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1
F Sutter Latorre, Gustavo. "Liberacao miofascial pelvica profunda (Manobra do Ligamento Largo) associada ou nao ao LPF." Revista Brasileira de Fisioterapia Pelvica 2, no. 1 (2022): 4–15. http://dx.doi.org/10.62115/rbfp.2022.2(1)4-15.
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Background: Among genitopelvic pain is the pain deep into the vagina and deeper than the uterine cervix, different from pain related to penetration or superficial connective pain. Aims: To test the view of abdominal and pelvic fascia, muscles and viscera by ultrasound (USG), as well as the view of two myofascial techniques, one intravaginal and the other external, and diaphragmatic aspiration of LPF, comparing the effectiveness of each technique alone or in combination, regarding the mobilization of visceral and parietal fasciae. Method: Exploratory experimental study guided by USG. Results: Muscles, fasciae and organs were well seeing by USG, as well as the fascial movements caused by each technique. LPF mobilized visceral fascia better, but manual techniques mobilized parietal fascia better. The Broad Ligament Maneuver mobilized both fasciae. The combination of manual techniques with LPF was superior in releasing parietal and visceral fasciae. Conclusion: Fascial mobilization can be effectively visualized by USG. The combination of manual myofascial release techniques with LPF is more effective in mobilizing all fasciae and should be the first choice.
2
Pirri, Carmelo, Nina Pirri, Andrea Porzionato, Rafael Boscolo-Berto, Raffaele De Caro, and Carla Stecco. "Inter- and Intra-Rater Reliability of Ultrasound Measurements of Superficial and Deep Fasciae Thickness in Upper Limb." Diagnostics 12, no. 9 (2022): 2195. http://dx.doi.org/10.3390/diagnostics12092195.
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Ultrasound (US) imaging is increasingly the most used tool to measure the thickness of superficial and deep fasciae, but there are still some doubts about its reliability in this type of measurement. The current study sets out to assess the inter-rater and intra-rater reliability of US measurements of superficial and deep fasciae thicknesses in the arm and forearm. The study involved two raters: the first (R1) is an expert in skeletal–muscle US imaging and, in particular, the US assessment of fasciae; the second (R2) is a radiologist resident with 1 year’s experience in skeletal–muscle US imaging. R2, not having specific competence in the US imaging of fasciae, was trained by R1. R1 took US images following the protocol by Pirri et al. 2021, and the US-recorded images were analyzed separately by the two raters in different sessions. Each rater measured both types of fasciae at different regions and levels of the arm and forearm. Intra- and inter-rater reliability was excellent for the deep fascia and good and excellent for the superficial fascia according to the different regions/levels (for example for the anterior region of the arm: deep fascia: Ant 1: ICC2,2 = 0.95; 95% CI = 0.81–0.98; superficial fascia: Ant 1: ICC2,2 = 0.85, 95% CI = 0.79–0.88). These findings confirm that US imaging is a reliable and cost-effective tool for evaluating both fasciae, superficial and deep.
3
Constantinescu, Gheorghe M., and Robert C. McClure. "Anatomy of the orbital fasciae and the third eyelid in dogs." American Journal of Veterinary Research 51, no. 2 (1990): 260–63. http://dx.doi.org/10.2460/ajvr.1990.51.02.260.
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SUMMARY 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. The body of the third eyelid was located between superficial and middle muscular fascia layers and was fixed ventrally to the lateral angle of the eye by the deep sheet of the middle muscular fascia.
4
Skandalakis, Panagiotis N., Odyseas Zoras, John E. Skandalakis, and Petros Mirilas. "Transversalis, Endoabdominal, Endothoracic Fascia: Who's Who?" American Surgeon 72, no. 1 (2006): 16–18. http://dx.doi.org/10.1177/000313480607200104.
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In Terminologia Anatomica of 1998, the fasciae of the trunk are listed as parietal, extraserosal, and visceral. Parietal fascia is defined as the fascia located outside the parietal layer of a serosa (e.g., pleura, peritoneum) lining a body wall cavity. The parietal fascia of the thorax is endothoracic fascia, and that of the abdomen is endoabdominal fascia. According to Terminologia Anatomica, endoabdominal fascia comprises: 1) transversalis fascia and 2) investing abdominal fascia: deep, intermediate and superficial. Thus, transversalis fascia is the innermost layer of endoabdominal fascia and, consequently, not synonymous with it. We assert that transversalis fascia is the inner epimysium of transversus abdominis muscle; no separate deep investing fascia exists. Embryologically, deep, intermediate and superficial layers of investing fascia are produced as muscular primordia–originating from somites invading somatopleura–penetrate somatic wall connective tissue, and thus obtain epimysium on either side, which give layers of investing fascia. In the thoracic wall, muscle layers are not separated and no distinct investing fasciae are found on them. Furthermore, in the thorax extraserosal fascia does not exist. Therefore, only endothoracic fascia is found on the inner side of the innermost intercostal muscle, which is deprived of investing fascia, to separate this muscle from pleura.
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Nash, Lance, Helen D. Nicholson, and Ming Zhang. "Does the Investing Layer of the Deep Cervical Fascia Exist?" Anesthesiology 103, no. 5 (2005): 962–68. http://dx.doi.org/10.1097/00000542-200511000-00010.
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Background The placement of the superficial cervical plexus block has been the subject of controversy. Although the investing cervical fascia has been considered as an impenetrable barrier, clinically, the placement of the block deep or superficial to the fascia provides the same effective anesthesia. The underlying mechanism is unclear. The aim of this study was to investigate the three-dimensional organization of connective tissues in the anterior region of the neck. Methods Using a combination of dissection, E12 sheet plastination, and confocal microscopy, fascial structures in the anterior cervical triangle were examined in 10 adult human cadavers. Results In the upper cervical region, the fascia of strap muscles in the middle and the fasciae of the submandibular glands on both sides formed a dumbbell-like fascia sheet that had free lateral margins and did not continue with the sternocleidomastoid fascia. In the lower cervical region, no single connective tissue sheet extended directly between the sternocleidomastoid muscles. The fascial structure deep to platysma in the anterior cervical triangle comprised the strap fascia. Conclusions This study provides anatomical evidence to indicate that the so-called investing cervical fascia does not exist in the anterior triangle of the neck. Taking the previous reports together, the authors' findings strongly suggest that deep potential spaces in the neck are directly continuous with the subcutaneous tissue.
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Chen, David Z., Aravinda Ganapathy, Yash Nayak, et al. "Analysis of Superficial Subcutaneous Fat Camper’s and Scarpa’s Fascia in a United States Cohort." Journal of Cardiovascular Development and Disease 10, no. 8 (2023): 347. http://dx.doi.org/10.3390/jcdd10080347.
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Together, the Camper’s and Scarpa’s fasciae form the superficial fat layer of the abdominal wall. Though they have clinical and surgical relevance, little is known about their role in body composition across diverse patient populations. This study aimed to determine the relationship between patient characteristics, including sex and body mass index, and the distribution of Camper’s and Scarpa’s fascial layers in the abdominal wall. A total of 458 patients’ abdominal CT examinations were segmented via CoreSlicer 1.0 to determine the surface area of each patient’s Camper’s, Scarpa’s, and visceral fascia layers. The reproducibility of segmentation was corroborated by an inter-rater analysis of segmented data for 20 randomly chosen patients divided between three study investigators. Pearson correlation and Student’s t-test analyses were performed to characterize the relationship between fascia distribution and demographic factors. The ratios of Camper’s fascia, both as a proportion of superficial fat (r = −0.44 and p < 0.0001) and as a proportion of total body fat (r = −0.34 and p < 0.0001), showed statistically significant negative correlations with BMI. In contrast, the ratios of Scarpa’s fascia, both as a proportion of superficial fat (r = 0.44 and p < 0.0001) and as a proportion of total body fat (r = 0.41 and p < 0.0001), exhibited statistically significant positive correlations with BMI. Between sexes, the females had a higher ratio of Scarpa’s facia to total body fat compared to the males (36.9% vs. 31% and p < 0.0001). The ICC values for the visceral fat, Scarpa fascia, and Camper fascia were 0.995, 0.991, and 0.995, respectively, which were all within the ‘almost perfect’ range (ICC = 0.81–1.00). These findings contribute novel insights by revealing that as BMI increases the proportion of Camper’s fascia decreases, while the ratio of Scarpa’s fascia increases. Such insights expand the scope of body composition studies, which typically focus solely on superficial and visceral fat ratios.
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Opperer, Mathias, Reinhard Kaufmann, Matthias Meissnitzer, et al. "Depth of cervical plexus block and phrenic nerve blockade: a randomized trial." Regional Anesthesia & Pain Medicine 47, no. 4 (2022): 205–11. http://dx.doi.org/10.1136/rapm-2021-102851.
