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Berardo A, Bonaldi L, Stecco C, Fontanella CG. Biomechanical properties of the human superficial fascia: Site-specific variability and anisotropy of abdominal and thoracic regions. J Mech Behav Biomed Mater 2024; 157:106637. [PMID: 38914036 DOI: 10.1016/j.jmbbm.2024.106637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/30/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024]
Abstract
Superficial fascia is a fibrofatty tissue found throughout the body. Initially described in relation to hernias, it has only recently received attention from the scientific community due to new evidence on its role in force transmission and structural integrity of the body. Considering initial difficulties in its anatomical identification, to date, a characterization of the superficial fascia through mechanical tests is still lacking. The mechanical properties of human superficial fasciae of abdominal and thoracic districts (back) of different subjects (n = 4) were then investigated, focusing on anisotropy and viscoelasticity. Experimental tests were performed on samples taken in two perpendicular directions according to body planes (cranio-caudal and latero-medial axes). Data collected from two different uniaxial tensile protocols, failure (i.e., ultimate tensile strength and strain at break, Young's modulus and toughness) and stress-relaxation (i.e., residual stress), were processed and then grouped for statistical analysis. Failure tests confirmed tissue anisotropy, revealing the stiffer nature of the latero-medial direction compared to the cranio-caudal one, for both the districts (with a ratio of the respective Young's moduli close to 2). Furthermore, the thoracic region exhibited significantly greater strength and resultant Young's modulus compared to the abdomen (with greater results along the latero-medial direction, such as 6.13 ± 3.11 MPa versus 0.85 ± 0.39 MPa and 24.87 ± 15.23 MPa versus 3.19 ± 1.62 MPa, respectively). On the contrary, both regions displayed similar strain at break (varying between 38 and 47%), with no clear dependence from the loading directions. Stress-relaxation tests highlighted the viscous behavior of the superficial fascia, with no significant differences in the stress decay between directions and districts (35-38% of residual stress after 300 s). All these collected results represent the starting point for a more in-depth knowledge of the mechanical characterization of the superficial fascia, which can have direct implications in the design, implementation, and effectiveness of site-specific treatments.
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Affiliation(s)
- Alice Berardo
- Department of Civil, Environmental and Architectural Engineering, University of Padova, 35131, Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, 35131, Padova, Italy
| | - Lorenza Bonaldi
- Department of Civil, Environmental and Architectural Engineering, University of Padova, 35131, Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, 35131, Padova, Italy.
| | - Carla Stecco
- Centre for Mechanics of Biological Materials, University of Padova, 35131, Padova, Italy; Department of Neuroscience, Institute of Human Anatomy, University of Padova, 35121, Padova, Italy
| | - Chiara Giulia Fontanella
- Centre for Mechanics of Biological Materials, University of Padova, 35131, Padova, Italy; Department of Industrial Engineering, University of Padova, 35131, Padova, Italy
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Shibuya J, Takahara M, Satake H, Takagi M. Subcutaneous Anterior Transposition With Modified Procedures to Prevent Recurrence Associated With the Transposed Ulnar Nerve. Tech Hand Up Extrem Surg 2024; 28:132-136. [PMID: 38736381 DOI: 10.1097/bth.0000000000000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Subcutaneous anterior transposition of the ulnar nerve is a common surgical treatment for cubital tunnel syndrome. However, there are surgical failures associated with the new compressive sites at the edge of flexor carpi ulnaris (FCU) and resubluxation posterior to the medial epicondyle of the transposed nerve. To reduce the muscle volume at the edge of FCU, we approach the ulnar nerve by dividing the muscle belly of the FCU humeral heads. This procedure can reduce repeated traction forces on the transposed nerve at the edge of the FCU. To keep the transposed ulnar nerve anteriorly, we use a fat flap including the membranous superficial fascia. This flap can softly stabilize the ulnar nerve and act as a pliable cover to prevent perineural scarring or further constriction around the flap. Ninety-three elbows in 90 patients who had undergone this procedure for cubital tunnel syndrome were evaluated. According to Messina's criteria, the numbers of patients showing excellent, good, fair, and poor recovery were 41 (44%), 47 (51%), 5 (5%), and 0 (0%), respectively. Most patients experience resolution of symptoms and good functional outcomes. None of the patients suffered recurrence, infection, or nerve injury.
