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Fascial Anatomy
Published in David Lesondak, Angeli Maun Akey, Fascia, Function, and Medical Applications, 2020
The deep fascia can be divided into the aponeurotic and epimysial fascia according to orientation, composition, and architecture. Aponeurotic fasciae are formed by two to three layers of parallel bundles of collagen fibers. Each layer is separated from the adjacent one by a thin layer of loose connective tissue (Figure 2.2).
The Cause of Pressure Sores
Published in J G Webster, Prevention of Pressure Sores, 2019
Skeletal muscle constitutes about 40% of the total body weight in man (Heistad and Abboud 1974). Muscle is surrounded and penetrated by layers of fibrous, avascular connective tissue called deep fascia. At rest the total blood flow through muscle is about 1 1/min; strenuous exercise increases this flow up to 25 1/min. Blood flow to muscle is determined by arterial pressure and vascular resistance in muscle. Studies in animals have shown that muscle and subcutaneous tissue are more susceptible to pressure-induced injury than the epidermis (Daniel et al 1981). Harman (1948) demonstrated that muscle is extremely sensitive to ischemia and that degeneration begins after 4 h of ischemia. Muscle fibers degenerate after exposure to contact pressure of 60 to 70 mm Hg for 1 to 2 h (Kosiak 1959). Muscle has a high tensile strength because of its fibers but it has a poor tolerance for compression and angulation (Torrance 1983).
Fascial Syndromes
Published in Kohlstadt Ingrid, Cintron Kenneth, Metabolic Therapies in Orthopedics, Second Edition, 2018
While anatomy books like to divide fascia into discrete units and aggregates, it is vital to remember that all these parts, pieces and layers are part of one system. Starting just under the skin with the more superficial or areolar layer to the deep fascia or fascia profunda. The deep fascia comprises all the layers that interact with the musculoskeletal body (Figure 21.2). The deep fascia is highly organized and very much like an elastic, full-length body stocking – the innermost layer peeling away to form an epimysium, a pocket around each muscle. These epimysial pockets are free to glide due to hyaluronan [5]. This layer continues to the bundled perimysium, down to each individual muscle fiber wrapped in its own endomysium. This honeycomb arrangement allows for load sharing among the individual myofibers. Electron microscope studies have also revealed collagen fibers running in a more perpendicular fashion, creating a longitudinal network through the epimysium to the adjacent antagonistic muscle [16]. Other imaging studies clearly show the collagen fibers getting smaller and smaller, going all the way down to and through individual cell walls [17].
The superficial peroneal neurocutaneous flap: a cadaveric study
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Thepparat Kanchanathepsak, Katanyata Kunsook, Wasit Panoinont, Chinnawut Suriyonplengsaeng, Sorasak Suppaphol, Ittirat Watcharananan, Panithan Tuntiyatorn, Tulyapruek Tawonsawatruk
To ensure that the vascularity of the flap was provided by the paraneural vessels, and the subcutaneous layer was nourished by neurocutaneous perforators that received blood supply from the perforating branches of the dorsalis pedis artery, the proximally based SPNC flap was harvested before methylene blue injection. The deep fascia was included while the paratenon was left intact during flap dissection. The advantage of deep fascia inclusion is that it helps to protect the neurovascular axis while facilitating dissection [3]. The procedure correlates with that used in our previous study, performed on the upper extremities [23]. In this study, while numerous proximally perforating branches of the dorsalis pedis artery were found 1 cm distal to the anterior ankle joint line, the average distance was calculated as 1.51 cm along the same direction. In addition, to increase the mobility of the flap, the extensor retinaculum was proximally dissected to identify the perforating branches of the anterior tibialis vessel to create the proximal pivot point and long pedicle to cover the lower leg area. These perforator findings are consistent with a previous study that reported branching, at approximately 4 cm proximal to the intermalleolar line [11,24]. However, in this study, we focused on the proximal perforating branch of the dorsalis pedis artery, to avoid injury to the extensor retinaculum. Usually, if the donor site defect is unable to primary closure, it would be cover by split thickness skin graft.
Immune-cell infiltration in high-grade soft tissue sarcomas; prognostic implications of tumor-associated macrophages and B-cells
Published in Acta Oncologica, 2023
Helena Nyström, Mats Jönsson, Mef Nilbert, Ana Carneiro
High-grade tumors were defined as grade 3–4, corresponding to grade 3 in the Féderation Nationale des Centers de Lutte Contre le Cancer (FNCLCC) grading system. In Scandinavia, prognostication of STS is based on the combination of the SING- factors, i.e., size >8 cm, vascular invasion, necrosis and growth pattern. Necrosis was defined as the presence of amorphous cellular debris, typically associated with a neutrophil polynuclear response, and was dichotomized as present/absent. Vascular invasion was defined as tumor cells surrounded by an endothelial lining with tumor cells required to be adherent to the luminal aspect of the vessel wall or associated with adherent fibrin, red blood cells or leukocytes, and was classified as absent/present. Depth was defined in relation to deep fascia and was classified as subcutaneous/deep. Growth pattern is defined as either pushing or infiltrative. Clustering of CD20+ lymphocytes within the tumor area was noted when present. Patient data and tumor characteristics are summarized and presented in Table 1.
Perinatal pubic symphysis separation combined with pubic fracture: a case report and literature review
Published in Journal of Obstetrics and Gynaecology, 2022
Liang Deng, Liang-Yu Xiong, Ji-Huan Zeng, Qiang Xiao, Yuan-Huan Xiong
After the definite diagnosis, the patient underwent the open reduction and internal fixation of the pubic symphysis separation and pubic fracture, as well as the repair of perineum. Under general anaesthesia, the patient was placed in a supine position and exposed through the Stoppa approach. The skin, subcutaneous tissue, deep fascia and muscle were incised layer by layer. Soft tissue beneath the pubic symphysis was widely torn, the separation of pubic symphysis was about 8 cm, and the right pubic branch split horizontally and horizontally. Then, the separated pubic symphysis was repositioned horizontally and vertically with the push rod, then fixed with two reduction screws, and further fixed with steel plates. Ultimately, the fixation position of screws and steel plates were verified by the C-arm fluoroscopy. After the operation of open reduction and internal fixation, the patient was then placed in the lithotomy position. The partial tissue and clitoris tears were seen from the upper part of urethral orifice to pubic symphysis, and sutured with the 2-0 absorbable suture.