The Experts below are selected from a list of 74139 Experts worldwide ranked by ideXlab platform
Paolo Tozzi - One of the best experts on this subject based on the ideXlab platform.
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a unifying neuro Fasciagenic model of somatic dysfunction underlying mechanisms and treatment part i
Journal of Bodywork and Movement Therapies, 2015Co-Authors: Paolo TozziAbstract:This paper offers an extensive review of the main Fascia-mediated mechanisms underlying various dysfunctional and pathophysiological processes of clinical relevance for manual therapy. The concept of somatic dysfunction is revisited in light of the diverse Fascial influences that may come into play in its genesis and maintenance. A change in perspective is thus proposed: from a nociceptive model that for decades has viewed somatic dysfunction as a neurologically-mediated phenomenon, to a unifying Fascial model that integrates neural influences into a multifactorial and multidimensional interpretation of dysfunctional process as being partially, if not entirely, mediated by the Fascia.
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A unifying neuro-Fasciagenic model of somatic dysfunction - Underlying mechanisms and treatment - Part II.
Journal of bodywork and movement therapies, 2015Co-Authors: Paolo TozziAbstract:This paper offers an extensive review of the main Fascia-mediated mechanisms underlying various therapeutic processes of clinical relevance for manual therapy. The concept of somatic dysfunction is revisited in light of the several Fascial influences that may come into play during and after manual treatment. A change in perspective is thus proposed: from a nociceptive model that for decades has viewed somatic dysfunction as a neurologically-mediated phenomenon, to a unifying neuro-Fascial model that integrates neural influences into a multifactorial and multidimensional interpretation of manual therapeutic effects as being partially, if not entirely, mediated by the Fascia. By taking into consideration a wide spectrum of Fascia-related factors - from cell-based mechanisms to cognitive and behavioural influences - a model emerges suggesting, amongst other results, a multidisciplinary-approach to the intervention of somatic dysfunction. Finally, it is proposed that a sixth osteopathic 'meta-model' - the connective tissue-Fascial model - be added to the existing five models in osteopathic philosophy as the main interface between all body systems, thus providing a structural and functional framework for the body's homoeostatic potential and its inherent abilities to heal.
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A unifying neuro-Fasciagenic model of somatic dysfunction – Underlying mechanisms and treatment – Part I
Journal of Bodywork and Movement Therapies, 2015Co-Authors: Paolo TozziAbstract:This paper offers an extensive review of the main Fascia-mediated mechanisms underlying various dysfunctional and pathophysiological processes of clinical relevance for manual therapy. The concept of somatic dysfunction is revisited in light of the diverse Fascial influences that may come into play in its genesis and maintenance. A change in perspective is thus proposed: from a nociceptive model that for decades has viewed somatic dysfunction as a neurologically-mediated phenomenon, to a unifying Fascial model that integrates neural influences into a multifactorial and multidimensional interpretation of dysfunctional process as being partially, if not entirely, mediated by the Fascia.
Carla Stecco - One of the best experts on this subject based on the ideXlab platform.
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Anatomical and histological study of the alar Fascia.
Clinical Anatomy, 2020Co-Authors: Michael Snosek, Veronica Macchi, Carla Stecco, Raffaele De Caro, R. Shane Tubbs, Marios LoukasAbstract:INTRODUCTION The alar Fascia remains one of the most variably described Fascial structure in the human body. Much disagreement persists in the literature and mainstream anatomical texts about its anatomy, function, and clinical significance. It is generally described as a coronally oriented Fascial sheet separating the retropharyngeal space anteriorly from the danger space posteriorly. The current study aimed to confirm the presence of the alar Fascia and delineate its anatomical characteristics, connections, and potential function through gross dissection and microscopic analysis. Possible clinical and surgical implications are considered. METHODS Twelve (12) cadaveric necks were dissected and examined histologically. Smooth muscle (αSMA), nerve (S100 protein), and myosin proteins were identified immunohistologically to characterize the composition and possible functions of the alar Fascia. RESULTS The alar Fascia was found in all specimens spanning between the carotid sheaths. Morphologically, it was not a delamination or derivative of the prevertebral Fascia. It extended from the base of the skull to the upper thoracic level (T2) where it fused with the visceral Fascia. No midsagittal connection was found between the alar and visceral Fasciae. Immunohistochemically, the alar Fascia was positive in focal areas for αSMA and S100 proteins but negative for fast and slow myosin. CONCLUSION The alar Fascia is an independent and constant coronal Fascial layer between the carotid sheaths. It contains neurovasculature and may limit the spread of retropharyngeal infections into the thorax as well as facilitate normal physiological functions of the cervical viscera.
