The membranous layer of superficial fascia: evidence for its widespread distribution in the body

A discrete membranous layer, “stratum membranosum”, in human subcutaneous tissue is classically described as confined to the lower anterior abdominal wall and perineum and referred to as Scarpa’s and Colles’ fasciae, respectively. Evidence for its existence elsewhere in the body is scanty and therefore the present study was undertaken. Dissection of six embalmed adult cadavers, along with ultrasound imaging on four living subjects, were carried out to determine the existence, topography, and thickness of the membranous layer of superficial fascia in different regions of the body. In all six cadavers, a continuous layer of fibrous membrane in the superficial fascia was found consistently in all the dissected regions of the body and was also confirmed by ultrasonography. The arrangement and thickness of this membranous layer varied according to body region, body surface, and gender. It was thicker in the lower than in the upper extremity, on the posterior than anterior aspect of the body, and in females than in males. The mean thickness of the membranous layer ranged from 39 to 189 μm, being thickest in the leg and thinnest over the dorsum of the hand. The membranous layer was observed to have two or even three components in regions such as the breast, back, thigh, and arm and was seen to split, forming special compartments around subcutaneous major veins of upper and lower extremities, with fibrous septa extending to attach to the vessel wall. Functionally, the membranous superficial fascia may play a role in the integrity of the skin and support for subcutaneous structures particularly veins, by ensuring their patency. Understanding the topographic anatomy of this fascial layer may help explain body-contour deformities and provide the anatomic basis for surgical correction.     

3D reconstruction of the crural and thoracolumbar fasciae

Purpose  

To create computerized three-dimensional models of the crural fascia and of the superficial layer of the thoracolumbar fascia.     

Fascias of the male external genitalia and perineum

The fascias of the male external genitalia and perineum serve as surgical landmarks and are considered to act as initial barriers to urinary extravasation; thus they are of fundamental importance to the urologist and anatomist. There is little agreement, however, about the naming and function of these fascias because they have been defined inconsistently. The extensive use of eponyms for the fascias adds even further confusion to the proper nomenclature. Our findings, based upon dissection and magnetic resonance imaging (MRI), show that except for the single layer of dartos (smooth muscle) in the scrotum, there are two distinct layers of fascia in the penis and perineum that are continuous with each other and the anterior wall fascias. To minimize confusion, we conclude that the fascial layrs around the penis be termed the superficial and deep penile fascias, and those to which they are continuous in the perineum be termed the membranous layer of the superficial perineal fascia (the fibrous stratum that traverses the superficial fascia) and the deep perineal fascia. Their presumed role in limiting urinary extravasation is based upon relatively few well-detailed report and currently remains poorly understood. However, this may be improved upon in the future through combined application of clinical findings and MRI to individual cases of urinary extravasation. © 1994 Wiley-Liss, Inc.     

An anatomical comparison of the fasciae of the thigh: A macroscopic,microscopic and ultrasound imaging study

Although the number of Ultrasound (US) imaging studies investigating the fascial layers are becoming more numerous, the majority tend to use different reference points and terminology to describe their findings. The current work set out to compare macroscopic and microscopic data of specimens of the fascial layers of the thigh with US imaging findings. Specimens of the different fascial layers of various regions of the thigh were collected for macroscopic and histological analyses from three fresh cadavers and compared with in vivo US images of the thighs of 20 healthy volunteers. The specimens showed that the subcutaneous tissue of the thigh is made up of three layers: a superficial adipose layer, a membranous layer/superficial fascia, and a deep adipose layer. The deep fascia is composed of an aponeurotic fascia, which envelops all the thigh muscles and is laterally reinforced by the iliotibial tract and an epimysial fascia, which is specific for each muscle. The morphometric measurements of the thickness of the superficial fascia were different (anterior: 153.2 ± 39.3 µm; medial: 128.4 ± 24.7 µm; lateral: 154 ± 28.9 µm; and posterior: 148.8 ± 33.2 µm) as were those of the deep fascia (anterior: 556.8 ± 176.2 µm; medial: 820.4 ± 201 µm; lateral: 1112 ± 237.9 µm; and posterior: 730.4 ± 186.5 µm). The US scans showed a clear picture of the superficial adipose tissue, the superficial fascia, and the deep adipose tissue, as well as the deep fasciae. The epimysial and aponeurotic fasciae of only some topographic areas could be independently identified. The US imaging findings confirmed that the superficial and deep fascia have different thicknesses, and they showed that the US measurements were always larger with respect to those produced by histological analysis (p < 0.001) probably due to shrinkage during the processing. The posterior region (level 1) of the superficial fascia had, for example, a mean thickness of 0.56 ± 0.12 mm at US, while the histological analysis showed that it was 148.8 ± 33.2 µm. Showing a similar pattern, the thickness of the deep fascia was as follows: 1.64 ± 0.85 mm versus 730.4 ± 186.5 µm. Study results have confirmed that US can be considered a valid, non-invasive instrument to evaluate the fascial layers. In any event, there is a clear need for a set of standardised protocols since the thickness of the fascial layers of different parts of the human body varies and the data obtained using inaccurate reference points are not reproducible or comparable. Given the inconsistent terminology used to describe the fascial system, it would also be important to standardise the terminology used to define its parts. The difficulty in distinguishing between the epimysial and aponeurotic/deep fascia can also impede data interpretation.     

