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Deep Fascia

James Bowness, Katie Turnbull, Alasdair Taylor, Jayne Halcrow, Fraser Chisholm, Calum Grant, Ourania Varsou
Regional anesthesia relies on a sound understanding of anatomy and the utility of ultrasound in identifying relevant structures. We assessed the ability to identify the point at which the superficial peroneal nerve (SPN) emerges through the deep fascia by ultrasound on 26 volunteers (mean age 27.85 years ±13.186; equal male:female). This point was identified, characterized in relation to surrounding bony landmarks (lateral malleolus and head of the fibula), and compared to data from 16 formalin-fixed human cadavers (mean age 82...
December 10, 2018: Clinical Anatomy
Xiao Yang, Woonhyeok Jeong, Daegu Son, Youngwook Ryoo, Jinhee Kim, Youngkee Oh, Sunyoung Kwon, Dalie Liu
INTRODUCTION: Radiation-delayed wounds require diverse therapeutic strategies to achieve effective healing. However, the development of novel therapies with a radiation-delayed wound healing model is hindered by the lack of standardized animal models. OBJECTIVE: In this study, the authors propose and verify a procedure to establish a radiation-delayed wound healing model in pigs. MATERIALS AND METHODS: Two female pigs received a single 18-Gy dose of a 6-MeV electron beam per 18 cm x 8 cm area...
November 22, 2018: Wounds: a Compendium of Clinical Research and Practice
Benjamin H Miranda, Charlotte Elliott, Christopher C Kearsey, David N Haughton, Mark R Webb, Ian Harvey, Fahmy S Fahmy
BACKGROUND: Numerous Dupuytren's fasciectomy techniques have been described, each associated with unique surgical challenges, complications and recurrence rates. We describe a common ground surgical approach to Dupuytren's disease; 3-dimensional fasciectomy (3DF). 3DF aims to address the potential contributors to the high recurrence rate of Dupuytren's disease and unite current limited fasciectomy practice that varies considerably between surgeons. METHODS: We describe the 3DF principles; raising thin skin flaps (addressing dermal involvement), excising diseased palmar fascia with a 3-5 mm clearance margin (treating highly locally recurrent conditions) and excising the vertical septae of Legueu and Juvara (providing deep clearance, hence addressing all potentially involved pathological tissue)...
November 2018: Archives of Plastic Surgery
Cara A Cipriano, Jonathan Dalton, Douglas J McDonald
BACKGROUND: A rotational gastrocnemius flap is often used for soft tissue reconstruction after proximal tibia sarcoma resection. However, little is known about the frequency and severity of complications and the recovery of extensor function after this procedure. QUESTIONS/PURPOSES: After gastrocnemius flap reconstruction with split-thickness skin grafting (STSG) to augment the extensor mechanism repair after proximal tibial resection for sarcoma, we asked: (1) What ROM was achieved (including extensor lag and active flexion)? (2) How often did complications and reoperations occur and what caused them? METHODS: Between 1991 and 2014, one surgeon treated 26 patients with proximal tibial resections for primary bone sarcoma...
November 9, 2018: Clinical Orthopaedics and related Research
Alexander J Werth, Margo A Lillie, Marina A Piscitelli, A Wayne Vogl, Robert E Shadwick
The tongue of rorqual (balaenopterid) whales slides far down the throat into the expanded oral pouch as an enormous mouthful of water is engulfed during gulp feeding. As the tongue and adjacent oral floor expands and slides caudoventrally, it glides along a more superficial (outer) layer of ventral body wall musculature, just deep to the accordion-like ventral throat pleats. We hypothesize that this sliding movement of adjacent musculature is facilitated by a slick, stretchy layer of loose areolar connective tissue that binds the muscle fibers and reduces friction: fascia...
November 17, 2018: Anatomical Record: Advances in Integrative Anatomy and Evolutionary Biology
Layla Belliraj, Rabiou Sani, Ibrahim Issoufou, Marouane Lakranbi, Yassine Ouadnouni, Mohamed Smahi
INTRODUCTION: necrotizing fasciitis of the chest wall is a rare condition in subcutaneous tissues and deep fascia. Primary thoracic involvement is exceptional and is a diagnostic and therapeutic emergency. AIM: To report our experience in the management of this rare pathology of which clinical picture is unknown by most practitioners. METHODS: This is a retrospective study carried out over a period of 07 years, compiling 07 cases of primitive necrotizing fasciitis of the thoracic wall at the department of thoracic surgery at the CHU Hassan II in Fez...