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Background and objectivesCervical plexus blocks are commonly used to facilitate carotid endarterectomy (CEA) in the awake patient. These blocks can be divided into superficial, intermediate, and deep blocks by their relation to the fasciae of the neck. We hypothesized that the depth of block would have a significant impact on phrenic nerve blockade and consequently hemi-diaphragmatic motion.MethodsWe enrolled 45 patients in an observer blinded randomized controlled trial, scheduled for elective, awake CEA. Patients received either deep, intermediate, or superficial cervical plexus blocks, using 20 mL of 0.5% ropivacaine mixed with an MRI contrast agent. Before and after placement of the block, transabdominal ultrasound measurements of diaphragmatic movement were performed. Patients underwent MRI of the neck to evaluate spread of the injectate, as well as lung function measurements. The primary outcome was ipsilateral difference of hemi-diaphragmatic motion during forced inspiration between study groups.ResultsPostoperatively, forced inspiration movement of the ipsilateral diaphragm (4.34±1.06, 3.86±1.24, 2.04±1.20 (mean in cm±SD for superficial, intermediate and deep, respectively)) was statistically different between block groups (p<0.001). Differences were also seen during normal inspiration. Lung function, oxygen saturation, complication rates, and patient satisfaction did not differ. MRI studies indicated pronounced permeation across the superficial fascia, but nevertheless easily distinguishable spread of injectate within the targeted compartments.ConclusionsWe studied the characteristics and side effects of cervical plexus blocks by depth of injection. Diaphragmatic dysfunction was most pronounced in the deep cervical plexus block group.Trial registration numberEudraCT 2017-001300-30.
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Magerl, Walter, Emanuela Thalacker, Simon Vogel, et al. "Tenderness of the Skin after Chemical Stimulation of Underlying Temporal and Thoracolumbar Fasciae Reveals Somatosensory Crosstalk between Superficial and Deep Tissues." Life 11, no. 5 (2021): 370. http://dx.doi.org/10.3390/life11050370.
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Musculoskeletal pain is often associated with pain referred to adjacent areas or skin. So far, no study has analyzed the somatosensory changes of the skin after the stimulation of different underlying fasciae. The current study aimed to investigate heterotopic somatosensory crosstalk between deep tissue (muscle or fascia) and superficial tissue (skin) using two established models of deep tissue pain (namely focal high frequency electrical stimulation (HFS) (100 pulses of constant current electrical stimulation at 10× detection threshold) or the injection of hypertonic saline in stimulus locations as verified using ultrasound). In a methodological pilot experiment in the TLF, different injection volumes of hypertonic saline (50–800 µL) revealed that small injection volumes were most suitable, as they elicited sufficient pain but avoided the complication of the numbing pinprick sensitivity encountered after the injection of a very large volume (800 µL), particularly following muscle injections. The testing of fascia at different body sites revealed that 100 µL of hypertonic saline in the temporal fascia and TLF elicited significant pinprick hyperalgesia in the overlying skin (–26.2% and –23.5% adjusted threshold reduction, p < 0.001 and p < 0.05, respectively), but not the trapezius fascia or iliotibial band. Notably, both estimates of hyperalgesia were significantly correlated (r = 0.61, p < 0.005). Comprehensive somatosensory testing (DFNS standard) revealed that no test parameter was changed significantly following electrical HFS. The experiments demonstrated that fascia stimulation at a sufficient stimulus intensity elicited significant across-tissue facilitation to pinprick stimulation (referred hyperalgesia), a hallmark sign of nociceptive central sensitization.
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Zhang, Ming, and Antonio S. J. Lee. "The Investing Layer of the Deep Cervical Fascia does not Exist between the Sternocleidomastoid and Trapezius Muscles." Otolaryngology–Head and Neck Surgery 127, no. 5 (2002): 452–57. http://dx.doi.org/10.1067/mhn.2002.129823.
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OBJECTIVE: We sought to describe the 3-dimensional organization of connective tissues in the suboccipital region. STUDY DESIGN AND SETTING: We conducted a sectional anatomic investigation with the use of E12 sheet plastination. SUBJECTS: Six human adult cadavers (2 male and 4 female; age range, 54 to 86 years) were used in this study. Five of them were sectioned as 2.5-mm-thick coronal (1 cadaver), transverse (2 cadavers), or sagittal (2 cadavers) sections. RESULTS: No aggregation of fibrous connective tissue was seen between the sternocleidomastoid and trapezius muscles. The intervening space was fully occupied by fatty tissue that was indistinguishable from the subcutaneous tissue. CONCLUSIONS: The investing layer of the deep cervical fascia is incomplete so that the carotid sheath is directly exposed to the subcutaneous tissue via a gap between the sternocleidomastoid and trapezius muscle. SIGNIFICANCE: This anatomic feature should be considered when designing a minimally invasive endoscopic approach to the carotid sheath and the surrounding deep cervical structures. The eminent success of laparoscopic cholecystectomy has motivated surgeons to expend this minimally invasive surgical approach to the neck–-for example, the carotid sheath and parathyroid area. 1,2 To successfully apply this technique, the knowledge of the detailed configuration of the deep cervical fascia is essential as dissection should be kept in the correct fascial plane to avoid unnecessary damage. On the other hand, deep neck infections are still common despite the wide use of antibiotics, 3 and these infections spread along the fascial planes. 4 Understanding the fascial planes and deep neck spaces is also essential to managing these infections. Although the anatomy of the deep cervical fasciae is quite complex, its outermost or investing layer is believed to be simple and “everyone is agreed on the existence and disposition of this layer.” 5 In brief, the investing layer of the deep cervical fascia is described as a definite continuous sheet of fibrous tissue that completely encircles the neck. 6 It attaches posteriorly to the cervical spinal processes 7 via the nuchal ligament. 5 It envelops 2 muscles, the sternoclaidomastoid and trapezius, and 2 glands, the submandibular and parotid. 6,8 However, several recent reports are not consistent with this general description. For instance, a study conducted on serial sections of ten human fetuses has indicated that the superficial surface of the parotid gland is only covered by the subcutaneous tissue. 9 It has also been stated that the portion of the investing layer between the sternomastoid and trapezius is areolar connective tissue rather than dense connective tissue. 10,11 Using the E12 sheet plastination technique, Johnson et al 12 demonstrated that there is no defined nuchal ligament in the upper cervical region, indicating the lack of the direct connection between the investing layer and upper cervical vertebrae. The study of the coniguration of connective tissue in the cadaver is difficult because great difficulties exist in dissecting out the fasciae. 6 Under a dissecting microscope, one may be able to trace the aponeurotic or tendon fibres of a muscle, but it is almost impossible to distinguish between the membranous (or fibrous) part of the subcutanous tissue, deep fascia, epimysium, and epitendinium. Although histologic examination may be able to overcome the problem, the application of such method is greatly limited by the size of sample areas. The recently developed E12 sheet plastination technique provides a new approach to illustrate the detailed structural arrangement of the connective tissue at the macroscopic and microscopic levels. Therefore, the aim of this study was to use this technique to describe the 3-dimensional organization of connective tissues in the suboccipital region.
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Polselli, Roberto, Dario Bertossi, Charles East, Olivier Gerbault, and Yves Saban. "Facial Layers and Facial Fat Compartments: Focus on Midcheek Area." Facial Plastic Surgery 33, no. 05 (2017): 470–82. http://dx.doi.org/10.1055/s-0037-1606855.
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AbstractFacial cosmetic procedures are doubtless in constant augmentation directly related to fillers and botulinum toxin injections. Many articles are published in the literature to warn about the complications of these aesthetic procedures. The need for a clear anatomic classification and review of deeper ultrastructural studies on adipose tissues in the midface area are obvious. This study aims: (1) To present midface anatomy of clinical relevance in a practical way for surgeons and cosmetologists. (2) To analyze the facial fasciae related to the fat compartments. (3) To show pictures of anatomic dissections of these anatomic structures. (4) To suggest an anatomic classification. The authors analyzed the facial anatomic layers and the facial fat compartments through facial anatomical dissections and experience in the field of facial surgical and cosmetic procedures. The authors propose a dynamic three-dimensional concept of facial layers related to muscle actions and facial fat compartmentalization in the midcheek area. A “lip–lid” superficial system associated with the malar fat pad represents the first layer; two deeper lip levator systems stratification explains the deep fat compartments as an anatomic division related to fasciae extensions. Facial grooves and segments correspond to these systems action. Moreover, the importance of ultrastructural studies has been underlined.
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Bento-Rodrigues, Joana, Fernando Judas, Jorge Pedrosa Rodrigues, et al. "Necrotizing Faciitis after Shoulder Mobilization and Intra-Articular Infiltration with Betametasone." Acta Médica Portuguesa 26, no. 4 (2013): 456. http://dx.doi.org/10.20344/amp.149.
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Necrotizing Fasciitis is a rapidly progressive, potentially fatal infection of superficial fasciae and subcutaneous tissue, usually resulting from an inciting trauma to the skin. Medical literature refers few cases of necrotizing fasciitis related to intra-articular infiltrations, that often lead to patients death. This report describes the clinical events on a 55 year-old diabetic patient who developed upper extremity Necrotizing Fasciitis, 18 days after shoulder mobilization and intra-articular infiltration, due to Staphylococcus epidermidis. An early surgical debridement was performed and antibiotherapy was established, resulting in a successful outcome, despite the functional disability. We point out, through this case, the possibility of intra-articular injections of drugs causing Necrotizing Fasciitis, especially in risk patients.