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Affiliation(s)
- Junichiro Shibuya
- Department of Orthopedic Surgery, Izumi Orthopedic Hospital, Sendai-city, Miyagi-prefecture
| | - Masatoshi Takahara
- Department of Orthopedic Surgery, Izumi Orthopedic Hospital, Sendai-city, Miyagi-prefecture
| | - Hiroshi Satake
- Department of Orthopedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Michiaki Takagi
- Department of Orthopedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
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Karatas E, Koc K, Yilmaz M, Aydin HM. Characterization and Comparative Investigation of Hydroxyapatite/Carboxymethyl Cellulose (CaHA/CMC) Matrix for Soft Tissue Augmentation in a Rat Model. ACS OMEGA 2024; 9:31586-31600. [PMID: 39072135 PMCID: PMC11270726 DOI: 10.1021/acsomega.4c01503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/29/2024] [Accepted: 07/05/2024] [Indexed: 07/30/2024]
Abstract
This study endeavors to develop an injectable subdermal implant material tailored for soft tissue repair and enhancement. The material consists of a ceramic phase of calcium hydroxyapatite (CaHA), which is biocompatible, 20-60 μm in size, known for its biocompatibility and minimal likelihood of causing foreign body reactions, antigenicity, and minimal inflammatory response, dispersed in a carrier phase composed of carboxymethyl cellulose (CMC), glycerol, and water for injection. The gel formulation underwent comprehensive characterization via various analytical techniques. X-ray diffraction (XRD) was employed to identify crystalline phases and investigate the structural properties of ceramic particles, while thermogravimetric analysis (TGA) was conducted to evaluate the thermal stability and decomposition behavior of the final formulation. Scanning electron microscopy (SEM) was utilized to examine the surface morphology and particle size distribution, confirming the homogeneous dispersion of spherical CaHA particles within the matrix. SEM analysis revealed particle sizes ranging from approximately 20-60 μm. Elemental analysis confirmed a stoichiometric Ca/P ratio of 1.65 in the hydroxyapatite (HA) structure. Heavy metal content exhibited suitability for surgical implant use without posing toxicity risks. Rheological analysis revealed a storage modulus of 58.6 and 68.9 kPa and a loss modulus of 21.7 and 24.8 kPa at the frequencies of 2 and 5 Hz, respectively. 150 μL of sterilized CaHA/CMC was injected subcutaneously into rats and compared with a similar product, Crystalys, to assess its effects on soft tissues. Skin tissue samples of rats were collected at specific intervals throughout the study (30, 45, 60, 90 and 120 days), and examined histologically. Results demonstrated that CaHA/CMC gel led to a significant increase in dermal thickness, elastic fibers, and collagen density. Based on the findings, the formulated CaHA/CMC gel was found to be biocompatible, biodegradable, nonimmunogenic, nontoxic, safe, and effective, and represents a promising option for soft tissue repair and augmentation.
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Affiliation(s)
- Erkan Karatas
- Department
of Molecular Biology and Genetics, Erzurum
Technical University, 25100 Erzurum, Turkey
- Bioengineering
Division, Institute of Science, Hacettepe
University, 06800 Ankara, Turkey
| | - Kubra Koc
- Department
of Biology, Faculty of Science, Ataturk
University, 25240 Erzurum, Turkey
| | - Mehmet Yilmaz
- Department
of Chemical Engineering, Ataturk University, 25240 Erzurum, Turkey
| | - Halil Murat Aydin
- Bioengineering
Division, Institute of Science, Hacettepe
University, 06800 Ankara, Turkey
- Centre
for Bioengineering, Hacettepe University, 06800 Ankara, Turkey
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Štěpánková T, Quittková A, Čech Z, Machač S. Sonographic measurement of deep fascia parameters - Interrater reliability. Surg Radiol Anat 2024:10.1007/s00276-024-03423-9. [PMID: 39014213 DOI: 10.1007/s00276-024-03423-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 06/17/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE The deep fascia has recently been a current topic in many medical fields, including rehabilitation. Some research has already focused on assessing deep fascia, however results of individual authors differ in certain aspects. This study focuses on the inter-rater reliability of ultrasound (US) measurement of the thickness of deep fascia and loose connective tissue (LCT). The aim was to define the causes of any discrepancies in measurement that could contribute to the unification of management of evaluating fascia. METHODS An observational study was performed including 20 healthy individuals in whom fascia lata of the anterior thigh was examined by US imaging and then measured in Image J software. Three raters participated in this study: the first with 6 years of US imaging experience, other two were newly trained. The measurement of fascial parameters was conducted in two phases with special consultation between them resulting in an agreement of the research team on the more precise way of measurement. RESULTS Results revealed the value of inter-rater reliability ICC3,1 = 0.454 for deep fascia thickness and ICC3,1 = 0.265 for LCT thickness in the first phase and any significant difference in the second phase. This poor inter-rater reliability led to a search for possible causes of discrepancies, which authors subsequently highlighted. CONCLUSION The findings of the study show the main pitfalls of deep fascia measurement that should contribute to the unification of evaluation.