The olfactory fascia: an evo–devo concept of the fibrocartilaginous nose

Purpose

Evo–devo is the science that studies the link between evolution of species and embryological development. This concept helps to understand the complex anatomy of the human nose. The evo–devo theory suggests the persistence in the adult of an anatomical entity, the olfactory fascia, that unites the cartilages of the nose to the olfactory mucosa.

Methods

We dissected two fresh specimens. After resecting the superficial tissues of the nose, dissection was focused on the disarticulation of the fibrocartilaginous noses from the facial and skull base skeleton.

Results

Dissection shows two fibrocartilaginous sacs that were invaginated side-by-side in the midface and attached to the anterior skull base. These membranous sacs were separated in the midline by the perpendicular plate of the ethmoid. Their walls contained the alar cartilages and the lateral expansions of the septolateral cartilage, which we had to separate from the septal cartilage. The olfactory mucosa was located inside their cranial ends.

Conclusion

The olfactory fascia is a continuous membrane uniting the nasal cartilages to the olfactory mucosa. Its origin can be found in the invagination and differentiation processes of the olfactory placodes. The fibrous portions of the olfactory fascia may be described as ligaments that unit the different components of the olfactory fascia one to the other and the fibrocartilaginous nose to the facial and skull base skeleton. The basicranial ligaments, fixing the fibrocartilaginous nose to the skull base, represent key elements in the concept of septorhinoplasty by disarticulation.

     

Functional aspects of the coracoclavicular space

Background  

The coracoclavicular joint has been described as an articulation found inconstantly between the coracoid process and clavicle. We often observe a small space bordered by the fascia which covers the anterior surface of the subclavius muscle and the coracoclavicular ligament. The aim of this study was to observe the space in detail and to discuss the functional role of the coracoclavicular joint.     

Interrelation of temporal fascia,temporalis and masseter muscles

Introduction

In the study; interrelation in between the distal part of deep layer of temporal fascia, temporalis muscle and the muscle fibers of deep layer of masseter were examined in order to detect the possible different relationships in between them.

对颈动脉鞘解剖的再认识及其意义

目的　通过对颈动脉鞘与颈筋膜关系的解剖观察,探讨对颈动脉鞘的正确认识。 方法 福尔马林处理的成人尸体标本20具（40侧）。解剖观察构成胸锁乳突肌筋膜后鞘的颈筋膜浅层与颈动脉鞘是否联结、联结的紧密程度;解剖观察颈动脉鞘与颈筋膜中层、椎前筋膜浅层、深层之间的关系、联结的质地与紧密程度。 结果 颈筋膜浅层与颈动脉鞘相联结,但较疏松,钝性分离可将二者分开;颈筋膜中层由舌骨下肌群各肌肉筋膜鞘汇合后向外侧续行汇入颈动脉鞘前部;椎前筋膜浅层向外侧分为浅、深两层,浅层包绕颈总动脉、颈内静脉和迷走神经,深层不参与构成颈动脉鞘。颈筋膜中层和椎前筋膜浅层与颈动脉鞘的联结质地韧厚,联结紧密。 结论 颈动脉鞘与颈筋膜各层存在密切的联系,颈筋膜中层和椎前筋膜浅层是构成颈动脉鞘的主体。     

Clinical anatomy study of autonomic nerve with respective to the anterior approach lumbar surgery

