SURGERY •

- by Adil Ceydeli
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- Fascia, Clinical Sciences, Curriculum and Pedagogy, Abdominal Wall Hernias

We compared inflammatory response, fibrosis and biomechanical properties of different polypropylene materials from one manufacturer (Tyco Healthcare) in a rat model for primary fascial repair. Full-thickness abdominal wall defects were primarily repaired using 'overlay' technique. Multifilament implants were Surgipro SPM and SPMW, the latter a wider-weave type of the former. Monofilament SPMM implants and polypropylene suture repair (Surgipro II) served as controls. Explants were evaluated macroscopically and changes in thickness, shrinkage and tensile strength were measured. Inflammatory and connective tissue response was assessed on haematoxylin-eosin and Movat stains. Immunohistochemistry was done to localise rat macrophages/monocytes. Multifilament materials induced a shorter acute inflammatory response and more pro-nounced chronic inflammatory reaction compared to monofilament implants. Macrophages could be found deep in interstices 7.5 by 12.5 μm. No difference in collagen deposition and neovascularisation was observed. At 90 days time point, explants reconstructed with tighter woven multifilament SPM were weaker than sutured or SPMM controls. Overall shrinkage of 10% was comparable for all groups.

- by Eric Verbeken
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- Wound Healing, Inflammation, Immunohistochemistry, Inflammatory Immune Response

Fascia Iliaca Compartment Block (FICB) has been widely used as a postoperative analgesic adjunct to opioids for total hip arthroplasty (THA), either by the conventional infrainguinal approach or the modified proximal suprainguinal approach irrespective of any specific advantage of one over the other. This study was conducted to compare the analgesic efficacy of the two techniques of FICB for postoperative analgesia. The 40 patients scheduled for THA were recruited for Intervention (s) and randomized to receive FICB either by suprainguinal approach (group S) or infrainguinal approach (group I) for postoperative analgesia with 40 ml of 0.2% bupivacaine, in addition to postoperative patient controlled analgesia (PCA) with morphine. Visual analogue scale (VAS) and PCA morphine consumption was used to assess the postoperative pain at 3, 6, 12 and 24 hours. The primary outcome was cumulative PCA morphine consumption in 24 hours. The pain intensity as measured by VAS scores showed signific...

- by Lokesh Kashyap
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- Surgery, Medicine, Prospective studies, Fascia

Background: Fascial dehiscence is uncommon in children but can have serious consequences when it occurs. There are multiple risk factors for fascial dehiscence, including the type of incision used. Pediatric surgeons often use a supraumbilical transverse incision particularly in infants because of the access this incision provides to the entire abdomen. This article details the experience with fascial wound dehiscence at a large tertiary children's hospital and focuses on problems with the types of incision used.

- by Louise Davies
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- Surgery, Statistical Analysis, Treatment, Adolescent

Background Breast augmentation usually is performed in subglandular, subfascial, or partial submuscular pockets, including the dual plane. A new pocket has been described and used by the author. The initial pocket was made in the subglandular plane up to the lower level of the nipple–areolar complex, and the submuscular plane was reached by splitting the pectoralis major muscle without its release from the costal margin. The implant lies in this plane simultaneously behind and in front of the pectoralis. Methods From October 2005 to November 2006, 125 patients underwent bilateral breast augmentation using the new technique. Soft cohesive gel microtextured round implants ranging in size from 230 to 440 ml were used. Results All the patients experienced a quick recovery with three-dimensional enhancement and having the benefits of both subglandular and submuscular planes. No rippling, lateral displacement, double-bubble deformity, or muscle contraction–associated deformities were seen. All the patients had aesthetically natural cleavage, with the nipple at the most projected part of the breast. Postoperative analgesia requirements were reduced because of dissection in natural planes. Conclusion For adequate cover of the prosthesis, only the upper part of the pectoralis major muscle is required. This can be achieved by using the pectoralis muscle-splitting technique. The pectoralis major was split in the direction of its fibers, avoiding extensive muscle release. Surgical morbidity was reduced, resulting in a quick postoperative recovery and a more natural three-dimensional appearance of the breast.