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Affiliation(s)
- Tereza Štěpánková
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
| | - Adéla Quittková
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Zdeněk Čech
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Stanislav Machač
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
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Pirri C, Petrelli L, Guidolin D, Porzionato A, Fede C, Macchi V, De Caro R, Stecco C. Myofascial junction: Emerging insights into the connection between deep/muscular fascia and muscle. Clin Anat 2024; 37:534-545. [PMID: 38476005 DOI: 10.1002/ca.24148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/13/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024]
Abstract
Muscles and fasciae are mutually connected and are influenced by force transmission. However, the anatomical connectivity and histological features of these structures remain unclear. The aim of this study was to assess the evidence for connection between muscles and deep/muscular fasciae. We assessed this relationship in different topographical regions of human cadavers and in mice. The results showed that myofascial junctions (MFJ) were made up of collagen I immune-positive structures occupying an average area of 5.11 ± 0.81 μm2, distributed in discrete regions at the interface between muscle and fascia with an average density of 9.7 ± 2.51 MFJ/mm and an average inclination angle of 35.25 ± 1.52°. These specialized structures also showed collagen III and HA immunopositivity and the presence of elastic fibers. The human myofascial junction can be visualized, opening emerging insights into the connection between deep/muscular fascia and muscle.
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Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua, Italy
| | - Lucia Petrelli
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua, Italy
| | - Diego Guidolin
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua, Italy
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua, Italy
| | - Caterina Fede
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua, Italy
| | - Veronica Macchi
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padua, Italy
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Wang H, Liu Y, Xu S, Wang T, Chen X, Jia H, Dong Q, Zhang H, Wang S, Ma H, Hou Z. Proteomics analysis of deep fascia in acute compartment syndrome. PLoS One 2024; 19:e0305275. [PMID: 38950026 PMCID: PMC11216580 DOI: 10.1371/journal.pone.0305275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/27/2024] [Indexed: 07/03/2024] Open
Abstract
Acute compartment syndrome (ACS) is a syndrome in which local circulation is affected due to increased pressure within the compartment. We previously found in patients with calf fractures, the pressure of fascial compartment could be sharply reduced upon the appearance of tension blisters. Deep fascia, as the important structure for compartment, might play key role in this process. Therefore, the aim of the present study was to examine the differences in gene profile in deep fascia tissue in fracture patients of the calf with or without tension blisters, and to explore the role of fascia in pressure improvement in ACS. Patients with lower leg fracture were enrolled and divided into control group (CON group, n = 10) without tension blister, and tension blister group (TB group, n = 10). Deep fascia tissues were collected and LC-MS/MS label-free quantitative proteomics were performed. Genes involved in fascia structure and fibroblast function were further validated by Western blot. The differentially expressed proteins were found to be mainly enriched in pathways related to protein synthesis and processing, stress fiber assembly, cell-substrate adhesion, leukocyte mediated cytotoxicity, and cellular response to stress. Compared with the CON group, the expression of Peroxidasin homolog (PXDN), which promotes the function of fibroblasts, and Leukocyte differentiation antigen 74 (CD74), which enhances the proliferation of fibroblasts, were significantly upregulated (p all <0.05), while the expression of Matrix metalloproteinase-9 (MMP9), which is involved in collagen hydrolysis, and Neutrophil elastase (ELANE), which is involved in elastin hydrolysis, were significantly reduced in the TB group (p all <0.05), indicating fascia tissue underwent microenvironment reconstruction during ACS. In summary, the ACS accompanied by blisters is associated with the enhanced function and proliferation of fibroblasts and reduced hydrolysis of collagen and elastin. The adaptive alterations in the stiffness and elasticity of the deep fascia might be crucial for pressure release of ACS.