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Blocking around the transversalis Fascia: behind the scene.
Minerva Anestesiologica, 2019Co-Authors: Francesco Vasques, Carla Stecco, Raffaele De Caro, Raffaele Mitri, Pierfrancesco Fusco, A. U. BehrAbstract:BACKGROUND The transversalis Fascia plane and the quadratus lomborum blocks target the branches of T12-L1 nerves and provide analgesia in patients undergoing surgery involving the corresponding dermatomes. The transversalis Fascia is believed to contribute to determine the spread of local anesthetic in such blocks. Nonetheless, the anatomy of this Fascia and its possible role in these blocks still have to be precisely defined. METHODS We conducted a series of 10 dissections and full-thickness specimens were obtained from one side for the microscopic analysis. RESULTS Macroscopic study showed failed to identify a distinguishable Fascial structure between the Fascia of the transversus abdominis muscle and the peritoneum. Microscopic examination showed the presence of a further Fascial layer (0.1-0.2 mm), ascribable to transversalis Fascia. Transversalis Fascia and transversus abdominis epimysium posteriorly diverge: transversus epimysium goes posteriorly to quadratus lomborum to joint the oblique internal aponeurosis, while transversalis Fascia continues in front to quadratus lomborum. So, a little Fascial triangle (2-3 mm) is formed on the lateral border of quadratus lomborum, defined by transversalis Fascia and transversus abdominis. Inside this triangle, T12 and L1 nerves are present. CONCLUSIONS Considering the thinness of the transversalis Fascia and the small size of the triangular space that contains the target nerves, this is most likely a virtual, ideal rather than realistic injection site. Accordingly, it is probable that the local anesthetic is injected in the much wider retroperitoneal space and reaches the nerves by spreading backwards through the thin transversalis Fascia.
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Morphometric and dynamic measurements of muscular Fascia in healthy individuals using ultrasound imaging: a summary of the discrepancies and gaps in the current literature
Surgical and Radiologic Anatomy, 2018Co-Authors: Caterina Fede, Veronica Macchi, Raffaele De Caro, Nathaly Gaudreault, Carla SteccoAbstract:Purpose The objectives of this work was to conduct a comprehensive state-of-the art review of the current literature to identify any gaps or discrepancies and summarize the main challenges for obtaining a homogeneous evaluation of muscular Fascia in healthy individuals. Methods An electronic document search using key words and MeSH terms was performed with various databases. Two independent investigators were tasked with the screening of articles and data extraction. A critical appraisal of what is known was then conducted. Results The literature search identified 65 articles related to healthy facia in the various databases consulted and 20 articles were kept for the review. The thickest portion of the Fascia lata (the iliotibial tract) and the plantar Fascia are the most often studied muscular Fasciae whereas there is paucity of studies on Fascia related to other muscles in the body. Conclusion US imaging is suitable to complement physical examination and for evaluating treatment outcomes. However, the small number of studies and the heterogeneity of the methods did not allow us to establish normal reference values for muscular Fascia thickness and to provide strong recommendations about measurement protocols.
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Fascia thickness, aging and flexibility: is there an association?