- by Umar Khan
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- Treatment Outcome, Breast Implants, Fascia, Clinical Sciences
- by Karen Mickle
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- Mechanical Engineering, Skeletal muscle biology, Adolescent, Fascia

There is signiWcant paucity in the literature regarding vertebral aponeurosis. We were able to Wnd only a few descriptions of this speciWc fascia in the extant medical literature. To elucidate further the anatomy of this structure, forty adult human cadavers were dissected. Both quantitation and anatomical observations were made of the vertebral aponeurosis. The vertebral aponeurosis was iden-tiWed in 100% of specimens. This fascia was identiWed as a thin Wbrous layer consisting of longitudinal and transverse connective tissue Wbers blended together deep to the latissimus dorsi muscle. It attached medially to the spinous processes of the of the thoracic vertebrae; laterally to the angles of ribs; inferiorly to the fascia covering the serratus posterior inferior muscle (superWcial lamina of the posterior layer of thoracolumbar fascia); superiorly it ran deep to the serratus posterior superior and splenius capitis muscles to blend with the deep fascia of the neck. At the level of the serratus posterior inferior muscle, the vertebral aponeurosis fused to form a continuous layer descending toward the sacrotuberous ligament covering the erector spinae muscle. Morphometrically, the mean length of the vertebral aponeurosis was 38 cm and the mean width was 24 cm. The mean thickness was three mm. There was no signiWcant diVerence between left and right sides, gender or age with regard to vertebral aponeurosis length, width, or thickness (P > 0.05). During manual tension of the vertebral aponeurosis, the tensile force necessary for failure had a mean of 38.7 N. In all specimens, the vertebral aponeurosis was capable of holding sutures placed through its substance. We hope that these data will be of use for descriptive purposes and may potentially add to our understanding of the biomechanics involved in movements of the back. As back pain is perhaps the most common reason patients visit their physicians, additional knowledge of this anatomical region is important.

- by Marios Loukas
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- Skeletal muscle biology, Back Pain, Fascia, Connective tissue

Based on a tensegrity principle, direct or indirect connections between fascia or muscles which stretch the aponeurosis or intermuscular septum may allow the transfer of tension over long distances, without loss of muscle force produced during rest and activity. The present study aimed to test an effect of massage on electrical (EMG) and mechanical (MMG) activities of a muscle lying distant, but indirectly connected to, the massaged muscle. Thirty-three healthy men participated in the study. To record the activity of the middle deltoid muscle the brachioradialis was massaged, and for the tensor fasciae latae-the peroneal muscles were massaged. An EMG/MMG hybrid probe was used to detect EMG and MMG signals from the middle deltoid and tensor fasciae latae muscles. The EMG amplitude increased during massage in the tensor fasciae lata only, while the MMG amplitude increased significantly in both muscles. It was concluded that there was an electrical as well as a mechanical response of muscle connected indirectly by structural elements with the muscle being massaged indicating an application for the tensegrity principle in massage therapy. It also has a practical importance, because it provides a means for a physiotherapist to influence adverse muscle tension by massaging another distant muscle.

- by Katarzyna Kisiel-sajewicz and +2
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- Complementary and Alternative Medicine, Skeletal muscle biology, Massage, Fascia

Four free-flap types were compared regarding perioperative blood perfusion parameters and to define critical values for success. 166 cases were investigated: radial forearm flap (fasciocutaneous, n=89); fibula flap (osteocutaneous, n=32); ALT flap (myocutaneous, n=25); soleus perforator flap (n=20). All flaps were monitored with simultaneous laser-Doppler flowmetry and tissue spectrophotometry intra- and postoperatively up to 14 days. In 24 (15%) of 166 cases perfusion irregularity occurred. Operative exploration was performed in 12 cases (9 successful). 11 flaps (5 radial forearm, 3 fibula, 2 ALT, 1 perforator) were lost due to vascular compromise, which led to an overall success rate of 93%. Rapid increase in haemoglobin concentration of >30% identified venous congestion. Abrupt decline of blood flow and haemoglobin oxygenation indicated arterial occlusion. For radial forearm flaps haemoglobin oxygenation of 15% and a deep flow of 20 AU were identified as minimum values for fla...