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Jiang, Dongsheng, and Yuval Rinkevich. "Furnishing Wound Repair by the Subcutaneous Fascia." International Journal of Molecular Sciences 22, no. 16 (2021): 9006. http://dx.doi.org/10.3390/ijms22169006.
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Mammals rapidly heal wounds through fibrous connective tissue build up and tissue contraction. Recent findings from mouse attribute wound healing to physical mobilization of a fibroelastic connective tissue layer that resides beneath the skin, termed subcutaneous fascia or superficial fascia, into sites of injury. Fascial mobilization assembles diverse cell types and matrix components needed for rapid wound repair. These observations suggest that the factors directly affecting fascial mobility are responsible for chronic skin wounds and excessive skin scarring. In this review, we discuss the link between the fascia’s unique tissue anatomy, composition, biomechanical, and rheologic properties to its ability to mobilize its tissue assemblage. Fascia is thus at the forefront of tissue pathology and a better understanding of how it is mobilized may crystallize our view of wound healing alterations during aging, diabetes, and fibrous disease and create novel therapeutic strategies for wound repair.
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S. U., Arrvinthan. "Retrograde Spread of Buccal Space Infection into Temporal Space with Temporal Muscle Necrosis in a Medically Compromised Patient - A Case Report." Journal of Evolution of Medical and Dental Sciences 10, no. 37 (2021): 3301–5. http://dx.doi.org/10.14260/jemds/2021/689.
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Superficial temporal space lies between the temporal fasciae. Abscess in the temporal and infratemporal space is very rare. They develop as a result of the extraction of infected maxillary molars. Temporal space infections or abscesses can be seen in the superficial or deep temporal regions. A 65 - year - old male patient reported with a complaint of painful swelling over the right cheek and restricted mouth opening with a history of extraction of second mandibular molar before four weeks. On examination, an ill-defined diffuse swelling was seen. Treatment was started with IV empirical antibiotics and planned for surgical drainage. Surgical drainage of the abscess in the temporal space was done along with debridement of the necrosed temporalis muscle. Infections of the maxillofacial region are of great significance to general dentists and maxillofacial surgeons. They are of clinical importance as they are commonly encountered, and are also challenging as timely intervention is needed to prevent fatal complications. The infections arising from the tooth are initially confined to the alveolar bone and surrounding periosteum. They spread along the path of the least resistance to the cortical plates. Once the infection penetrates the cortical plates, they reach the muscle plane.1 If the infection perforated is above the muscle attachments, it’s confined to an intraoral abscess. If the cortical plates are perforated below the muscular attachments, extraoral swelling develops. The next barrier is the periosteum which is strong and elastic in nature. Once the periosteum is breached, infections reach the soft tissue planes, the fascia. Most of the infections are confined to a particular space and the surrounding fascia. Based on the toxins produced by the microorganisms, the infection can spread to adjacent spaces and even retrograde. Common deep space infections are Ludwig's angina followed by peritonsillar, submandibular, and parotid abscesses. 2 Infratemporal and temporal space infections are rarely compared to other deep space infections. Many etiological factors form the base for the infections of deep spaces, dental caries, extraction of infected, non-infected tooth maxillary sinusitis, tonsillitis, maxillary sinus fracture, temporomandibular arthroscopy, drug-induced infections. Infections of odontogenic origin, spreading along infratemporal and temporal space are most common with maxillary molars followed by mandibular molars. We report a case of retrograde spread of buccal space infection into temporal space secondary to mandibular tooth extraction.
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S. U., Arrvinthan, Lokesh Bhanumurthy, Jimson Samson, and Anandh Balasubramanian. "Retrograde Spread of Buccal Space Infection into Temporal Space with Temporal Muscle Necrosis in a Medically Compromised Patient - A Case Report." Journal of Evolution of Medical and Dental Sciences 10, no. 37 (2021): 3301–5. http://dx.doi.org/10.14260/jemds/2021/669.
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Superficial temporal space lies between the temporal fasciae. Abscess in the temporal and infratemporal space is very rare. They develop as a result of the extraction of infected maxillary molars. Temporal space infections or abscesses can be seen in the superficial or deep temporal regions. A 65 - year - old male patient reported with a complaint of painful swelling over the right cheek and restricted mouth opening with a history of extraction of second mandibular molar before four weeks. On examination, an ill-defined diffuse swelling was seen. Treatment was started with IV empirical antibiotics and planned for surgical drainage. Surgical drainage of the abscess in the temporal space was done along with debridement of the necrosed temporalis muscle. Infections of the maxillofacial region are of great significance to general dentists and maxillofacial surgeons. They are of clinical importance as they are commonly encountered, and are also challenging as timely intervention is needed to prevent fatal complications. The infections arising from the tooth are initially confined to the alveolar bone and surrounding periosteum. They spread along the path of the least resistance to the cortical plates. Once the infection penetrates the cortical plates, they reach the muscle plane.1 If the infection perforated is above the muscle attachments, it’s confined to an intraoral abscess. If the cortical plates are perforated below the muscular attachments, extraoral swelling develops. The next barrier is the periosteum which is strong and elastic in nature. Once the periosteum is breached, infections reach the soft tissue planes, the fascia. Most of the infections are confined to a particular space and the surrounding fascia. Based on the toxins produced by the microorganisms, the infection can spread to adjacent spaces and even retrograde. Common deep space infections are Ludwig's angina followed by peritonsillar, submandibular, and parotid abscesses. 2 Infratemporal and temporal space infections are rarely compared to other deep space infections. Many etiological factors form the base for the infections of deep spaces, dental caries, extraction of infected, non-infected tooth maxillary sinusitis, tonsillitis, maxillary sinus fracture, temporomandibular arthroscopy, drug-induced infections. Infections of odontogenic origin, spreading along infratemporal and temporal space are most common with maxillary molars followed by mandibular molars. We report a case of retrograde spread of buccal space infection into temporal space secondary to mandibular tooth extraction.
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Wang, Tina, Roya Vahdatinia, Sarah Humbert, and Antonio Stecco. "Myofascial Injection Using Fascial Layer-Specific Hydromanipulation Technique (FLuSH) and the Delineation of Multifactorial Myofascial Pain." Medicina 56, no. 12 (2020): 717. http://dx.doi.org/10.3390/medicina56120717.
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Background and objectives: The aims of this study were to delineate the contribution of specific fascial layers of the myofascial unit to myofascial pain and introduce the use of ultrasound-guided fascial layer-specific hydromanipulation (FLuSH) as a novel technique in the treatment of myofascial pain. Materials and Methods: The clinical data of 20 consecutive adult patients who underwent myofascial injections using FLuSH technique for the treatment of myofascial pain were reviewed. The FLuSH technique involved measuring the pain pressure threshold using an analog algometer initially and after each ultrasound guided injection of normal saline into the specific layers of the myofascial unit (superficial fascia, deep fascia, or muscle) in myofascial points corresponding with Centers of Coordination/Fusion (Fascial Manipulation®). The outcome measured was the change in pain pressure threshold after injection of each specific fascial layer. Results: Deep fascia was involved in 73%, superficial fascia in 55%, and muscle in 43% of points. A non-response to treatment of all three layers occurred in 10% of all injected points. The most common combinations of fascial layer involvement were deep fascia alone in 23%, deep fascia and superficial fascia in 22%, and deep fascia and muscle in 18% of injected points. Each individual had on average of 3.0 ± 1.2 different combinations of fascial layers contributing to myofascial pain. Conclusions: The data support the hypothesis that multiple fascial layers are responsible for myofascial pain. In particular, for a given patient, pain may develop from discrete combinations of fascial layers unique to each myofascial point. Non-response to treatment of the myofascial unit may represent a centralized pain process. Adequate treatment of myofascial pain may require treatment of each point as a distinct pathologic entity rather than uniformly in a given patient or across patients.
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Senos, R., and H. Benedicto. "Gluteal nerves in Crab-eating fox." Journal of Morphological Sciences 31, no. 04 (2014): 233–35. http://dx.doi.org/10.4322/jms.078314.
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Abstract Introduction: The Crab-eating fox is a medium-sized South American canid. Although there are several studies regarding this species, especially in epidemiology and parasitology studies, only few data regarding the morphology has been reported. The aim of our study was to describe the gluteal nerves of the Crab-eating fox and compare them with the domestic dogs for homology concerns and surgical application. Materials and Methods: We used four pelvic limbs of Crab-eating foxes fixed with 10% formalin and injected with red neoprene latex. Muscles, arteries and nerves were anatomically dissected. Results: The Cranial gluteal nerve supplied the Middle gluteal, Deep gluteal and Tensor Fasciae Latae muscles, while the Caudal gluteal nerve supplied the Middle Gluteal, Superficial Gluteal, Pirirformis, Gemilli and Coccygeus muscles. Conclusions: Our results presented a variable relation between muscles and nerve supplies between the Crab-eating fox and the domestic dogs. The indings also suggested morphological differentiation in lumbosacral plexus during canids species evolution. Finally, for surgical approaches to hip joint and pelvis, the domestic dog can be used as model for the Crab-eating fox.