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Affiliation(s)
- Haofei Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Yan Liu
- Department of Endocrinology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Sujuan Xu
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
- Department of Nephrology, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Tao Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Xiaojun Chen
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Huiyang Jia
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Qi Dong
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Heng Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Shuai Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
| | - Huijie Ma
- Department of Physiology, Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei Province, China
- Orthopaedic Research Institution of Hebei Province, Shijiazhuang, Hebei Province, China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
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Klein RD, Myrga JM, Redinger J, Bastacky SI, Baker EE, Quiroga-Garza GM, Rubin JP, Rusilko PJ. The Role of Suprapubic Superficial Fascial System Reconstruction During Repair of Adult-Acquired Buried Penis. Aesthetic Plast Surg 2024:10.1007/s00266-024-04182-z. [PMID: 38886196 DOI: 10.1007/s00266-024-04182-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 06/04/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Adult-Acquired Buried Penis is a disorder associated with systemic obesity that confers increased risks of malignancy, sexual dysfunction, urinary abnormalities, and psychological distress. Surgical correction improves patient-reported functional and psychological outcomes and often requires collaboration between plastic and urologic surgeons. To improve postoperative cosmetic outcomes and decrease wound complications following adult-acquired buried penis repair, we performed an anatomic and histologic study of the superficial fascial layers providing support to the external male genitalia and describe our approach for fascial reconstruction. METHODS We characterized the superficial fascial anatomy in three patients undergoing adult-acquired buried penis repair, including two patients with Wisconsin Type II disease and one patient with Wisconsin Type IV disease. Gross specimens were sent from two patients histologic analysis using H&E and elastin-specific stains to characterize the identity of the superficial fibrofatty tissue. RESULTS In all three patients, the fundiform ligament overlying the suspensory ligament was identified, isolated, and transected for removal with the suprapubic specimen. We found that reapproximation of this ligament following transection at the time of escutcheonectomy provided significant lift to the penis and genitals via improved support of dartos fascia. Histologic analysis of the superficial fibrofatty tissue located beneath the dermis revealed histologic similarities with the superficial fascial system described previously in abdominal and breast tissue. CONCLUSIONS Reapproximation of the fundiform ligament and superficial fascial tissue following suprapubic/lower abdominal fat pad removal during adult-acquired buried penis may improve postoperative cosmesis by reducing strain on the dermal closure. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .
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Affiliation(s)
- Roger D Klein
- UPMC Department of Urology, UPMC, 3471 Fifth Ave, Suite 801, Pittsburgh, PA, 15213, USA
| | - John M Myrga
- UPMC Department of Urology, UPMC, 3471 Fifth Ave, Suite 801, Pittsburgh, PA, 15213, USA
| | - Juliet Redinger
- UPMC Department of Pathology, UPMC, 1515 Locust St, Pittsburgh, PA, 15219, USA
| | - Sheldon I Bastacky
- UPMC Department of Pathology, UPMC, 1515 Locust St, Pittsburgh, PA, 15219, USA
| | - Evan E Baker
- UPMC Department of Pathology, UPMC, 1515 Locust St, Pittsburgh, PA, 15219, USA
| | | | - J Peter Rubin
- UPMC Department of Plastic Surgery, 3601 Fifth Ave #6B, Pittsburgh, PA, 15213, USA
| | - Paul J Rusilko
- UPMC Department of Urology, UPMC, 3471 Fifth Ave, Suite 801, Pittsburgh, PA, 15213, USA.
- UPMC Department of Plastic Surgery, 3601 Fifth Ave #6B, Pittsburgh, PA, 15213, USA.