- by Warren Rozen
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- Dentistry, Skeletal muscle biology, Microcirculation, Treatment Outcome

To determine the distribution of ivermectin in plasma and tissues of onchocerciasis patients following a single oral dose of 150 micrograms kg-1. Medical Department at Soba University Hospital, Khartoum. Twenty five patients and fourteen healthy volunteers. Serial blood samples were obtained from both groups. Tissue samples were removed from various patients as full thickness skin punch biopsies or during nodulectomy. Ivermectin concentration was determined by radioimmunoassay. The plasma pharmacokinetic variables for patients were; maximum plasma concentration 52.0 ng ml-1; time to achieve maximum concentration, 5.2 h.; elimination half life, 35.0 h; and the area under the plasma concentration curve versus time, 2852 ng.h.ml-1. In healthy volunteers, the plasma ivermectin distribution was similar to that in patients, and both groups showed a tendency for a second rise in plasma concentration of the drug suggestive of enterohepatic recirculation. Ivermectin was detected in tissues obtained from patients. Fat showed the highest and most persistent levels, whilst values for skin, nodular tissues, and worms were comparable. Subcutaneous fascia contained the lowest concentrations. Infection with O. volvulus does not affect the pharmacokinetics of ivermectin, and filarial infected tissues and parasites themselves do take up the drug. There may be prolonged retention of ivermectin because of depot formation in fat tissue.

- by Timothy Geary
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- Adipose tissue, Blood sampling, Fascia, Skin

Pandiculation is the involuntary stretching of the soft tissues, which occurs in most animal species and is associated with transitions between cyclic biological behaviors, especially the sleep-wake rhythm (Walusinski, 2006). Yawning is considered a special case of pandiculation that affects the musculature of the mouth, respiratory system and upper spine (Baenninger, 1997). When, as often happens, yawning occurs simultaneously with pandiculation in other body regions (Bertolini and Gessa, 1981; Lehmann, 1979; Urba-Holmgren et al., 1977) the combined behavior is referred to as the stretch-yawning syndrome (SYS). SYS has been associated with the arousal function, as it seems to reset the central nervous system to the waking state after a period of sleep and prepare the animal to respond to environmental stimuli (Walusinski, 2006). This paper explores the hypothesis that the SYS might also have an auto-regulatory role regarding the locomotor system: to maintain the animal's ability to express coordinated and integrated movement by regularly restoring and resetting the structural and functional equilibrium of the myofascial system. It is now recognized that the myofascial system is integrative, linking body parts, as the force of a muscle is transmitted via the fascial structures well beyond the tendonous attachments of the muscle itself (Huijing and Jaspers, 2005). It is argued here that pandiculation might preserve the integrative role of the myofascial system by (a) developing and maintaining appropriate physiological fascial interconnections and (b) modulating the pre-stress state of the myofascial system by regularly activating the tonic musculature. The ideas presented here initially arose from clinical observations during the practice of a manual therapy called Muscular Repositioning (MR) (Bertolucci, 2008; Bertolucci and Kozasa, 2010a; Bertolucci, 2010b). These observations were supplemented by a review of the literature on the subject.

The objective of the study was to compare preoperative and postoperative sexual function between women undergoing rectocele repair with porcine dermis graft and women undergoing site-specific repair of rectovaginal fascia. A standardized, validated questionnaire (Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire [PISQ]) was used to collect preoperative sexual function data from 100 patients with rectocele pelvic organ prolapse quantification stage

- by Catherine S Bradley and +1
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- Urinary incontinence, Pelvic Organ Prolapse, Urogynecology, Fascia

Background: The development and anatomy of Denonvilliers' fascia have been controversial for many years and confusion exists about its operative appearance. Better appreciation of this poorly understood anatomy, and its signi®cance for... more

- by I. Lindsey
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- British, Erectile dysfunction, Autonomic Nervous System, Fascia