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Wormald, P. J., and T. Alun-Jones. "Anatomy of the temporalis fascia." Journal of Laryngology & Otology 105, no. 7 (1991): 522–24. http://dx.doi.org/10.1017/s0022215100116500.
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AbstractThe anatomy of the different layers of the temporalis fascia is reviewed. The superficial and deep layers of the temporalis fascia have been studied by light microscopy to assess any histological difference between the two. We have also assessed the physical characteristics of the different layers by measuring their Young's modulus in the wet and dry states.Anatomically the superficial layer is part of the epicranial aponeurosis and thus covers nearly the entire lateral aspect of the skull. The deep temporal fascial layer covers exactly the temporalis muscle and measures 10 × 12 cm. The fascial layers have a separate arterial and venous supply enabling them to be used as a homograft, a rotation flap or free microvascular flap. Histologically there is no difference between the two layers. A study of the physical characteristics of the two fascial layers using Young's modulus revealed no significant difference in elasticity between the two. The most significant factor affecting the elasticity was the state of hydration of the fascia.
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Slesarenko, N. A., E. O. Oganov, and E. O. Shirokova. "Anatomical and topographic features of fascia of the gluteal-femoral region in the common lynx." International Journal of Veterinary Medicine, no. 4 (December 13, 2023): 250–62. http://dx.doi.org/10.52419/issn2072-2419.2023.4.250.
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The article presents anatomical features of the superficial and deep fascia, in particular on the pelvic limb of the common lynx, which are absent in the available literature. The material for the research was a sectional material - pelvic limbs (n= 6), selected from the common lynx, without external signs of pathologies of the musculoskeletal system. Methods of fine macro- and microanatomic dissection of the lynx's left pelvic limb were used. At the same time, a functional analysis of the studied structures and skeletotopic projection of muscles, fascia and fascial nodes were carried out. Based on the conducted studies, it was found that the deep fascia is separated from the superficial fascia by an interfacial space filled with loose connective (or fatty) tissue. In the pelvic limb area, it is represented by the gluteal-femoral fascia, and on the lower leg it continues as the deep fascia of the lower leg. In the process of dissecting the deep fascia, we noted that in the gluteal region, the deep gluteal fascia is fixed on the supracosteal ligament, in the area of the root of the tail, along the tail fold and up to the sciatic tubercle. We noted that the deep gluteal fascia begins from the vertebral head of the biceps femoris muscle and, in the cranial direction, covers successively the posterior, superficial gluteal and caudal part of the middle gluteus muscle. Along the way, the perimysium of the above muscles are interwoven into it, however, in the area of the iliac wing, it fuses with the perimysium of the middle gluteal muscle and then continues into the lumbar fascia. At the same time, it forms a fascial node in the maklok area. Distally, the deep gluteal fascia continues as the deep femoral fascia. The data obtained are the reference in assessing the structural and functional state of the fascial formations of the pelvic limb in the common lynx.
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Ribeiro, L. A., L. P. Iglesias, F. O. C. Silva, et al. "Evolutionary aspects on the origin, distribution and ramifications of the ischiadicus nerve in the giant anteater (Myrmecophaga tridactyla)." Arquivo Brasileiro de Medicina Veterinária e Zootecnia 71, no. 4 (2019): 1149–57. http://dx.doi.org/10.1590/1678-4162-10639.
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ABSTRACT This work aimed to describe the origin, distribution, and ramifications of the ischiadicus nerve in the giant anteater and to provide anatomical data which could explain not only the evolutionary aspects but also provide important information for other related works. For the present study, four specimens were used, prepared by perfusion of 10% formaldehyde solution via the femoral artery, for conservation and dissection. The origin of the right and left ischiadicus nerves in the giant anteater from the ventral ramification of the third lumbar (L3) and the first (S1), second (S2), and third (S3) sacral spinal nerves. These nerves were symmetrical in all animals studied. The distribution and ramification occurred to the superficial, middle, and deep gluteal, gemelli, piriform, quadratus femoris, tensor fasciae latae, caudal crural abductor, cranial and caudal parts of the biceps femoris, adductor, semitendinous, and cranial and caudal parts of the semimembranous muscles. Based on the origins of the ischiadicus nerves, there is a caudal migration in the nerve location in animals in a more recent position on the evolutionary scale due to reconfiguration of the lumbosacral plexus, resulting from the increase in a number of lumbar vertebrae. There is no complete homology of the muscle innervation.
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Pirri, Carmelo, Nina Pirri, Diego Guidolin, Veronica Macchi, Raffaele De Caro, and Carla Stecco. "Ultrasound Imaging of the Superficial Fascia in the Upper Limb: Arm and Forearm." Diagnostics 12, no. 8 (2022): 1884. http://dx.doi.org/10.3390/diagnostics12081884.
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The superficial fascia has received much attention in recent years due to its important role of compartmentalizing the subcutaneous tissue. Ultrasound (US) imaging, owing to its high definition, provides the possibility of better visualizing and measuring its thickness. The aim of this study was to measure and compare, with US imaging, the thickness of superficial fascia in the arm and forearm in different regions/levels. An observational study has been performed using US imaging to measure superficial fascia thickness in the anterior and posterior regions at different levels in a sample of 30 healthy volunteers. The results for superficial fascia thickness revealed statistically significant differences (p < 0.0001) in the arm between the anterior and posterior regions; in terms of forearm, some statistically significant differences were found between regions/levels. However, in the posterior region/levels of the arm, the superficial fascia was thicker (0.53 ± 0.10 mm) than in the forearm (0.41 ± 0.10 mm); regarding the anterior regions/levels, the superficial fascia of the arm (0.40 ± 0.10 mm) was not statistically different than the forearm (0.40 ± 0.12 mm). In addition, the intra-rater reliability was good (ICC2,k: 0.88). US helps to visualize and assess the superficial fascia inside the subcutaneous tissue, improving the diagnosis of fascial dysfunction, and one of the Us parameters to reliably assess is the thickness in different regions and levels.
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Olson, Krista L., and Spiros Manolidis. "The Pedicled Superficial Temporalis Fascial Flap: A New Method for Reconstruction in Otologic Surgery." Otolaryngology–Head and Neck Surgery 126, no. 5 (2002): 538–47. http://dx.doi.org/10.1067/mhn.2002.125114.
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OBJECTIVES: Our goal was to describe a novel fascial flap of the temporal region and its use for reconstruction in otologic and neurotologic surgery. METHODS: The superficial temporalis fascia has an axial blood supply derived from the middle temporal artery and can be raised independently from the overlying temporoparietal fascia or the underlying deep temporalis fascia. This flap was used on 15 consecutive patients to solve a wide variety of reconstructive problems after otologic procedures. RESULTS: No additional morbidity was observed from the use of this flap. There were no complications related to the reconstruction. Adequate exposure for raising this flap was obtained using standard incisions for the otologic procedures. Follow-up ranges from 2 to 25 months. CONCLUSIONS: This fascial flap provides a wide surface area of tissue on a narrow-based pedicle capable of a wide arc of rotation. It provides thin, pliable tissue that can be adapted to the needs of various reconstructive otologic/neurotologic problems.
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Fede, Caterina, Lucia Petrelli, Carmelo Pirri, Cesare Tiengo, Raffaele De Caro, and Carla Stecco. "Detection of Mast Cells in Human Superficial Fascia." International Journal of Molecular Sciences 24, no. 14 (2023): 11599. http://dx.doi.org/10.3390/ijms241411599.
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The recent findings showed that the superficial fascia is a fibrous layer in the middle of hypodermis, richly innervated and vascularized, and more complex than so far demonstrated. This study showed the presence of mast cells in the superficial fascia of the human abdomen wall of three adult volunteer patients (mean age 42 ± 4 years; 2 females, 1 male), by Toluidine Blue and Safranin-O stains and Transmission Electron Microscopy. Mast cells are distributed among the collagen bundles and the elastic fibers, near the vessels and close to the nerves supplying the tissue, with an average density of 20.4 ± 9.4/mm2. The demonstration of the presence of mast cells in the human superficial fascia highlights the possible involvement of the tissue in the inflammatory process, and in tissue healing and regeneration processes. A clear knowledge of this anatomical structure of the hypodermis is fundamental for a good comprehension of some fascial dysfunctions and for a better-targeted clinical practice.
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Zerbinati, Nicola, Edoardo D’Este, Antonia Icaro Cornaglia, et al. "New System Delivering Microwaves Energy for Inducing Subcutaneous Fat Reduction: In - Vivo Histological and Ultrastructural Evidence." Open Access Macedonian Journal of Medical Sciences 7, no. 18 (2019): 2991–97. http://dx.doi.org/10.3889/oamjms.2019.778.
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BACKGROUND: Recently, it has been developed a new technology for the reduction of subcutaneous adipose tissue through a non-invasive treatment by microwaves. The main objective of the present study is to demonstrate the feasibility of utilising a non-invasive, localised microwaves (MW) device to induce thermal modifications into subcutaneous adipose tissue only by a controlled electromagnetic field that heats up fat preferentially. This device is provided with a special handpiece appropriately cooled, directly contacting the cutaneous surface of the body, which provides a calibrated energy transfer by microwaves.