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Fede C, Petrelli L, Pirri C, Tiengo C, De Caro R, Stecco C. Detection of Mast Cells in Human Superficial Fascia. Int J Mol Sci 2023; 24:11599. [PMID: 37511360 PMCID: PMC10380524 DOI: 10.3390/ijms241411599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
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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Affiliation(s)
- Caterina Fede
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Via Gabelli 65, 35121 Padova, Italy
| | - Lucia Petrelli
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Via Gabelli 65, 35121 Padova, Italy
| | - Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Via Gabelli 65, 35121 Padova, Italy
| | - Cesare Tiengo
- Plastic and Reconstructive Surgery Unit, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Via Gabelli 65, 35121 Padova, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Via Gabelli 65, 35121 Padova, Italy
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Albertin G, Astolfi L, Fede C, Simoni E, Contran M, Petrelli L, Tiengo C, Guidolin D, De Caro R, Stecco C. Detection of Lymphatic Vessels in the Superficial Fascia of the Abdomen. Life (Basel) 2023; 13:life13030836. [PMID: 36983991 PMCID: PMC10058564 DOI: 10.3390/life13030836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/03/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
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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Affiliation(s)
- Giovanna Albertin
- Department of Neuroscience (DNS), Section of Human Anatomy, University of Padova, 35122 Padova, Italy
| | - Laura Astolfi
- Bioacoustics Research Laboratory, Department of Neuroscience (DNS), University of Padova, 35129 Padova, Italy
- Interdepartmental Research Center of International Auditory Processing Project in Venice (I-APPROVE), Department of Neurosciences, University of Padova, Santi Giovanni e Paolo Hospital, ULSS3 Serenissima, 30122 Venezia, Italy
| | - Caterina Fede
- Department of Neuroscience (DNS), Section of Human Anatomy, University of Padova, 35122 Padova, Italy
| | - Edi Simoni
- Bioacoustics Research Laboratory, Department of Neuroscience (DNS), University of Padova, 35129 Padova, Italy
- Interdepartmental Research Center of International Auditory Processing Project in Venice (I-APPROVE), Department of Neurosciences, University of Padova, Santi Giovanni e Paolo Hospital, ULSS3 Serenissima, 30122 Venezia, Italy
| | - Martina Contran
- Department of Neuroscience (DNS), Section of Human Anatomy, University of Padova, 35122 Padova, Italy
| | - Lucia Petrelli
- Department of Neuroscience (DNS), Section of Human Anatomy, University of Padova, 35122 Padova, Italy
| | - Cesare Tiengo
- Clinic of Plastic Surgery, Padova University Hospital, 35128 Padova, Italy
| | - Diego Guidolin
- Department of Neuroscience (DNS), Section of Human Anatomy, University of Padova, 35122 Padova, Italy
| | - Raffaele De Caro
- Department of Neuroscience (DNS), Section of Human Anatomy, University of Padova, 35122 Padova, Italy
| | - Carla Stecco
- Department of Neuroscience (DNS), Section of Human Anatomy, University of Padova, 35122 Padova, Italy
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Fascia Layer-A Novel Target for the Application of Biomaterials in Skin Wound Healing. Int J Mol Sci 2023; 24:ijms24032936. [PMID: 36769257 PMCID: PMC9917695 DOI: 10.3390/ijms24032936] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
As the first barrier of the human body, the skin has been of great concern for its wound healing and regeneration. The healing of large, refractory wounds is difficult to be repaired by cell proliferation at the wound edges and usually requires manual intervention for treatment. Therefore, therapeutic tools such as stem cells, biomaterials, and cytokines have been applied to the treatment of skin wounds. Skin microenvironment modulation is a key technology to promote wound repair and skin regeneration. In recent years, a series of novel bioactive materials that modulate the microenvironment and cell behavior have been developed, showing the ability to efficiently facilitate wound repair and skin attachment regeneration. Meanwhile, our lab found that the fascial layer has an indispensable role in wound healing and repair, and this review summarizes the research progress of related bioactive materials and their role in wound healing.