There are two main conflicting theories on how the nasolabial crease is formed: a muscular theory and a fascial theory. The muscular theory states that the nasolabial crease is mainly formed by the musculodermal insertions of the lip elevator muscles. The fascial theory claims that the nasolabial crease is mainly formed by dense fibrous tissue and by the firm fascial attachments to the fascia of the lip elevator muscles. If the muscular theory was true, the musculodermal insertions of the facial muscles could be interrupted directly by intradermal injections of low doses of botulinum toxin. Eight cadavers who presented with bilateral nasolabial creases were enrolled in the study. The nasolabial creases were harvested from 14 facial halves in their entire lengths and breadths with 5-mm medial and lateral rims. The horizontally cut samples were stained with hematoxylin-eosin (H&E) and Elastica van Gieson (EVG). Immunohistochemistry for the smooth muscle marker actin and the skeletal muscle marker desmin was also performed. In each of the nasolabial creases, numerous skeletal muscle fibers were found in the dermis, which confirmed the muscular theory of the cause of the nasolabial crease. In addition, muscle fibers were present in the dermis 4 mm medial and 4 mm lateral the nasolabial crease, but the amounts were significantly less than the amount located directly in the crease. Botulinum toxin injected intradermally into the nasolabial crease might constitute a new treatment option to minimize or even eradicate the crease and the fold. Clin. Anat. 2012. V V C 2012 Wiley Periodicals, Inc.

- by Mirjana Manestar
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- Skeletal muscle biology, Morphogenesis, Clinical Anatomy, Fascia
- by Roberto Marci and +1
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- Chronic Pain, Prospective studies, Fascia, Young Adult

Our aim was to evaluate urinary urge incontinence following intrafascial and extrafascial abdominal hysterectomies in a prospective randomized study. Women scheduled for total abdominal hysterectomy were randomized to the extrafascial (n=38) and the intrafascial techniques (n=42). The groups were controlled for demographic variables, obstetric and gynecologic history, uterine size, indications for hysterectomy, and preoperative hemoglobin values. Short-term surgical morbidity and presence of urge incontinence defined as urodynamically established detrusor overactivity at the end of 12 months were the main outcome measures. Major surgical morbidity did not differ between the two groups. Percentages of women with urge incontinence at the end of the follow-up period were also similar. However, when women with pre-existing urge incontinence were evaluated separately, there was a trend towards the intrafascial operation to be associated with more urge-incontinence-free patients at the end of the follow-up period ( p =0.06, borderline significant). As a result, short-term surgical morbidity seems to be similar across the intrafascial and extrafascial techniques of abdominal hysterectomy. The effects of intrafascial abdominal hysterectomy on women presenting with urge incontinence in the preoperative period merit further investigation.

- by Hakan Kaya
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- Treatment Outcome, Urinary incontinence, Prospective studies, Urogynecology

Background: Breast augmentation usually is performed in subglandular, subfascial, or partial submuscular pockets, including the dual plane. A new pocket has been described and used by the author. The initial pocket was made in the subglandular plane up to the lower level of the nip-pleÀareolar complex, and the submuscular plane was reached by splitting the pectoralis major muscle without its release from the costal margin. The implant lies in this plane simultaneously behind and in front of the pectoralis. Methods: From October 2005 to November 2006, 125 patients underwent bilateral breast augmentation using the new technique. Soft cohesive gel microtextured round implants ranging in size from 230 to 440 ml were used. Results: All the patients experienced a quick recovery with three-dimensional enhancement and having the benefits of both subglandular and submuscular planes. No rippling, lateral displacement, double-bubble deformity, or muscle contractionÀassociated deformities were seen. All the patients had aesthetically natural cleavage, with the nipple at the most projected part of the breast. Postoperative analgesia requirements were reduced because of dissection in natural planes. Conclusion: For adequate cover of the prosthesis, only the upper part of the pectoralis major muscle is required. This can be achieved by using the pectoralis muscle-splitting technique. The pectoralis major was split in the direction of its fibers, avoiding extensive muscle release. Surgical morbidity was reduced, resulting in a quick postoperative recovery and a more natural three-dimensional appearance of the breast.