Introduction  Male genital dysfunction was recognized as a complication following anterior approach lumbar surgery. Disruption of efferent sympathetic pathways such as the abdominal aortic plexus (AAP) and superior hypogastric plexus (SHP) which lied pre-abdominal aorta and iliac artery had been thought as the main reason. Though there were some clinical reports of retrograde ejaculation, the applied anatomic study of the autonomic nerve anterior to the lumbar was little. The purpose was to find out a lumbar surgery approach which was ejaculation preservation through the detailed study of the anatomy and histology observation of the autonomic nerve anterior to the lumbar vertebrae. Methods  The lumbar region of ten male cadavers was dissected and analyzed. We investigated the relationship between the peritoneum and abdominal aorta, iliac artery and sacral promontory fascia, as well as the trend and distribution of the autonomic nerve and SHP anterior to the L5-S1. We also observed the distribution of autonomic nerve at retroperitoneum through hematoxylin and eosin (HE)-stained tissues pre-aorta, para-aorta, and pre-vertebrae sacrales. Results  Superior hypogastric plexus, which deviated to left, located in a triangle formed by the common iliac arteries and its bilateral branches, its truck sited anterior to the lumbarsacral space in seven cases (70%), and anterior to sacrum in three cases (30%); at the aortic bifurcation, SHP strided over left iliac artery from left-hand side, then located in front of sacrum in four cases (40%), and sifted to the left at the lumbar sacral promontory in six cases (60%); from both anatomic and histological view, the autonomic nerve plexus lying in an fascia layer of retroperitoneum. Conclusion  At the anterior approach lumbar surgery of trans-peritoneum, we should choose the right-hand side incision; the SHP should be pushed aside carefully from right to left along intervertebral disc. The accurate surgical plane was at the deeper layer of autonomical nerve fascia; we also could lift the complete autonomical nerve layer which lies behind the aorta and lumbar sacral promontory, so that the autonomic nerve could be preserved.     

Three-dimensional study of the skin/subcutaneous complex using in vivo whole body 3T MRI: review of the literature and confirmation of a generic pattern of organization

Purpose

With a view to developing a tool for predicting the behavior of soft tissues during plastic surgery procedures, we looked for the existence of homologies in the overall pattern of organization of the skin/subcutaneous tissue complex between various body parts, using high-resolution in vivo imaging methods and data available in the literature.

Methods

3T MRI scanning sequences were performed using appropriate radiofrequency coils on the face, thorax, breast, abdomen and lower extremity of six healthy volunteers. The radiological findings were segmented and converted into volumetric data.

Results

The superficial and deep adipose tissue was found to be clearly separated by an intermediate layer called stratum membranosum or superficial fascia. This continuous layer covered all the anatomical parts of the body examined. It was found to have several components in the trunk and limbs and to form a continuous layer with the superficial muscular aponeurotic system in the face. A retaining connective network consisting of superficial and deep retinacula cutis detected in all the regions investigated sometimes formed more densely packed structures playing the role of skin ligaments.

Conclusion

The results of a 3T MRI study on subcutaneous tissue showed the existence of a common pattern of organization of the skin–subcutaneous tissue complex in the various parts of the body studied. This general model is subject to quantitative variations and tissue differentiation processes promoting the sliding or contractility of the supporting tissue. Three-dimensional reconstructions were obtained by post-processing the MRI images and will be used to perform pre-surgical simulations by settings a generic model that can be adapted to the different localization of the human body in a procedural way.

     

Does the Latissimus dorsi insert on the iliac crest in man? Anatomic and ontogenic study

Objective  

The Latissimus dorsi muscle is usually considered as inserted on the iliac crest, but it is separated from it by the thoracolumbar fascia. In our experience based on the harvesting of pedicled Latissimus dorsi flaps to cover cervicofacial loss of substances, we have found that in some cases, the muscular fibers of the anterior border of the muscle are directly inserted on the iliac crest. In these cases, the harvesting of the flap could be more distal.     

腹膜后间隙纵向联系的应用解剖

运用矢状断面解剖。整体层次解剖和光镜观察方法,在34具尸体标本上研究了肾筋膜和腹膜后间隙在纵向上的延伸,附着和通连,结果显示,(1)肾前筋膜其上下在不同部位与后腹壁腹膜愈合,肾后筋膜向上与膈下筋膜愈合,向下愈着髂腰筋膜,外侧与腹膜愈合;(2)肾周间隙向上伸入肝裸区,肾旁前、后间隙向上受阻于肾前、后筋膜与后腹壁腹膜和膈下筋膜的愈合处,(3)肾周间隙向下开放,延续盆部腹膜外间隙,腹股沟深面及腹前外侧壁,肾旁前、后间隙在下方互不通连。     