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Pirri C, Petrelli L, Fede C, Guidolin D, Tiengo C, De Caro R, Stecco C. Blood supply to the superficial fascia of the abdomen: An anatomical study. Clin Anat 2022; 36:570-580. [PMID: 36576229 DOI: 10.1002/ca.23993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/21/2022] [Accepted: 12/11/2022] [Indexed: 12/29/2022]
Abstract
The aim of this study was to examine data demonstrating that Scarpa's fascia, a superficial fascia of the anterior abdominal wall, is a vascularized tissue. Specimens of the fascia of seven volunteers undergoing abdominoplasty surgical procedures at the Plastic Surgery Unit of the University of Padova Medical Center were collected. Fractal analysis and quantitative assessment of the vascular network of the fascia was carried out, exploiting the presence of blood in the vessels. Each sample was divided and processed for histological/immunohistochemical analysis (into 5 micron-paraffin embedded sections and cryo-sectioned free-floating samples) as well as for electron microscopy study. A rich vascular pattern forming a fine, dense meshwork with an area percentage of 6.20% ± 2.10% von Willebrand factor stained vessels was noted in all the specimens of the fascia examined; the area percentage of the αSMA-stained vessels was 2.93% ± 1.80%. The diameters of the vessels fell between the 13 and 65 μm range; the network was composed of arteries, veins, capillaries and lymphatic segments. Topological results showed that the vascular network within Scarpa's fascia is well branched (segments: 6615 ± 3070 and 8.40 ± 3.40 per mm2 ; crossing points: 3092 ± 1490 and 3.40 ± 1.90 per mm2 ). Fractal analysis (fractal dimension = 1.063 ± 0.10; lacunarity = 0.60 ± 0.10) revealed that this particular vascular network has an optimal spatial distribution and homogeneity occupying the entire space of the superficial fascia. These findings could undoubtedly be useful to plastic surgeons as well as to pain management specialists.
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Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy
| | - Lucia Petrelli
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy
| | - Caterina Fede
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy
| | - Diego Guidolin
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy
| | - Cesare Tiengo
- Department of Neurosciences, The Plastic Surgery Unit of the University of Padova Medical Center, Padova, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy
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12
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Dong Y, Zhang D, Cao Y, Zhang Y, Sun X, Chen T, Zhang Y, Xu G. Mathematical analysis for spatial distribution of vessels, mast cells and adipocytes in superficial fascia. Front Physiol 2022; 13:1026019. [PMID: 36452040 PMCID: PMC9702360 DOI: 10.3389/fphys.2022.1026019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/31/2022] [Indexed: 12/18/2023] Open
Abstract
As a novel origin of adipocytes, the superficial fascia, a typical soft connective tissue, has abundant adipocytes and preadipocytes, accompanied by numerous mast cells. Blood vessels pass through the fascia to form a network structure. The more reasonable statistical analysis methods can provide a new method for in-depth study of soft connective tissue by clarifying the spatial distribution relation between cells (point structure) and blood vessels (linear structure). This study adopted the Guidolin et al. statistical analysis methods used by epidemiology and ecology to quantitatively analyze the distribution pattern and correlations among blood vessels, adipocytes, and mast cells. Image-processing software and self-written computer programs were used to analyze images of whole-mounted fascia, and the relevant data were measured automatically. Voronoi's analysis revealed that the vascular network was non-uniformly distributed. In fascia with average area of 3.75 cm2, quantitative histological analysis revealed 81.16% of mast cells and 74.74% of adipocytes distributed within 60 μm of blood vessels. A Spearman's correlation coefficient (rs) of >0.7 showed the co-distribution of the two types of cells under different areas. Ridge regression analysis further revealed the spatial correlation among blood vessels, adipocytes and mast cells. The combination of classical epidemiological analysis and extended computer program analysis can better analyze the spatial distribution relation between cells and vessels and should provide an effective analysis method for study of the histology and morphology of fascia and related connective tissues.