- by Umar Khan
- •
- Treatment Outcome, Breast Implants, Fascia, Clinical Sciences

Objective: Common techniques of tympanic membrane repair include underlay and overlay grafting. The over-under tympanoplasty, an innovative method for tympanic membrane repair, will be described as a reliable alternative that has advantages over traditional procedures. Study Design: This study was a retrospective case review. Setting: Tertiary referral center with hospital-setting surgery and outpatient ambulatory patient visits. Patients: One hundred twenty patients who underwent over-under tympanoplasty were included in this study. Average follow-up was 1.8 years. Intervention: Over-under tympanoplasty is performed by placing the graft over the malleus and under the annulus. This technique was used for patients undergoing ear surgery for chronic otitis media, perforations, cholesteatoma, and/or conductive hearing loss. All degrees of ear pathology were included. Main Outcome Measures: Main outcome measures were graft success (no perforation, atelectasis, or lateralization within 6 mo) and improvement of hearing. Patients were stratified by severity of disease (according to the Middle Ear Risk Index), cholesteatoma presence, and type of mastoidectomy. Results: All 120 patients had successful grafts. Lateralization of the grafted drum did not occur. Seventeen patients had late atelectasis, and 12 patients had late perforations; nearly all of these were noted more than 1 year after surgery and were attributed to persistent eustachian tube dysfunction or infections. Average improvement in air-bone gap for all patients was 5.3 dB, whereas speech reception threshold improved by 5.9 dB. Conclusion: Over-under tympanoplasty has an excellent success rate while being technically easier than lateral tympanoplasty. Thus, it is a useful method for practitioners of all levels.

- by Jack Kartush
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- Adolescent, Child, Chronic Disease, Fascia

Auto-immune conditions such as Scleroderma and SLE induce fascial sclerosis and fibrosis, with related vascular, lymphatic, neural, joint, and visceral compression. Ensuing ischaemic pain, necrosis, autonomic and immune dysfunction in turn account for much of patients' pain, functional impairment, and psychological distress. Fascial Release Therapy (FRT) is a hands-on therapeutic model focused on restoring postural and functional integrity by addressing fascial imbalance, with hypothesized efficacy for SLE patients in: Reducing pain, stiffness, fatigue, anxiety. Enhancing functional mobility, autonomy, quality of life, emotional state, autonomic and immune function. Two SLE patients who received FRT treatment along KMI Ò SI methodology, reported improvements to seven symptoms, namely: Reduced pain, fatigue/exhaustion, anxiety. Enhanced functional mobility, autonomy, emotional state, and quality of life. While 'spontaneous recovery' cannot be ruled out without controls, these anecdotal results support further, broader-based clinical research with stringent evaluation tools to enhance outcome validity.

- by Tanya Ball
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- Pain, Depression, Complementary and Alternative Medicine, Systemic Lupus Erythematosus
- by Daniele Perucchini
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- Skeletal muscle biology, Smooth muscle, Fascia, Urinary Tract

If not for Fascia you would be a bag of gushy mixed organic and metal molecules that dissolves in the rain. Fascia is the reason you stay together, and it is the “Strings and springs” in connective tissues. Fascia is only recognized as... more

If not for Fascia you would be a bag of gushy mixed organic and metal molecules that dissolves in the
rain. Fascia is the reason you stay together, and it is the “Strings and springs” in connective tissues.
Fascia is only recognized as important in the last few years.

- by Roger Spurr
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- Medical Sciences, Science Education, Vertebrate Fossil Preparation, Fossil Fuels

It has been speculated that repetitive patterns of movement will lead to specific patterns in fascia contraction, which, if it exceeds a specific limit, will lead to injury. Therapists working in the athletic environment are challenged to find ways not only to assess and measure fascia dysfunction, but also to restore functional strength by manipulating the fascia back to its neutral position. The 'Bunkie' test was developed over a period of 12 years to measure the function of the specific fascia lines in athletes. Numerous athletes from various sports were assessed and treated. Results have shown over the years that this test can be used successfully to find the cause of and treat injuries and to determine the progress of treatment in elite and recreational athletes.