August 2018: La Tunisie Médicale
Kazuhiro Tanaka, Toshifumi Ozaki
The Cancer Staging Manual of the American Joint Committee on Cancer (AJCC) has recently been revised and updated to its eighth edition. This review focuses on the new staging system of bone and soft tissue sarcomas and outlines the revision points and caveats in the latest edition. The major changes in the eighth edition of the AJCC staging for bone and soft tissue sarcomas are the following four points. (i) Tumors are described separately according to the primary sites. For bone sarcoma, three tumor locations are described: (a) appendicular skeleton, trunk, skull and facial bones; (b) spine and (c) pelvis...
November 13, 2018: Japanese Journal of Clinical Oncology
Jan Wilke, Veronica Macchi, Raffaele De Caro, Carla Stecco
The morphology of the connective tissue may play an important role in locomotor mechanics. Recent research has revealed an association between increased fascia thickness and reduced joint flexibility in patients with chronic pain. The present study aimed to examine the relationship of both factors in healthy individuals, additionally testing the hypothesis that older subjects display a higher fascia thickness. Young (n = 18, 22 ± 1 years) and old (n = 17, 69 ± 4 years) healthy females were recruited for a quasi-experimental, cross-sectional trial...
November 11, 2018: Journal of Anatomy
Qinqin Liu, Lu Fang, Bo Li
RATIONALE: Desmoid fibromatosis is a rare benign neoplasm arising from musculoaponeurotic structures with the potential to infiltrate local tissues and recur locally. While the commonly affected regions are the shoulder, chest wall and back, thigh, head and neck, localization in the foot is rare and only a few cases have been reported. Deep-seated lesions of foot tend to spread along the fascia and nerve or tendon sheaths. PATIENT CONCERNS: We present a case of a 41-year-old female with a 3 years history of a slowly enlarging painful mass in the right foot...
November 2018: Medicine (Baltimore)
Leland Muller, Christina Henson, Brian Firestone, Salahuddin Ahmad, Terence S Herman, Tania De La Fuente Herman
The primary occurrence of mucoepidermoid carcinoma (MEC) of the conjunctiva is extremely rare, aggressive, and easily mistaken for squamous cell carcinoma. With fewer than 50 cases reported in the literature, there is no consensus on the most effective treatment. Radiation is an alternative to enucleation or orbital exenteration with the potential of eye preservation. We investigated several radiation approaches for a case with postresection positive margins at Tenon's fascia, and reported the patient's clinical course during the treatment and for a short time thereafter...
October 23, 2018: Medical Dosimetry: Official Journal of the American Association of Medical Dosimetrists
Daniel Brauman, Rene R W J van der Hulst, Berend van der Lei
Background: Combining liposuction with abdominoplasties was considered risky during the 1980s and 1990s due to reports of increased complications rates and the belief that liposuction posed a danger to flap circulation. However, the corresponding author's intraoperative observations at that time, that liposuction preserved all but the smallest blood vessels, negated the prevailing opinions that liposuction increased the risk to flap circulation, and in October 1996, liposuction assisted abdominoplasty (LAA) was first performed...
September 2018: Plastic and Reconstructive Surgery. Global Open
Eric Swanson
Background: Ultrasound in plastic surgery is quickly finding new applications. Ultrasound surveillance may replace ineffective individual risk stratification and chemoprophylaxis for deep venous thromboses. Abdominal penetration can be a catastrophic complication of liposuction. Preoperative screening for fascial defects may reduce risk. Limiting buttock fat injections to the subcutaneous plane is critical for patient safety, but it is difficult to know one's injection plane. Methods: The author's use of diagnostic ultrasound was evaluated from May 2017 to May 2018...
September 2018: Plastic and Reconstructive Surgery. Global Open
Jamal N Shillingford, Joseph L Laratta, Hemant Reddy, Alex Ha, Ronald A Lehman, Lawrence G Lenke, Charla R Fischer
STUDY DESIGN: Retrospective review of prospectively collected data. OBJECTIVE: Analyze the Scoliosis Research Society (SRS) Morbidity & Mortality (M&M) database to assess the incidence and characteristics related to postoperative surgical site infection (SSI) after spinal deformity surgery. SUMMARY OF BACKGROUND DATA: Infections involving spinal instrumentation are associated with greater rates of disability. Rates of postoperative SSI after spinal deformity surgery range from 1...