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Affiliation(s)
- Yingyue Dong
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Dandan Zhang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Yingri Cao
- Department of Civil Engineering, Tsinghua University, Beijing, China
| | - Yanfei Zhang
- Department of Anatomy, School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaozhe Sun
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Tongsheng Chen
- Key Laboratory of Functional and Clinical Translational Medicine, Department of Physiology, Xiamen Medical College, Xiamen, China
| | - Yuanyuan Zhang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Guoheng Xu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Beijing, China
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Manon J, Evrard R, Maistriaux L, Fievé L, Heller U, Magnin D, Boisson J, Kadlub N, Schubert T, Lengelé B, Behets C, Cornu O. Periosteum and fascia lata: Are they so different? Front Bioeng Biotechnol 2022; 10:944828. [DOI: 10.3389/fbioe.2022.944828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: The human fascia lata (HFL) is used widely in reconstructive surgery in indications other than fracture repair. The goal of this study was to compare microscopic, molecular, and mechanical properties of HFL and periosteum (HP) from a bone tissue engineering perspective.Material and Methods: Cadaveric HP and HFL (N = 4 each) microscopic morphology was characterized using histology and immunohistochemistry (IHC), and the extracellular matrix (ECM) ultrastructure assessed by means of scanning electron microscopy (SEM). DNA, collagen, elastin, glycosaminoglycans, major histocompatibility complex Type 1, and bone morphogenetic protein (BMP) contents were quantified. HP (N = 6) and HFL (N = 11) were submitted to stretch tests.Results: Histology and IHC highlighted similarities (Type I collagen fibers and two-layer organization) but also differences (fiber thickness and compaction and cell type) between both tissues, as confirmed using SEM. The collagen content was statistically higher in HFL than HP (735 vs. 160.2 μg/mg dry weight, respectively, p < 0.0001). On the contrary, DNA content was lower in HFL than HP (404.75 vs. 1,102.2 μg/mg dry weight, respectively, p = 0.0032), as was the immunogenic potential (p = 0.0033). BMP-2 and BMP-7 contents did not differ between both tissues (p = 0.132 and p = 0.699, respectively). HFL supported a significantly higher tension stress than HP.Conclusion: HP and HFL display morphological differences, despite their similar molecular ECM components. The stronger stretching resistance of HFL can specifically be explained by its higher collagen content. However, HFL contains many fewer cells and is less immunogenic than HP, as latter is rich in periosteal stem cells. In conclusion, HFL is likely suitable to replace HP architecture to confer a guide for bone consolidation, with an absence of osteogenicity. This study could pave the way to a bio-engineered periosteum built from HFL.
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Fede C, Petrelli L, Pirri C, Neuhuber W, Tiengo C, Biz C, De Caro R, Schleip R, Stecco C. Innervation of human superficial fascia. Front Neuroanat 2022; 16:981426. [PMID: 36106154 PMCID: PMC9464976 DOI: 10.3389/fnana.2022.981426] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
The superficial fascia has only recently been recognized as a specific anatomical structure. Furthermore, whereas it is actually recognized that the innervation of the deep/muscular fascia plays a key role in proprioception and nociception, there are very few studies that have analyzed these characteristics in the superficial fascia. In this work, our group analyzed two different anatomical districts (abdomen and thigh), from volunteer patients, undergoing surgery procedures. Each sample was processed for histological analysis by Hematoxylin&Eosin, and by immunohistochemistry stainings (in 5-micron-paraffin embedded section and in cryosectioned free floating samples), with antibodies specific for nerve fibers: S100 antibody for myelinating and non-myelinating Schwann cells, PGP9.5 antibody as pan-neuronal marker, tyrosine hydroxylase for autonomic innervation. The results revealed a huge innervation: the nervous structures were found above all around blood vessels and close to adipocytes, but they penetrated also in the connective tissue itself and are found in the midst of fibro-adipose tissue. The tissue is pervaded by both thin (mean diameter of 4.8 ± 2.6 μm) and large nerve fiber bundles of greater diameter (21.1 ± 12.2 μm). The ratio S100/TH positivity was equal to 2.96, with a relative percentage of autonomic innervation with of 33.82%. In the light of these findings is evident that the superficial fasciae have a clear and distinct anatomical identity and a specific innervation, which should be considered to better understand their role in thermoregulation, exteroception and pain perception. The knowledge of the superficial fascia may improve grading and developing of different manual approach for treatments of fascial dysfunctions, and the understanding of how some factors like temperature or manual therapies can have an impact on sensitivity of the fascia.