改良先天性肌性斜颈手术方法的解剖学研究

【摘要】目的：根据颈筋膜解剖特点,改进传统的先天性肌性斜颈的手术方法。方法：选取经福尔马林固定,颈部无肉眼病变的成人尸体标本12具。沿锁骨切开皮肤、颈阔肌,向上在颈筋膜浅层浅面（封套筋膜）进行仔细分离,观察封套筋膜和颈阔肌的相互关系,粘连程度。以锁骨上方1.5 cm水平为中心,在胸锁乳突肌内缘内侧0.5 cm纵行剪开封套筋膜约3 cm,在胸锁乳突肌后鞘深面进行分离达胸锁乳突肌外侧,感觉分离的难易程度,观察封套筋膜和颈动脉鞘的完整性。结果：封套筋膜在颈前完整、致密,将胸锁乳突肌完整套封,颈阔肌与封套筋膜可以轻易地完整分离;在颈中下部胸锁乳突肌后鞘与颈动脉鞘也无粘连,各自独立,很容易完整分离。结论：依据胸锁乳突肌前后筋膜鞘的结构特点,可以将先天性肌性斜颈传统手术加以改进,提高疗效。     

Waldeyer��s fascia: anatomical location and relationship to neighboring fasciae in retrorectal space

Purpose  

The term Waldeyer’s fascia has caused confusion in surgery for rectal cancer. We have therefore dissected endopelvic fasciae to clarify the structure and location of Waldeyer’s fascia, and to determine its anatomical relationships with adjacent fasciae.     

Prestyloid compartment of the parapharyngeal space: a histological study using late-stage human fetuses

Purpose

Although the prestyloid space is well known, its definition still remains unclear.

Methods

Using semiserial sagittal sections of 15 late-stage human fetal heads, we studied details of the topographical anatomy.

Results

A definite posterior marginal fascia of the space was seen along the anterior aspect of the stylopharyngeus and styloglossus muscles. Inferiorly, the prestyloid space faced the bucallis and medial pterygoid muscles and the submandibular gland. The external carotid artery ran along the posterolateral side of the space. The tensor veli palatini fascia did not contribute to the posterior marginal fascia. A major supplying artery of the space was the ascending palatine artery.

Conclusions

The prestyloid compartment of the parapharyngeal space (hereafter, the prestyloid space) seems to correspond to a border between the first and second pharyngeal arch derivatives. This concept may provide a better understanding of prestyloid space.     

The anatomy of nasopharyngeal carcinoma spread through the pharyngobasilar fascia to the trigeminal mandibular nerve on 1.5 T MRI

Purpose  

To analyze, from 1.5 Tesla (T) MRI clinical cases, anatomical accessibility of nasopharyngeal tumors through the pharyngobasilar fascia (PBF) to the mandibular nerve for potential perineural spread.     

MDCT of abdominal wall lumbar hernias: anatomical review, pathologic findings and differential diagnosis

Purpose

To review the anatomical landmarks of the abdominal wall lumbar region and its normal appearance on multidetector computed tomography (MDCT) and to briefly describe the MDCT features of lumbar hernias.

Methods

We performed a retrospective search of the imaging report database from November 2007 to October 2011. We retrieved the clinical data and MDCT studies of patients suffering from abdominal wall lumbar hernias. We reviewed the imaging features of abdominal lumbar hernias and compared those with the normal appearance of the lumbar region in asymptomatic individuals.

Results

We classified lumbar wall hernias as diffuse, superior (or Grynfelt–Lesshaft) and inferior (or Petit) lumbar hernias. We briefly describe the imaging features of each subtype and review the anatomy and MDCT appearance of normal lumbar region.

Conclusions

Currently available MDCT provides an excellent opportunity for reviewing the normal anatomy of the wall lumbar region and may be considered a useful modality for evaluating lumbar hernias.     

Anatomical basis of transgluteal approach for pudendal neuralgia and operative technique

Background

Pudendal neuralgia is an entrapment syndrome whose both anatomic landmarks and operative technique remain relatively unfamiliar to neurosurgeons.

Objective

To provide an outline of operative steps that is important to correct application of this approach.

Methods

Surgical illustrations are included. The different figures detail the important steps of the operation.

Results

We perform a transmuscular approach leading to the sacrotuberous ligament, which is opened sagittally. The pudendal nerve and internal pudendal artery are found to be enclosed by a fascia sheath. The pudendal nerve swings around the sacrospinous ligament sacrospinous ligament with tension. Both distal branches of the pudendal nerve can be followed, especially the rectal branch running medially. After the section of the sacrospinous ligament, the pudendal nerve can be transposed frontally to the ischial spine within the ischiorectal fat. During this maneuver, significant venous bleeding may be encountered as perineural satellite veins dilatation can accompany or surround the pudendal nerve. It is important to avoid overpacking to limit compression injury to the pudendal nerve using judiciously small pieces of hemostatic device and soft cottonoid with light pressure. Then, the obturator fascia and the membranous falciform process of the sacrotuberous ligament that extend toward the ischioanal fossa must be incised.

Conclusion

Transgluteal approach is a safe technique and we demonstrate that this approach can be performed safely minimizing pain, size of incision, surgical corridor, and trauma to adjacent muscles of buttock.