 AIM: In this paper, microscopic and ultrastructural modifications of subcutaneous adipose tissue induced by microwaves irradiation are evaluated.
 METHODS: Our experimental plan was designed for collecting biopsy samples, for each skin region treated with a single irradiation session, 1) before treatment (control), 2) immediately after treatment, 3) after 6 hrs, 4) after 1 month, 5) after 2 months. Bioptic samples from each step were processed for light microscopy and transmission electron microscopy. At the same time, each region where biopsies were collected was subjected to ultrasound examination. Recorded images permitted to evaluate the thickness of different layers as epidermis, dermis, hypodermis, connective fasciae, until to muscle layer, and related modifications induced by treatment.
 RESULTS: In every biopsy collected at different time-steps, epidermis and superficial dermis appeared not modified compared to control. Differently, already in the short-term biopsies, in the deep dermis and superficial hypodermis, fibrillar connective tissue appeared modified, showing reduction and fragmentation of interlobular collagen septa. The most important adipose tissue modifications were detectable following 1 month from treatment, with a significant reduction of subcutaneous fat, participating both the lysis of many adipocytes and the related phagocytic action of monocytes/macrophages on residuals of compromised structures of adipocytes. In the samples collected two months following treatment, the remnants of adipose tissue appeared normal, and macrophages were completely absent.
 CONCLUSIONS: Ultrasound, microscopic and ultrastructural evidence are supporting significant effectiveness of the new device treatment in the reduction of subcutaneous fat. In this paper, the possible mechanisms involved in the activation of the monocytes/macrophages system responsible for the removal of adipocytes residuals have also been discussed.
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Kanagamuthu, Priya, Guna Keerthana Ramesh, Aswin Vaishali Natarajan, and Rajasekaran Srinivasan. "Deep Neck Space Abscess – A Case Report." Journal of Evolution of Medical and Dental Sciences 10, no. 37 (2021): 3310–13. http://dx.doi.org/10.14260/jemds/2021/671.
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Deep neck spaces are regions of loose connective tissue present between three layers of deep cervical fascia, namely, superficial, middle, and deep layers. The investing layer is the superficial layer, the pre-tracheal layer is the intermediate layer, and the prevertebral layer is the deep layer. Deep neck space infection (DNI) is defined as an infection in the potential spaces and actual fascial planes of the neck. Spread of infection occurs along communicating fascial boundaries. These deep neck spaces may be further classified into 3 anatomic groups, relative to the hyoid bone: Those located above the level of the hyoid, those that involve the entire length of the neck, those located below the level of hyoid. The patterns of infection may include abscess formation, cellulitis, and necrotizing fasciitis. Antibiotics and surgical drainage form the mainstay of treatment. There are some spaces in the neck present between these layers of deep cervical fascia. These deep neck spaces are filled with loose connective tissue. Deep neck space infection involves the spaces and fascial planes of the neck. Spread of infection occurs along communicating fascial boundaries after overcoming the natural resistance of the fascial planes. With relation to the hyoid bone, these deep neck spaces are further classified as follows: 1. Spaces above the level of the hyoid bone (peritonsillar, submandibular, parapharyngeal, masticator, buccal, and parotid spaces). 2. Spaces that involve the entire length of the neck (retropharyngeal, prevertebral, and carotid spaces). 3. Spaces located below the level of hyoid bone (anterior visceral or pre - tracheal space). Infection may present either as abscess, cellulitis, or necrotizing fasciitis. The mainstay of the management are antibiotics and surgical drainage.
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Kersschot J. "History of Glucopuncture." World Journal of Advanced Research and Reviews 21, no. 1 (2024): 1925–33. http://dx.doi.org/10.30574/wjarr.2024.21.1.0254.
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Glucopuncture is a treatment option originating from Europe (Austria) and Asia (South Korea). It is a medical technique which uses regional injections with 5% sugar water such as D5W (or G5W) into dermis, fascia, joints, muscles and ligaments. Pain modulation is mainly achieved by intradermal, fascial and US-guided perineural injections. Biotensegrity regulation is mainly achieved by injecting into the superficial layer of regional fascia. Functional improvement is achieved by giving injections into muscles. Such intramuscular injections can support and accelerate tissue repair, which is an interesting tool when treating sports injuries in professional athletes. Especially injections into superficial fascia are becoming more popular recently because of easy application and interesting clinical outcome. Over the last decades, clinicians worldwide came to see that regional D5W injections are safe, inexpensive and efficient tools to manage musculoskeletal pain and sports injuries. Both patient-guided as well as screen-guided glucopuncture gain popularity worldwide. Clinical research so far was mainly focused on treatment of carpal tunnel syndrome with D5W.
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Yang, Lynda J. S., Vishal C. Gala, and John E. McGillicuddy. "Superficial peroneal nerve syndrome: an unusual nerve entrapment." Journal of Neurosurgery 104, no. 5 (2006): 820–23. http://dx.doi.org/10.3171/jns.2006.104.5.820.
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✓Lower-extremity pain and paresthesia have multiple origins. Early recognition of the symptoms of peripheral nerve entrapment leads to timely treatment and avoids the cost of unnecessary studies. The authors report on a case of superficial peroneal nerve syndrome resulting from nerve herniation through a fascial defect, which was responsive to surgical treatment. This 22-year-old man presented with pain and paresthesias over the lateral aspect of the right calf and the dorsum of the foot without motor weakness. Exercise led to the formation of a tender bulge approximately 12 cm above the lateral malleolus. Percussion of this site worsened his symptoms. Radiography and electromyography studies were nondiagnostic. The patient underwent surgical decompression that involved division of the fascia overlying the nerve and neurolysis of the superficial peroneal nerve. The operation resulted in symptom-free relief. Superficial peroneal nerve syndrome is an entrapment neuropathy that results from mechanical compression of the nerve at or near the point where the nerve pierces the fascia to travel within the subcutaneous tissue. Surgical decompression of the mechanical entrapment usually provides relief from pain and paresthesia.
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Buergin, Joel, Lucas Werth, René Largo, Arnaud Scherberich, Dirk J. Schaefer, and Alexandre Kaempfen. "Cross-sectional Vascularization Pattern of the Adipofascial Anterolateral Thigh Flap for Application in Tissue-engineered Bone Grafts." Plastic and Reconstructive Surgery - Global Open 10, no. 2 (2022): e4136. http://dx.doi.org/10.1097/gox.0000000000004136.
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Background: As part of the engineering of bone grafts, wrapping constructs in well-vascularized tissue, such as fascial flaps, improves bone formation. Our aim was to understand the cross-sectional vascularization pattern of human adipofascial flaps for this application. Methods: Seven adipofascial anterolateral thigh (ALT) flaps were harvested from five human cadaveric specimens. Axial vessel density was analyzed by immunohistochemistry and quantitative histology. Results: We found a high density of blood vessels directly superficial to and close to the fascia. A secondary plexus in between this first suprafascial plexus and the subdermal plexus was also identified. In all specimens, this second plexus showed less vascular density, and appeared to be at a constant level within the suprafascial fat throughout the flaps. The peak measurements for this secondary plexus varied between 1.2 and 2 mm above the deep fascia, depending on the donor’s body mass index. Conclusions: Quantitative immunohistochemistry is a reliable method to quantify and locate vessel density in an adipofascial flap. This is vital information before wrapping nonvascularized material into such a flap to estimate the inosculation potential of these vessels and likelihood of survival of the tissue. To profit from both suprafascial vascular plexuses, a correlation between subcutaneous tissue thickness and distance of the second plexus to the fascia should be further investigated. For the moment, we recommend maintaining at least 2–3 mm of subcutaneous fatty tissue on the fascia, to profit from both plexuses. Engineered constructs should be wrapped on the superficial medial side of the fascial flap to enhance vascularization.
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Broderick, James M., Keith A. Synnott, and Kevin J. Mulhall. "Minimally invasive fasciotomy using a lighted retractor in the treatment of chronic exertional compartment syndrome." Journal of Orthopaedic Surgery 28, no. 1 (2019): 230949901989280. http://dx.doi.org/10.1177/2309499019892800.
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Chronic exertional compartment syndrome can be a debilitating cause of lower leg pain that typically affects young, healthy people during a variety of aerobic activities. Conservative management has produced a poor success rate and numerous techniques for surgical decompression have been described. Many of these, however, involve blind fascial dissection which increases the risk of direct nerve injury or insufficient fascial release. We describe a novel technique of mini-open fasciotomy using a lighted retractor which enables direct visualization of the fascia and the superficial peroneal nerve using a single, small incision. By the use of a 3- to 4-cm laterally based incision, a lighted retractor with fiber-optic illumination is introduced into the subcutaneous plane and advanced distally and proximally. The retractor gently elevates the subcutaneous tissues while focusing light directly into the surgical area and a long Metzenbaum scissors is then used to release the fascia under direct vision. Fasciotomy using this technique avoids the risks of blind fascial release and is a straightforward, safe, and effective method for compartment decompression.
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Balakrishnan, C., and S. B. Vanjari. "SUPERFICIAL FASCIAL SYSTEM." Plastic and Reconstructive Surgery 89, no. 2 (1992): 378. http://dx.doi.org/10.1097/00006534-199202000-00044.