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Affiliation(s)
- Caterina Fede
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Padua, Italy
- *Correspondence: Caterina Fede
| | - Lucia Petrelli
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Padua, Italy
| | - Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Padua, Italy
| | - Winfried Neuhuber
- Institute of Anatomy and Cell Biology, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Cesare Tiengo
- Plastic and Reconstructive Surgery Unit University of Padua, Padua, Italy
| | - Carlo Biz
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, Padua, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Padua, Italy
| | - Robert Schleip
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Padua, Italy
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Ultrasound Imaging of the Superficial Fascia in the Upper Limb: Arm and Forearm. Diagnostics (Basel) 2022; 12:diagnostics12081884. [PMID: 36010234 PMCID: PMC9406830 DOI: 10.3390/diagnostics12081884] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/26/2022] [Accepted: 07/31/2022] [Indexed: 12/29/2022] Open
Abstract
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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Ricci V, Ricci C, Cocco G, Donati D, Farì G, Mezian K, Naňka O, Özçakar L. From Histology to Sonography in Skin and Superficial Tissue Disorders: EURO-MUSCULUS/USPRM* Approach. Pathol Res Pract 2022; 237:154003. [DOI: 10.1016/j.prp.2022.154003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 12/12/2022]
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Pirri C, Petrelli L, Pérez-Bellmunt A, Ortiz-Miguel S, Fede C, De Caro R, Miguel-Pérez M, Stecco C. Fetal Fascial Reinforcement Development: From "a White Tablet" to a Sculpted Precise Organization by Movement. BIOLOGY 2022; 11:biology11050735. [PMID: 35625463 PMCID: PMC9138366 DOI: 10.3390/biology11050735] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 01/12/2023]
Abstract
Simple Summary Nowadays, the number of studies concerning fasciae is increasing, but few studies focus on fetal fasciae development and there is no study on the retinacula. The latter are fascial reinforcements with a crucial role in proprioception and coordination. We aimed to identify their structural organization by qualitative and quantitative assessments, to establish their role in myofascial development, highlighting their appearance and organization. Our data strongly suggest that the movement models the fascial reinforcements, structuring the fascial system, particularly at the end of the pregnancy. Abstract Fasciae have received much attention in recent years due to their important role in proprioception and muscular force transmission, but few studies have focused on fetal fasciae development and there is no study on the retinacula. The latter are fascial reinforcements that play a key role in proprioception and motor coordination. Furthermore, it is still unclear if they are genetically determined or if they are defined by movements, and if they are present during gestation or if they appear only later in the childhood. We aim to identify their structural organization by qualitative and quantitative assessments to establish their role the myofascial development, highlighting their appearance and organization. Samples from the wrist retinacula, posterior forearm, ankle retinacula, anterior leg, iliotibial tract and anterior thigh of six fetus body donors (from 24th to 40th week of gestation) and histological sections were obtained and a gross anatomy dissection was performed. Sections were stained with hematoxylin-eosin to observe their overall structure and measure their thicknesses. Using Weigert Van Gieson, Alcian blue and immunostaining to detect Hyaluronic Acid Binding Protein (HABP), Collagens I and III (Col I and III) were realized to assess the presence of elastic fibers and hyaluronan. This study confirms that the deep fasciae initially do not have organized layers and it is not possible to highlight any reinforcement. The fascial development is different according to the various area: while the deep fascia and the iliotibial tract is already evident by the 27th week, the retinacula begin to be defined only at the end of pregnancy, and their complete maturation will probably be reached only after birth. These findings suggest that the movement models the retinacula, structuring the fascial system, in particular at the end of pregnancy and in the first months of life. The fasciae can be imagined, initially, as “white tablets” composed of few elastic fibers, abundant collagens and HA, on which various forces, u movements, loads and gravity, “write their history”.
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Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (L.P.); (C.F.); (R.D.C.)
- Correspondence: (C.P.); (C.S.)
| | - Lucia Petrelli
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (L.P.); (C.F.); (R.D.C.)
| | - Albert Pérez-Bellmunt
- Basic Sciences Department, Universitat Internacional de Catalunya, 08017 Barcelona, Spain; (A.P.-B.); (S.O.-M.); (M.M.-P.)
- ACTIUM Functional Anatomy Group, Faculty of Medicine and Health Sciences, 08195 Barcelona, Spain
| | - Sara Ortiz-Miguel
- Basic Sciences Department, Universitat Internacional de Catalunya, 08017 Barcelona, Spain; (A.P.-B.); (S.O.-M.); (M.M.-P.)
- ACTIUM Functional Anatomy Group, Faculty of Medicine and Health Sciences, 08195 Barcelona, Spain
- Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, 08907 Hospitalet del Llobregat, Spain
| | - Caterina Fede
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (L.P.); (C.F.); (R.D.C.)
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (L.P.); (C.F.); (R.D.C.)
| | - Maribel Miguel-Pérez
- Basic Sciences Department, Universitat Internacional de Catalunya, 08017 Barcelona, Spain; (A.P.-B.); (S.O.-M.); (M.M.-P.)
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy; (L.P.); (C.F.); (R.D.C.)
- Correspondence: (C.P.); (C.S.)
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