November 2018: Spine Deformity
Andrew A Gassman, Judy Pan, Edwin Acevedo, Nicholas Haddock, Sumeet Teotia
The superficial inferior epigastric artery (SIEA) flap and the deep inferior epigastric perforator (DIEP) flap have been increasingly adopted for breast reconstruction; however, each have its own set of advantages and disadvantages. In the select subset of patients that cannot tolerate minimal abdominal fasciotomy that occurs with DIEP harvest and do not have adequate pedicle length that often occurs after SIEA harvest, we suggest another option for abdominally-based free flap breast reconstruction. Here, we describe the formation of a composite perforator based on the pedicle of the retro-rectus deep inferior epigastric vessels and the superficial inferior epigastric vessels, known as a superficial and deep inferior epigastric artery (SADIE) flap, which allows for a more compatible anastomotic size match than the SIEA and elongation of the vascular pedicle with minimal dissection of the anterior rectus fascia...
October 2018: Microsurgery
Asad Rizvi, Joe Iwanaga, Rod J Oskouian, Marios Loukas, R Shane Tubbs
The semitendinosus and gracilis muscles insert primarily onto the superior medial aspect of the tibia. These tendons can be harvested for anterior cruciate ligament reconstruction, and knowledge of their accessory attachments is important for the success of such harvesting procedures. Here, we present a case illustration and review of the attachment of these muscles into the crural fascia (deep fascia of the leg), which is often an underappreciated insertion site.
August 7, 2018: Curēus
Sergio Petroni, Paolo Capozzi, Rosa Parrilla, Gaetano Zinzanella, Luca Buzzonetti
PURPOSE: To evaluate the surgical outcome of a frontalis sling using deep temporal fascia in the treatment of severe congenital ptosis (SCP). METHODS: A retrospective, interventional case series was performed. The study involved 25 patients with SCP (>4 mm). All patients underwent frontalis sling surgery with deep temporal fascia between 2004 and 2012 with a follow-up period of 12 months at a minimum. Data regarding eyelid position, eyelid symmetry, cosmetic outcomes, and postoperative complications were evaluated...
October 16, 2018: Orbit
Min A Yoon, Choong Guen Chee, Hye Won Chung, Joon Seon Song, Jong Seok Lee, Wanlim Kim, Min Hee Lee, Sang Hoon Lee, Myung Jin Shin
OBJECTIVES: This study was conducted to evaluate the added value of diffusion-weighted imaging (DWI) to conventional magnetic resonance imaging (MRI) for predicting fascial involvement of soft tissue sarcomas located in close proximity to fascial boundaries. METHODS: This retrospective study included 29 patients with surgically resected soft tissue sarcomas located in proximity to deep fascia and with a curvilinear tail-like hyperintensity in the adjacent fascia on T2-weighted images...
October 15, 2018: European Radiology
Robert E Van Demark, Matthew C Anderson, Jeb T List, Meredith Hayes, Matthew Hayes, David Woodard
A 46-year-old female presented after 3 years of steadily increasing numbness in her hands bilaterally with worse symptoms in her right hand. She reported nighttime paresthesia and exacerbation of her symptoms while writing, typing, and driving. Tinel's and carpal tunnel compression test were positive bilaterally. During the right hand carpal tunnel release, a layer of synovium was present deep to the carpal ligament with a tendinous portion running midline longitudinally along the median nerve. This layer was an anomalous palmaris profundus (PP) tendon within the carpal tunnel, which inserted distally in the palmar fascia...
August 2018: Plastic and Reconstructive Surgery. Global Open
Anhad B S Sidhu, Sarah M Rosanowski, Alexandra M Davis, James F Griffith, Paul Robinson
OBJECTIVE: To quantitate the iatrogenic injury associated with deep plantar metatarsal fasciotomy performed with Metzenbaum scissors compared with a Y-shaped fasciotome. STUDY DESIGN: Experimental ex vivo surgical study. STUDY POPULATION: Cadaveric hind limbs (n = 20) from 10 sound thoroughbred racehorses. METHODS: A plantar metatarsal fasciotomy was performed, extending from the proximal extent of the deep metatarsal fascia, distally...
October 15, 2018: Veterinary Surgery: VS
Woo Jong Kim, Hong Seop Lee, Sung Hun Won, Yong Cheol Hong, Dhong Won Lee, Ji-Hye Lee, Chang Hyun Kim
RATIONALE: The Morel-Lavallée lesion (MLL) is a closed degloving injury developing when shear force acts between the muscle fascia and the subcutaneous layer. MLLs develop principally in the trochanteric area or the pelvis; lesions in the proximal calf are rare. Acute lesions can be treated conservatively, but chronic lesions are best treated surgically because of a high rate of recurrence. To the best of our knowledge, this is a rare case of successful treatment of an MLL in the proximal calf associated with tibio-fibular shaft fracture...
October 2018: Medicine (Baltimore)
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