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Lopushniak, L. Ya, T. V. Khmara, O. F. Marchuk, O. M. Boichuk, L. М. Gerasym, and A. A. Halahdyna. "DEVELOPMENTAL PECULIARITIES OF TOPOGRAPHIC MORPHOLOGY OF CERVICAL FASCIA AND CELLULAR SPACES IN ANTERIOR AND LATERAL CERVICAL REGIONS IN HUMAN FETUSES." Актуальні проблеми сучасної медицини: Вісник Української медичної стоматологічної академії 20, no. 2 (2020): 150–56. http://dx.doi.org/10.31718/2077-1096.20.2.150.
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In-depth study of the peculiarities of the morphological, topographic and anatomical relationships between fascia, muscles, vessels, nerves, cellular spaces and organs of other parts of the human body requires applying an appropriate methodology of morphological research. According to some researchers, the superficial, pretracheal, and prevertebral plates of the cervical fascia develop depending on the origin and morphogenesis of the respective groups of neck muscles. Obtaining data on the development of topographic morphology of the cervical fascia and interfascial cellular spaces of the anterior and lateral areas of the neck during the fetal period of human ontogenesis is an important area of fetal anatomy and surgery and can be used for age comparison. The purpose of the study was to clarify the peculiarities of the development of the topographic morphology in the cervical fascia and interfascial cellular spaces of the anterior and lateral areas of the neck in human fetuses of 4-10 months of gestation. The study was performed on 75 human fetuses of 81.0-375.0 mm parietal coccygeal length without external signs of anatomical abnormalities or developmental anomalies of the cervical region by preparing microscopic slides of organs and structures of the anterior and lateral areas of the neck. The samples taken from fetuses weighing more than 500.0 g were investigated directly at the Chernivtsi Regional Paediatric Pathological Bureau according to the association agreement. The material was also taken from the M.G. Turkevich Museum of the Human Anatomy Department, Bukovinian State Medical University. The macroscopic and microscopic investigation of the cervical region in human fetuses of 4-7 months revealed thin, semitranslucent plates of the cervical fascia: superficial, middle (pretracheal) and deep (prevertebral). In fetuses of 8-10 months in the anterior area of the neck, the plates of the cervical fascia were clearly seen and shiny. Subcutaneous, or superficial, and intracervical fascias were fascias propria of the neck, and having no clear boundaries passed into adjacent areas. In the fetal period of human ontogenesis the interfascial cellular spaces of the anterior and lateral areas of the neck develop including suprapectoral, anterovisceral, extravisceral, antescalenous, interscalenous cellular spaces and sheath of vascular-nervous bundles of the neck. During the fetal period of human ontogenesis, there is a pronounced variation in the development and location of the plates of the cervical fascia. The authors of this study state that the research and result publication have no conflicts regarding commercial or financial relations, relations with organizations and/or individuals who may have been related to the study.
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Kersschot J. "Treatment of Fascial Pain with Glucopuncture." International Journal of Science and Research Archive 11, no. 1 (2024): 1227–34. http://dx.doi.org/10.30574/ijsra.2024.11.1.0133.
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Over the last decade, clinicians worldwide discovered that fascia plays an important role in musculoskeletal posture, balance and tensegrity. Most physicians are not fully aware that the fascial system also contains a lot of nociceptors. This may explain its potential role in vague musculoskeletal pain syndromes. However, treating fascial pain effectively is not an easy task. Recently, it has been postulated that glucopuncture – a technique which applies multiple regional injections with dextrose 5% - can regulate pain originating from fascial dysfunction. The mode of action is probably related to ATP and TRPV1. Especially the superficial layer of fascia is an interesting target for regional injections when dealing with a patient with vague pain patterns. It is particularly interesting for sports injuries, neuralgia and chronic nonrheumatic musculoskeletal pain. The major advantage of glucopuncture over steroid injections is the interesting safety profile of dextrose 5%. The disadvantages of dextrose versus steroids is that multiple injections and multiple sessions are required. The latter is particularly the case when dealing with chronic myofascial pain. It is hypothesized that glucopuncture has a very interesting balance between efficacy versus side effects. More research in this field may confirm our preliminary findings. And we hope to spread this message worldwide, especially in low-income communities.
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Cheney, Robert A., Paul G. Melaragno, Michael J. Prayson, Gordon L. Bennett, and Glen O. Njus. "Anatomic Investigation of the Deep Posterior Compartment of the Leg." Foot & Ankle International 19, no. 2 (1998): 98–101. http://dx.doi.org/10.1177/107110079801900208.
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The purpose of this study is to critically investigate the anatomy of the deep posterior compartment of the leg. Specifically, the relationship of the deep posterior compartment to the superficial posterior compartment and their insertion onto the posteromedial border of the tibia are assessed. Cross-sectioning of 10 fresh-frozen cadaver legs was performed at 2-cm increments. The inferior surface of each section was photographed. The photographs were visually analyzed, and the fascial separation between the posterior compartments along with their relationship to the posteromedial border of the tibia were recorded for each specimen. Magnetic resonance images in the axial plane of 10 healthy, normal volunteers’ lower extremities at 2-cm increments were obtained and analyzed. All specimens and images demonstrated that the medial fascial attachment of the deep posterior compartment was along the posteromedial aspect of the tibia in the proximal third of the leg and was not superficially accessible. In the proximal third of the leg, the superficial posterior compartment fascial attachment overlapped the deep posterior compartment by inserting medial and anterior to the deep posterior compartment fascial attachment. In the middle and distal thirds of the leg, the medial fascial attachment of the deep posterior compartment shifted medially and anteriorly, making the deep posterior compartment superficially accessible. The surgeon must appreciate the change in the anatomic relationships along the medial side of the leg while performing double-incision four-compartment fasciotomy release to obtain a complete release of the muscular portion of the deep posterior compartment.
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Maharaj, Shivesh, Sumaya Ahmed, and Preba Pillay. "Deep Neck Space Infections: A Case Series and Review of the Literature." Clinical Medicine Insights: Ear, Nose and Throat 12 (January 2019): 117955061987127. http://dx.doi.org/10.1177/1179550619871274.
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Deep neck spaces are regions of loose connective tissue filling areas between the 3 layers of deep cervical fascia, namely, superficial, middle, and deep layers. The superficial layer is the investing layer, The pretracheal layer is the intermediate layer and the prevertebral layer is the deepest layer. Deep neck space infection (DNI) is defined as an infection in the potential spaces and actual fascial planes of the neck. Once the natural resistance of fascial planes is overcome, spread of infection occurs along communicating fascial boundaries. More recent trends include the increasing prevalence of resistant bacterial strains, a decline in DNIs caused by pharyngitis or tonsillitis, and a relative increase in DNIs of odontogenic origin. Most DNIs are polymicrobial. Only 5% are purely aerobic and 25% with isolated anaerobes. The epidemiology of DNIs needs to be monitored for changing trends and the impact of underlying host immunity and developing microbial multidrug resistance is established. Surveillance at laboratory level should include mandatory susceptibility testing of all empiric antibiotics against microbes commonly identified in adult DNI microscopy, culture, and sensitivity (MC&S) specimens. The role of susceptibility testing of microbes not commonly identified in adult DNI MC&S specimens needs further review, on a clinical case-by-case basis.
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Komatsu, Mika, Fuminari Komatsu, Antonio Di Ieva, Tooru Inoue, and Manfred Tschabitscher. "Endoscopic Reconstruction of the Middle Cranial Fossa Through a Subtemporal Keyhole Using a Pedicled Deep Temporal Fascial Flap." Operative Neurosurgery 70, suppl_1 (2011): ons157—ons162. http://dx.doi.org/10.1227/neu.0b013e31822fedbb.
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Abstract BACKGROUND: Reconstruction of the skull base is essential to prevent postoperative leakage of cerebrospinal fluid (CSF). However, a reliable method of reconstructing the middle cranial fossa via a subtemporal keyhole is not available. OBJECTIVE: To determine whether less invasive reconstruction of the middle cranial fossa under endoscopic guidance with a pedicled deep temporal fascia approach via a subtemporal keyhole is feasible and useful. METHODS: The middle cranial fossa in 4 fresh cadaver heads was reconstructed with a 4-mm 0° rigid endoscope. RESULTS: A subtemporal skin incision (subtemporal incision) was followed by 2 small skin incisions (temporal line incisions) made on the superior temporal line. The endoscope was inserted through the temporal line incisions, and then the deep temporal fascia was separated from the superficial temporal fascia and temporal muscle under endoscopic view. A pedicled flap was harvested from the subtemporal incision and applied to the middle cranial fossa after subtemporal keyhole craniotomy. The pedicled deep temporal fascial flap was flexible, long, and large enough to overlay skull base defects. CONCLUSION: This purely endoscopic technique using a pedicled deep temporal fascial flap provided reliable reconstruction of the middle cranial fossa through a subtemporal keyhole. This technique would also be applicable in preventing CSF leakage or treating traumatic, acquired nontraumatic, or congenital encephalocele in the middle cranial fossa.
