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Objective:To compare the effect on scar in donor area of small-and medium-sized anterolateral thigh perforator flap(ALTPF) harvested from superficial and deep layer of the superficial fascia.Methods:A retrospective analysis was performed on 31 patients who had small-and medium-sized soft tissue defects in the extremities and admitted to the Department of Burns and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University from January 2020 to February 2021. All the patients were repaired with ALTPFs. The sizes of defect ranged from 5.0 cm×3.5 cm to 17.0 cm×6.0 cm, and the flaps sized from 6.0 cm×4.0 cm to 20.0 cm×6.0 cm. Fifteen ALTPFs were harvested from superficial layer of superficial fascia (modified group), and 16 harvested from deep layer of superficial fascia (traditional group). The flap donor sites were sutured directly using the "Zunyi suture method". Appearance of scars was assessed within the Vancouver Scar Scale (VSS) and in addition the width of scars was been recorded. The data of the 2 groups were statistically analyzed. There was statistically significant difference when P<0.05. Results:All flaps were successfully viable. All wounds healed in Ⅰ stage and donor incisions healed in Ⅰ stage at 2-3 weeks after the surgery. All patients entered postoperative follow-up for 6 to 26 months, with a mean of 10.7 months. There was no ischaemic necrosis at the donor margin. There was no significant difference between circumference of thighs between the modified group and traditional group [ (0.10±0.40) cm and (0.03±0.39) cm, respectively]( P>0.05). VSS were found lower in the modified group (2.00±1.46) than that in the traditional group (3.06±1.61)( t=2.132, P=0.039), as well as the scars were found smaller at the widest point[(6.67±3.85) cm and(16.06±6.63) cm, respectively. t=2.807, P=0.005]. The differences were statistically significant( P<0.05). Conclusion:Small-and medium-sized ALTPFs, harvested in the superficial layer of superficial fascia, can reduce the width of the donor scar, improve the surgical outcome and increase patient satisfaction.
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BACKGROUND: It has been proved in clinical practice and basic research that acupuncture and moxibustion at Mingmen acupoint is an effective treatment for primary osteoporosis. As a new therapeutic method, heat-sensitive moxibustion has achieved good results in clinical practice, but the research on its mechanism is still in the blank stage. OBJECTIVE: To study the therapeutic mechanism of heat-sensitive moxibustion from the perspective of connective tissue and nervous system, and to explore the optimal therapeutic time of heat-sensitive moxibustion in a certain time range. METHODS: Female Sprague-Dawley rats of SPF grade were randomly divided into five groups: normal group, model group, 4-, 7-, and 14-day heat-sensitive moxibustion groups. Osteoporosis models were prepared by ovariectomy and treated with heat-sensitive moxibustion at different times. After treatment, the superficial subcutaneous fascia 0.5-1.5 cm around the Mingmen acupoint and the spinal cord were stained with fluorescence and hematoxylin-eosin staining. The concentrations of phosphorus ion, calcium ions and alkaline phosphatase in rat serum were detected before and after 14 days of heat-sensitive sensitive moxibustion. RESULTS AND CONCLUSION: (1) Morphological changes of intrafascial fibers by fluorescence staining: In the normal and model groups, collagen fibers were interlaced and arranged in a network. In the 4-day heat-sensitive moxibustion group, the arrangement of collagen fibers showed no changes. After 14 days of intervention the collagen fibers were stretched and pulled significantly under the effect of heat-sensitive moxibustion, and showed a centripetal arrangement toward the Mingmen acupoint. (2) Hematoxylin-eosin staining results of the spinal cord: After 4 days of heat-sensitive moxibustion, the rat spinal cord had no obvious change compared with the model group. After 7 days of heat-sensitive moxibustion, anterior cornual neurons increased in number and size, and the number of glial cells in the spinal dorsal horn increased. After 14 days of heat-sensitive moxibustion, anterior horn neurons increased significantly in number and in size, with large and round nuclei, obvious nucleoli, and enlarged and regularly arranged nerve fibers; glial cells in the posterior horn increased significantly in number and arranged densely. (3) Serum concentration determination: After 14 days of heat-sensitive moxibustion, the concentrations of phosphorus ions and alkaline phosphatase in rat serum increased significantly (P < 0.01), and the concentration of calcium ions decreased significantly (P < 0.05). These findings indicate that heat-sensitive moxibustion can ameliorate the symptoms of osteoporosis through the morphological changes of connective tissue and nerve-body fluid regulation. Heat-sensitive moxibustion for 14 days can achieve ideal results.
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Objective@#To describe the general and histological features of the full-length superficial fascia of the circumferential upper limb.@*Methods@#Fresh frozen arm specimens were dissected, and then MRI imaging in vivo, enhanced CT angiography and HE histological staining were used to describe the characteristics of the full-length superficial fascia of the circumferential arm and its relationship with important blood vessels.@*Results@#The four typical structures of the superficial fascia of the arm were divided into subcutaneous superficial fat, membrane-like substance, deep fat and deep fascia from superficial to deep. The thickness and stratification, fusion degree and histological characteristics of the superficial fascia of these four layers were obviously different in different levels and regions of the arm. MRI confirmed that the total thickness of superficial fascia gradually decreased from shoulder to wrist. Venography showed that the cephalic vein ran below the second layer of superficial fascia and above the deep fascia. The basilic vein originated from the dorsal vein network of the hand and always lied below the second layer of membranous material until the basilic vein penetrates below the deep fascia of the upper arm.@*Conclusions@#The deep understanding of the circumferential full-length of superficial fascia structure of the upper limb provides an important theoretical basis for improving the surgical safety and fine operation for the Dynamic Arm Circumferential Liposuction.
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The temporoparietal fascia (TPF) is a robust and distinct layer between the deep temporal fascia and the subcutaneous fat in the temporal region. The TPF is richly vascularized by superficial temporal vessels. Besides, its thin and pliable characteristics with secluded incision and minimal donor site morbidity provide a good option for the plastic and reconstructive surgeons. Recently, the TPF flap was employed to treat some rare diseases such as the laryngotracheal stenosis and pharyngocutaneous fistula. This article extensively reviewed relevant researches on the application of the fascial flaps in recent years.
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The "superficial fascia" is often interpreted as "tendon-membrane like structure" in acupuncture field and it is speculated that acupuncture stimulation-induced structural alteration of the superficial fascia may contribute to the alleviation of many medical conditions. The fact is that the superficial fascia mainly consists of subcutaneous adipose tissue and fibrotic network (which function in storing, supporting and buffering external pressure and are not responsible for producing "Deqi" or "needling sensations"), and has no typical tendon or membrane structure in hypodermis. In the present paper, the author tries to clarify its incorrect translation, misinterpretation, and misunderstanding in acupuncture and propose that the target of acupuncture stimulation is probably not only the subcutaneous soft tissue per se, but also the contents in subcutaneous soft tissue network as the nerves, blood vessels, lymph-vessels, cutaneous accessory structures, mast cells, multiple movable cells, related receptors, etc.
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In recent years,with the rapid development of orthopedic surgery and minimally invasive surgery,superficial fascia and its structures are receiving much recognition and more and more attention.Although opinions on naming and definition at different levels still vary,in-depth study of related structures offers clinical surgeons a broad prospect.