- by Benita Kropman and +1
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- Sports Medicine, Complementary and Alternative Medicine, Fascia, Cumulative Trauma Disorders
- by Robert Schleip
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- Manual Therapy, Pain Management, Low back pain, Fascia

Objective: As the muscle contracts, fibers get thicker, forcing the fascial tubular layers surrounding the muscle (endomysium, perimysium and epimysium) to expand in diameter and hence to shorten in length. We develop a mathematical model to determine the fraction of force generated by extremity muscles during contraction that is transmitted to the surrounding tubes of fascia. Methods: Theory of elasticity is used to determine the modulus of elasticity, radial strain and the radial stress transmitted to the fascia. Results: Starting with published data on dimensions of muscle and muscle force, we find radial stress is 50% of longitudinal stress in the soleus, medial gastrocnemius, and elbow flexor and extensor muscles. Conclusion: Substantial stress is transmitted to fascia during muscular exercise, which has implications for exercise therapies if they are designed for fascial as well as muscular stress. This adds additional perspective to myofascial force transmission research. Published by Elsevier Ltd.

- by amir hayati
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- Fascia, Fascia mechanics

Background: Restoration of the abdominal wall's integrity after postoperative wound dehiscence is frequently performed in a delayed fashion, necessitating a temporary dressing of the dehisced wound. Methods: The Vacuum Assisted Closure (VAC) system (Kinetic Concepts, Inc., San Antonio, TX) was used in 21 patients with postoperative abdominal wound dehiscences that could not be closed immediately and who were at high risk for healing complications. The VAC device was used in conjunction with sharp debridement and it was maintained on a continuous mode with a negative pressure of Ϫ75 to Ϫ125 mm Hg. The dressing was changed every 2 days. VAC therapy was continued until the integrity of the abdominal wall was reestablished by surgical procedures or secondary healing. Results: Thirteen patients had fascial dehiscence, and 9 of them had frank bowel exposure. Definitive fascial closure was performed in 9 of 13 patients with fascial dehiscence. Stable cutaneous coverage was subsequently achieved in all patients by local abdominal skin flap advancement (6), skin grafting (9), or secondary intention healing (6). Seven patients had part of their VAC therapy as outpatients. The complications included a low-output small bowel enterocutaneous fistula in 2 patients and partial skin graft loss in 1 patient. The fistulae resolved after operative treatment (1) or conservative treatment (1). Conclusion: Integration of the VAC system in the management of post-laparotomy wound dehiscence in patients with compromised wound healing appears to be successful and should be considered in such patients to provide a stable, healed wound.

- by Scott Levin and +1
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- Wound Healing, Treatment Outcome, Adolescent, Child