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Hu, Pei-an, and Zheng-rong Zhou. "Imaging findings of radiologically misdiagnosed nodular fasciitis." Acta Radiologica 60, no. 5 (2018): 663–69. http://dx.doi.org/10.1177/0284185118788894.
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Background Nodular fasciitis rarely occurs in young adults and children; it usually resembles other tumors, even malignancy. Purpose To review the imaging findings of six cases of nodular fasciitis misdiagnosed radiologically. Material and Methods The clinical and radiologic features of six cases of histologically proven but radiologically misdiagnosed nodular fasciitis were reviewed retrospectively. Two cases underwent both plain and enhanced computed tomography (CT) scans and the other four had both regular and enhanced magnetic resonance (MR) scans. Results All six patients were young (five children and one young adult). A rapid growing mass, pain or painless, was the most frequent presentation. Most masses were oval, well-defined, and homogeneous, with an average diameter of 2.2 cm. Five were found in superficial fascia with a broad base. Two cyst-like masses showed hypodensity relative to muscle on plain CT and without enhancement. Compared to muscle, these masses showed isointensity (n = 3) or slight hyperintensity (n = 1) on T1-weighted imaging, hyperintensity on T2-weighted imaging (n = 4), with homogeneous notable enhancement (n = 3) or mild enhancement (n = 1). Five (83.3%) were found with a “fascial tail” sign characterized as thickening of adjacent fascial layer with notable enhancement. One mass showed an “inverted target” sign. Conclusion Nodular fasciitis in young adults and children is usually superficial, rapid growing, well-defined, and homogeneous, frequently with a “fascial tail” sign. Radiologically, it can resemble a benign cyst and might be easily misdiagnosed. Therefore, nodular fasciitis should be remembered in the differential diagnosis for superficial soft tissue tumor found in young adult and children.
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Morales-Avalos, Rodolfo, and Priscila Madelein Requena-Araujo. "The Dynamic Microanatomy of skin and fascia. From the deep fascia to the skin surface." Dermatology and Dermatitis 2, no. 2 (2018): 01–05. http://dx.doi.org/10.31579/2578-8949/024.
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The study of the structure of the skin and fascia in recent years has made important advances with respect to the "dynamic anatomy" that they present, that is, the anatomical relationships and tissue interconnections that you share through different tissues. In the same way fascias have been recognized as important sources of origin of different pathologies in the last years, so the greater knowledge of their function and structure is indispensable. The aim of this article is to review the last advances in the anatomic terminology of the soft superficial tissues as advances and recent anatomical discoveries.
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WASILEWSKA, Agata, Jakub WASILEWSKI, and Andrzej PERMODA. "The effect of one-time task fascial therapy on range of motion during spinal flexion." Medycyna Manualna 1, no. 4 (2018): 5–12. http://dx.doi.org/10.5604/01.3001.0013.8446.
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The latest findings of scientists and literature, pay attention to the important role of fascia in the human body. The fascia is supplied with blood, innervated a n d b e c a u s e o f c h a r a c t e r i s t i c s construction, also very plastic. During d i a g n o s i s o f d y s f u n c t i o n o f m u s c u l o s k e l e t a l s y s t e m , it is important to look at the patient in a holistic way. In practice the fascial dysfunction is far away from the place of issue and is crucial to the impaired function. This thesis is a response for patients and therapists, who have problem with the scope of the traffic and local acting method of relaxing tight muscles does not bring the desired effects. The aim of this work is to evaluate the efficacy of a single therapy fascial method (TASK) to increase the range of motion of flexion during forward bend. The aim of researchers was to carry out the theraphy of the part of superficial back line - sacrolumbar fascia of erector spinae. Before and after therapy has been measured to lumbar flexion range of motion, bend the total spine and Thomayers test. A group of test subjects were 30 students of physiotherapy (18 women and 12 men) from the Academy of Physical Education and Sport in Gdansk. Improving the range of motion was reported in the whole group of patients.The latest findings of scientists and literature, pay attention to the important role of fascia in the human body. The fascia is supplied with blood, innervated a n d b e c a u s e o f c h a r a c t e r i s t i c s construction, also very plastic. During d i a g n o s i s o f d y s f u n c t i o n o f m u s c u l o s k e l e t a l s y s t e m , it is important to look at the patient in a holistic way. In practice the fascial dysfunction is far away from the place of issue and is crucial to the impaired function. This thesis is a response for patients and therapists, who have problem with the scope of the traffic and local acting method of relaxing tight muscles does not bring the desired effects. The aim of this work is to evaluate the efficacy of a single therapy fascial method (TASK) to increase the range of motion of flexion during forward bend. The aim of researchers was to carry out the theraphy of the part of superficial back line - sacrolumbar fascia of erector spinae. Before and after therapy has been measured to lumbar flexion range of motion, bend the total spine and Thomayers test. A group of test subjects were 30 students of physiotherapy (18 women and 12 men) from the Academy of Physical Education and Sport in Gdansk. Improving the range of motion was reported in the whole group of patients.
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Miller, Lauren E., and David A. Shaye. "Noma and Necrotizing Fasciitis of the Face and Neck." Facial Plastic Surgery 37, no. 04 (2021): 439–45. http://dx.doi.org/10.1055/s-0041-1722894.
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AbstractNecrotizing fasciitis (NF) is part of the class of necrotizing soft tissue infections characterized by rapid fascial spread and necrosis of the skin, subcutaneous tissue, and superficial fascia. If left untreated, NF can rapidly deteriorate into multiorgan shock and systemic failure. NF most commonly infects the trunk and lower extremities, although it can sometimes present in the head and neck region. This review provides an overview of NF as it relates specifically to the head and neck region, including its associated clinical features and options for treatment. Noma, a related but relatively unknown disease, is then described along with its relationship with severe poverty.
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Kanuck, David M., Thomas Zgonis, and Gary Peter Jolly. "Necrotizing Fasciitis in a Patient with Type 2 Diabetes Mellitus." Journal of the American Podiatric Medical Association 96, no. 1 (2006): 67–72. http://dx.doi.org/10.7547/0960067.
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Necrotizing fasciitis is a soft-tissue infection characterized by extensive necrosis of subcutaneous fat, neurovascular structures, and fascia. In general, fascial necrosis precedes muscle and skin involvement, hence its namesake. Initially, this uncommon and rapidly progressive disease process can present as a form of cellulitis or superficial abscess. However, the high morbidity and mortality rates associated with necrotizing fasciitis suggest a more serious, ominous condition. A delay in diagnosis can result in progressive advancement highlighted by widespread infection, multiple-organ involvement, and, ultimately, death. We present a case of limb salvage in a 52-year-old patient with type 2 diabetes mellitus and progressive fascial necrosis. A detailed review of the literature is presented, and current treatment modalities are described. Aggressive surgical debridement, comprehensive medical management of the sepsis and comorbidities, and timely closure of the resultant wound or wounds are essential for a successful outcome. (J Am Podiatr Med Assoc 96(1): 67–72, 2006)
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Putterman, Allen M. "Deep and Superficial Eyelid Fascia." Plastic and Reconstructive Surgery 129, no. 4 (2012): 721e—723e. http://dx.doi.org/10.1097/prs.0b013e318245e7a2.
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Albertin, Giovanna, Laura Astolfi, Caterina Fede, et al. "Detection of Lymphatic Vessels in the Superficial Fascia of the Abdomen." Life 13, no. 3 (2023): 836. http://dx.doi.org/10.3390/life13030836.
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Recently, the superficial fascia has been recognized as a specific anatomical structure between the two adipose layers—the superficial adipose tissue (SAT) and the deep adipose tissue (DAT). The evaluation of specific characteristics of cells, fibers, blood circulation, and innervation has shown that the superficial fascia has a clear and distinct anatomical identity, but knowledge about lymphatic vessels in relation to the superficial fascia has not been described. The aim of this study was to evaluate the presence of lymphatic vessels in the hypodermis, with a specific focus on the superficial fascia and in relation to the layered subdivision of the subcutaneous tissue into SAT and DAT. Tissue specimens were harvested from three adult volunteer patients during abdominoplasty and stained with D2-40 antibody for the lymphatic endothelium. In the papillary dermis, a huge presence of lymphatic vessels was highlighted, parallel to the skin surface and embedded in the loose connective tissue. In the superficial adipose tissue, thin lymphatic vessels (mean diameter of 11.6 ± 7.71 µm) were found, close to the fibrous septa connecting the dermis to the deeper layers. The deep adipose tissue showed a comparable overall content of lymphatic vessels with respect to the superficial layer; they followed the blood vessel and had a larger diameter. In the superficial fascia, the lymphatic vessels showed higher density and a larger diameter, in both the longitudinal and transverse directions along the fibers, as well as vessels that intertwined with one another, forming a rich network of vessels. This study demonstrated a different distribution of the lymphatic vessels in the various subcutaneous layers, especially in the superficial fascia, and the demonstration of the variable gauge of the vessels leads us to believe that they play different functional roles in the collection and transport of interstitial fluid—important factors in various surgical and rehabilitation fields.
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Kumar, Pramod, Arvind Kumar Pandey, Brijesh Kumar, K. S. Aithal, and Antony Sylvan Dsouza. "Gross anatomy of superficial fascia and future localised fat deposit areas of the abdomen in foetus." Indian Journal of Plastic Surgery 46, no. 03 (2013): 529–32. http://dx.doi.org/10.4103/0970-0358.122002.
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ABSTRACT Background: The development and popularity of body contouring procedures such as liposuction and abdominoplasty has renewed interest in the anatomy of the superficial fascia and subcutaneous fat deposits of the abdomen. The study of anatomy of fascia and fetal adipose tissue was proposed as it may be of value in understanding the possible programing of prevention of obesity. Objectives: The present study was undertaken to understand the gross anatomy of superficial fascia of abdomen and to study the gross anatomy of future localized fat deposits (LFDs) area of abdomen in fetus. Materials and Methods: Four fetus (two male & two female) of four month of intrauterine life were dissected. Attachments & layers of superficial fascia and future subcutaneous fat deposit area of upper and lower abdomen were noted. Results: Superficial fascia of the abdomen was multi layered in mid line and number of layers reduced laterally as in adult. The future abdominal LFD (localized fat deposits) area in fetus shows brownish-white blubbary tissue without well-defined adult fat lobules. Conclusion: The attachment and gross anatomy of superficial fascia of the fetus was similar to that in adults. The future LFD areas showed brownish white blubbary tissue with ill-defined fat lobules.
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Panicek, DM, and SH Leeson. "Superficial fascial calcification in epidermolysis bullosa." American Journal of Roentgenology 148, no. 3 (1987): 577–78. http://dx.doi.org/10.2214/ajr.148.3.577.
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Lockwood, Ted. "Brachioplasty with Superficial Fascial System Suspension." Plastic and Reconstructive Surgery 96, no. 4 (1995): 912–20. http://dx.doi.org/10.1097/00006534-199509001-00022.
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Aldana, Celso, Adriana Fabiola Peña, Javier Barrios, Pablo Heriberto Berra, and Renzo Destéfano. "Orbit defect reconstruction with pre-laminated temporal superficial fascia flap." Anales de la Facultad de Ciencias Médicas (Asunción) 54, no. 3 (2021): 173–78. http://dx.doi.org/10.18004/anales/2021.054.03.173.
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Herbst, Elmar, Marcio Albers, Andreas Imhoff, Freddie Fu, and Volker Musahl. "The Anterolateral Complex of the Knee." Orthopaedic Journal of Sports Medicine 6, no. 4_suppl2 (2018): 2325967118S0003. http://dx.doi.org/10.1177/2325967118s00031.
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The objective of this study was to clarify the layer-by-layer anatomy of the anterolateral complex of the knee. Twenty fresh-frozen human cadaveric knees (age range 38 - 56 yrs.) without any history of knee injury or surgery were used for this dissection study. After skin and subcutaneous tissue removal, the ITB was incised in its most anterior part and reflected posteriorly followed by blunt dissection of its deeper layers. Subsequently, an incision was made between the ITB and the short head of the biceps muscle with consecutive evaluation of the insertion site of the biceps tendon and its extensions. Once the deep layers of the ITB were identified, the connections to the lateral intermuscular septum and Kaplan fibers were cut. The superficial ITB was then reflected distally in order to assess the geographical relationship between the superficial and deep ITB as well as the distal anteromedial aspect of the biceps muscle. Finally, the anterolateral capsule was incised to evaluate its connections to the surrounding anatomic structures. The anterolateral aspect of the knee consists of three distinct layers. Superficially, the ITB with its insertion to Gerdy’s tubercle and extensions to the patella (iliopatellar band) was appreciated. Posterior reflection of the superficial ITB revealed a firm distinct connection of Kaplan fibers to the distal femoral metaphysis. The deep layer of the ITB runs from the Kaplan fibers in a distal direction and forms a functional arc. This arc is reinforced by the capsulo-osseous layer of the ITB, which originates from an area distal to the Kaplan fibers, the fascia of the lateral gastrocnemius and plantaris muscles. The distal half of the capsulo-osseous layer merges posteriorly with the fascia of the biceps muscle. The three layers of the ITB become confluent distally. Its insertion spanned from Gerdy’s tubercle to an area just posteriorly, with the capsulo-osseous layer forming the posterior part. The biceps muscle has fascial and aporoneurotical extensions, which insert to the proximal tibia together with the capsulo-osseous layer of the ITB. Layer 3 consists of the anterolateral capsule. In 7/20 (35%) specimens the mid-third capsular ligament was observed as a thickening within, but not separate from the anterolateral capsule. The anterolateral complex of the knee consists of the ITB with its three layers, the functional arc formed by the fibers between the distal femoral metaphysis and Gerdy’s tubercle, and the anterolateral capsule. In 35% of specimens a capsular thickening (mid-third capsular ligament) was identified. Surgeons should consider the complex anatomy of this functional unit, i.e. the anterolateral complex, when considering lateral extra-articular procedures.
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Zigiotti, GL, MB Liverani, and D. Ghibellini. "The relationship between parotid and superfical fasciae." Surgical and Radiologic Anatomy 13, no. 4 (1991): 293–300. http://dx.doi.org/10.1007/bf01627761.
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Hwang, Kun, and Jung Ho Choi. "Superficial Fascia in the Cheek and the Superficial Musculoaponeurotic System." Journal of Craniofacial Surgery 29, no. 5 (2018): 1378–82. http://dx.doi.org/10.1097/scs.0000000000004585.
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Park, Chan-Sol, Soo-Jin Ahn, Yeong-Bae Lee, and Chang-Ki Kang. "Effects of Polyurethane Absorber for Improving the Contrast between Fascia and Muscle in Diagnostic Ultrasound Images." Applied Sciences 14, no. 5 (2024): 2126. http://dx.doi.org/10.3390/app14052126.
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In ultrasound diagnostics, acoustic absorbers block unwanted acoustic energy or prevent the reception of echo signals from structures outside the target area. Non-metallic absorbers provide a low-echoic signal that is suitable for observing the anatomy of the area to which the absorber is attached. In this study, we aimed to evaluate the effect of a polyurethane film absorber (PU) on ultrasound diagnostic imaging and investigate its effectiveness in improving the image contrast between the fascia and muscle structures. Twenty-six healthy men in their twenties participated in this study. The experiment was performed with the participant in the supine position and with an ultrasound transducer probe placed at the center of the measurement area on the abdomen. Images of the rectus abdominis (RA; muscle) and rectus sheath, e.g., fascia including superficial fascia (SF) and deep fascia (DF), obtained after attaching a PU, were compared with those obtained without the absorber (No_PU). The thickness was measured using brightness mode ultrasound imaging. To analyze the quantitative differences in the fascia and muscle images depending on the presence of the absorber, the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were derived from the signal intensities measured in the target areas. The thickness of the fascia and muscle was similar in all regions of interest, regardless of the absorber; therefore, the existing diagnostic value was maintained. Overall, the signal intensity decreased; however, the SNRs of the RA, SF, and DF differed significantly. The SNR of the RA decreased in the PU but increased for the SF and DF. The CNRs for SF-RA and DF-RA significantly increased with the PU. In this study, we demonstrated that the PU behaved similarly to previously used metallic absorbers, reducing the signal from the attachment site while accurately indicating the attachment site in the ultrasound images. Furthermore, the results showed that the PU efficiently distinguished fascia from surrounding tissues, which could support studies requiring increased signal contrast between fascia and muscle tissue and aid the clinical diagnosis of fascial diseases.
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Caggiati, A., and S. Ricci. "The Long Saphenous Vein Compartment." Phlebology: The Journal of Venous Disease 12, no. 3 (1997): 107–11. http://dx.doi.org/10.1177/026835559701200307.
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Objective: To define the relationship between the long saphenous vein and the connective framework of the subcutaneous tissue (hypodermis) of the lower limb. Methods: The connective skeleton of the hypodermis was studied by anatomical dissection, stereomicroscopy of cross-sectioned specimens and ultrasound imaging in 88 lower extremities. Results: The long saphenous vein runs for most of its length in a narrow compartment delineated deeply by the muscular fascia and superficially by a connective tissue lamina descending from the inguinal ligament in the anteromedial part of the thigh and medial aspect of the calf. These two fascia fuse at the boundaries of the compartment. The long saphenous vein adventitia is anchored to both fasciase by thick connective tissue strands. Conclusion: The anatomical relationship between the long saphenous vein and the connective framework of the hypodermis suggests that: (1) only the vein running within the deep compartment of the hypodermis should be considered as the ‘true’ long saphenous vein; (2) the other subcutaneous veins running outside the compartment should be considered as collaterals of the long saphenous vein; (3) the connective sheath surrounding the long saphenous vein could oppose dilatation of this vessel should valvular incompetence develop; and (4) thigh muscle contraction could modify the calibre of the long saphenous vein as happens in the deep veins. Finally, the authors propose to term the deep compartment of the medial thigh and the leg hypodermis the ‘long saphenous vein compartment’ and consequently the hypodermic connective lamina, by which it is superficially delimited, as the ‘long saphenous vein fascia’.