Although the plantar fascia (PF) has been studied quite well from a biomechanical viewpoint, its microscopic properties have been overlooked: nothing is known about its content of elastic fibers, the features of the extracellular matrix or the extent of innervation. From a functional and clinical standpoint, the PF is often correlated with the triceps surae muscle, but the anatomical grounds for this link are not clear. The aim of this work was to focus on the PF macroscopic and microscopic properties and study how Achilles tendon diseases might affect it. Twelve feet from unembalmed human cadavers were dissected to isolate the PF. Specimens from each PF were tested with various histological and immunohistochemical stains. In a second stage, 52 magnetic resonance images (MRI) obtained from patients complaining of aspecific ankle or foot pain were analyzed, dividing the cases into two groups based on the presence or absence of signs of degeneration and/or inflammation of the Achilles tendon. The thickness of PF and paratenon was assessed in the two groups and statistical analyses were conducted. The PF is a tissue firmly joined to plantar muscles and skin. Analyzing its possible connections to the sural structures showed that this fascia is more closely connected to the paratenon of Achilles tendon than to the Achilles tendon, through the periosteum of the heel. The PF extended medially and laterally, continuing into the deep fasciae enveloping the abductor hallucis and abductor digiti minimi muscles, respectively. The PF was rich in hyaluronan, probably produced by fibroblastic-like cells described as 'fasciacytes'. Nerve endings and Pacini and Ruffini corpuscles were present, particularly in the medial and lateral portions, and on the surface of the muscles, suggesting a role for the PF in the proprioception of foot. In the radiological study, 27 of the 52 MRI showed signs of Achilles tendon inflammation and/or degeneration, and the PF was 3.43 AE 0.48 mm thick (99%CI and SD = 0.95), as opposed to 2.09 AE 0.24 mm (99%CI, SD = 0.47) in the patients in which the MRI revealed no Achilles tendon diseases; this difference in thickness of 1.29 AE 0.57 mm (99%CI) was statistically significant (P < 0.001). In the group of 27/52 patients with tendinopathies, the PF was more than 4.5 mm thick in 5, i.e. they exceeded the threshold for a diagnosis of plantar fasciitis. None of the other 25/52 paitents had a PF more than 4 mm thick. There was a statistically significant correlation between the thicknesses of the PF and the paratenon. These findings suggest that the plantar fascia has a role not only in supporting the longitudinal arch of the foot, but also in its proprioception and peripheral motor coordination. Its relationship with the paratenon of the Achilles tendon is consistent with the idea of triceps surae structures being involved in the PF pathology, so their rehabilitation can be considered appropriate. Finally, the high concentration of hyaluronan in the PF points to the feasibility of using hyaluronan injections in the fascia to treat plantar fasciitis.

- by Aldo Morra and +1
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- Biomedical Engineering, Magnetic Resonance Imaging, Immunohistochemistry, Anatomy

IV. SITUATION ACTUELLE………….…………………………..………………………………………………………..……...… p. 1) Des traitements inadaptés………….………………..………………………………………………………..……...… p. 107 2) Des questions sans réponses.……….……………………………………………………………………..….…….…. p. 3) Rétrospection….…………………………………………………………………………………………………...….…..……… p. 126 4) De manière générale………….…………………………..………………………………………………………..……...… p. 129 5) La mémoire traumatique réflexe……………….….………………………………………………….…..……...… p. 138 REMERCIEMENTS…………….…………….……………………………………………………….………………………………..…. p.

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.

Background: Myofascial Release (MFR) and Fascial Unwinding (FU) are widely used manual fascial techniques (MFTs), generally incorporated in treatment protocols to release fascial restrictions and restore tissue mobility. However, the effects of MFT on pain perception, and the mobility of fascial layers, have not previously been investigated using dynamic ultrasound (US) in patients with neck pain (NP) and low back pain (LBP). Objectives: a) To show that US screening can be a useful tool to assess dysfunctional alteration of organ mobility in relation to their fascial layers, in people with non-specific NP or LBP, in the absence of any organ disease; b) To assess, by dynamic US screening, the change of sliding movements between superficial and deep fascia layers in the neck, in people with non-specific NP, before and after application of MFTs c) To assess, by dynamic US screening, the variation of right reno-diaphragmatic (RD) distance and of neck bladder (NB) mobility, in patients with nonspecific LBP, before and after application of MFTs d) To evaluate 'if' and 'at what degree' pain perception may vary in patients with NP or LBP, after MFTs are applied, over the short term. Methods: An Experimental group of 60 subjects, 30 with non-specific NP and 30 with nonspecific LBP, were assessed in the area of complaint, by Dynamic Ultrasound Topographic Anatomy Evaluation (D.US.T.A.-E.), before and after MFTs were applied in situ, in the corresponding painful region, for not more than 12 min. The results were compared with those from the respective Sham-Control group of 30 subjects. For the NP sub-groups, the pre-to post-US recorded videos of each subject were compared and assessed randomly and independently by two blinded experts in echographic screening. They were asked to rate the change observed in the cervical fascia sliding motions as 'none', 'discrete' or 'radical'. For the LBP sub-groups,

- by Claudio Vitturini
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- Complementary and Alternative Medicine, Ultrasound, Adolescent, Low back pain

Several different mechanisms may account for the concealed appearance of the penis. A particular type of concealed penis is the retractile penis, due to dysgenetic fibrous bands tethering the penis to the prepubic subcutaneous tissue. The retractile nature of the concealment can be confirmed by flexion of the hips. A simple technique for surgical correction of the retractile penis is described. While there are many different methods to correct a concealed penis, proper selection of the technique based on understanding of the pathophysiology is critical to a successful outcome.

- by Mark Barraza
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- Urology, Male Circumcision, Child, Fascia

This article examines whether there is evidence to support the idea that acupuncture channels have an anatomical
reality as fascia or connective tissue planes. An examination of what is meant by ‘acupuncture channel’ and to
what the terms ‘fascia’ and ‘connective tissue plane’ refer is followed by an analysis of evidence published over the
last ten years; the article concludes with a summary of what can be said to be proven, and the implications of such
proof for acupuncture research and practice. The paper finds that there is little good quality conclusive evidence
available; what little there is, however, is compelling and suggests that there is much more to find out - information
that could potentially explain more about acupuncture’s physiological mechanisms. Two case studies are included
to illustrate how knowledge of connective tissue planes can be integrated into acupuncture practice.

- by Duncan McGechie
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- Chinese Medicine, Acupuncture, Fascia, Connective tissue

Fascia is the fabric of the body; not the vestments, covering the corpus, but the warp and weft of the material. The other tissues, muscle and bone, liver and lung, gut and urinary, brain and endocrine, are embroidered into the fascial fabric. Remove all other tissues from their fascial bed and the structure and form of the corpus remains, ghostlike, but clearly deﬁned. The fascial system is a continuum, (Guimberteau et al 2007) a structure that evolved hierarchically from the one cell embryo to the organism,
and it is constantly adapting to new stresses to meet the structural demands of the organism. Fascia without stiffeners would be as limp as a rag doll; remove the hydroxyapetite crystals from bone, and the form of bones remain, but soft, as if the starch has been removed from a stiff shirt. Wolff (Wolff, J., Wessinghage, D. 1892)
recognized that bone is stiffened in response to compression stress and what must happen is that the support structure of the body, the fascia with its enmeshed bone stiffeners, evolves in accordance with physical laws.

- by Stephen Levin
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- Biomechanics, Tensegrity, Fascia, Biotensegrity

Fifteen unembalmed cadavers were dissected in order to study the ''anatomical continuity'' between the various muscles involved in the movement of flexion of the upper limb. This study demonstrated the existence of specific myofascial expansions, with a nearly constant pattern, which originate from the flexor muscles and extend to the overlying fascia. The clavicular part of the pectoralis major sends a myofascial expansion, with a mean length of 3.6 cm, to the anterior region of the brachial fascia, and the costal part sends one to the medial region of the brachial fascia (mean length: 6.8 cm). The biceps brachii presents two expansions: the lacertus fibrosus, oriented medially, with a mean height of 4.7 cm and a base of 1.9 cm, and a second, less evident, longitudinal expansion (mean length: 4.5 cm, mean width: 0.7 cm). Lastly, the palmaris longus sends an expansion to the fascia overlying the thenar muscles (mean length: 1.6 cm, mean width: 0.5 cm).

Infections of the head and neck are frequent and usually have a good prognosis even though complications may sometimes be life threatening. In addition to airway compromise, intracranial and thoracic extension may occur. Diagnosis usually is made on clinical examination and imaging may play a significant role in assessing the extent of the disease, detecting complications and assist in surgical planning. The imaging protocol should be appropriate for the proposed diagnosis and suspected complications. CT of the soft tissues of the neck and chest is the imaging test of choice. Interpretation requires knowledge of the anatomy to understand the modalities of local and distant spread of the disease. Imaging evaluation is important but should not delay emergently needed treatment for entities such as epiglottitis and necrotizing fasciitis.

- by P. Cassagneau
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- Magnetic Resonance Imaging, Infection, Fascia, Head