Journal of Anatomy, 2018Co-Authors: Jan Wilke, Veronica Macchi, Raffaele De Caro, Carla SteccoAbstract: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. All participants underwent standardized ultrasound-based thickness measurements of the deep Fasciae of the trunk and lower limb. Flexibility was assessed using sit and reach testing (hamstring extensibility) and the Schober test (lumbar flexion and extension). Systematic between-group differences of Fascia thickness and variable associations (i.e. Fascia thickness and flexibility) were detected using non-parametric data analyses. Young adults exhibited higher Fascia thickness of the anterior and posterior lower leg, anterior thigh and abdominal wall (+12.3-25.8%, P
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microscopic anatomy of the visceral Fasciae
Journal of Anatomy, 2017Co-Authors: Carla Stecco, Maria Martina Sfriso, Anna Rambaldo, Giovanna Albertin, Veronica Macchi, Andrea Porzionato, Raffaele De CaroAbstract:The term ‘visceral Fascia’ is a general term used to describe the Fascia lying immediately beneath the mesothelium of the serosa, together with that immediately surrounding the viscera, but there are many types of visceral Fasciae. The aim of this paper was to identify the features they have in common and their specialisations. The visceral Fascia of the abdomen (corresponding to the connective tissue lying immediately beneath the mesothelium of the parietal peritoneum), thorax (corresponding to the connective tissue lying immediately beneath the mesothelium of the parietal pleura), lung (corresponding to the connective tissue under the mesothelium of the visceral pleura), liver (corresponding to the connective tissue under the mesothelium of the visceral peritoneum), kidney (corresponding to the Gerota Fascia), the oesophagus (corresponding to its adventitia) and heart (corresponding to the fibrous layer of the pericardial sac) from eight fresh cadavers were sampled and analysed with histological and immunohistochemical stains to evaluate collagen and elastic components and innervation. Although the visceral Fasciae make up a well-defined layer of connective tissue, the thickness, percentage of elastic fibres and innervation vary among the different viscera. In particular, the Fascia of the lung has a mean thickness of 134 μm (± 21), that of heart 792 μm (± 132), oesophagus 105 μm (± 10), liver 131 μm (± 18), Gerota Fascia 1009 μm (± 105) and the visceral Fascia of the abdomen 987 μm (± 90). The greatest number of elastic fibres (9.79%) was found in the adventitia of the oesophagus. The connective layers lying immediately outside the mesothelium of the pleura and peritoneum also have many elastic fibres (4.98% and 4.52%, respectively), whereas the pericardium and Gerota Fascia have few (0.27% and 1.38%). In the pleura, peritoneum and adventitia of the oesophagus, elastic fibres form a well-defined layer, corresponding to the elastic lamina, while in the other cases they are thinner and scattered in the connective tissue. Collagen fibres also show precise spatial organisation, being arranged in several layers. In each layer, all the fibrous bundles are parallel with each other, but change direction among layers. Loose connective tissue rich in elastic fibres is found between contiguous fibrous layers. Unmyelinated nerve fibres were found in all samples, but myelinated fibres were only found in some Fasciae, such as those of the liver and heart, and the visceral Fascia of the abdomen. According to these findings, we propose distinguishing the visceral Fasciae into two large groups. The first group includes all the Fasciae closely related to the individual organ and giving shape to it, supporting the parenchyma; these are thin, elastic and very well innervated. The second group comprises all the fibrous sheets forming the compartments for the organs and also connecting the internal organs to the musculoskeletal system. These Fasciae are thick, less elastic and less innervated, but they contain larger and myelinated nerves. We propose to call the first type of Fasciae ‘investing Fasciae’, and the second type ‘insertional Fasciae’.
Raffaele De Caro - One of the best experts on this subject based on the ideXlab platform.
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Anatomical and histological study of the alar Fascia.
Clinical Anatomy, 2020Co-Authors: Michael Snosek, Veronica Macchi, Carla Stecco, Raffaele De Caro, R. Shane Tubbs, Marios LoukasAbstract:INTRODUCTION The alar Fascia remains one of the most variably described Fascial structure in the human body. Much disagreement persists in the literature and mainstream anatomical texts about its anatomy, function, and clinical significance. It is generally described as a coronally oriented Fascial sheet separating the retropharyngeal space anteriorly from the danger space posteriorly. The current study aimed to confirm the presence of the alar Fascia and delineate its anatomical characteristics, connections, and potential function through gross dissection and microscopic analysis. Possible clinical and surgical implications are considered. METHODS Twelve (12) cadaveric necks were dissected and examined histologically. Smooth muscle (αSMA), nerve (S100 protein), and myosin proteins were identified immunohistologically to characterize the composition and possible functions of the alar Fascia. RESULTS The alar Fascia was found in all specimens spanning between the carotid sheaths. Morphologically, it was not a delamination or derivative of the prevertebral Fascia. It extended from the base of the skull to the upper thoracic level (T2) where it fused with the visceral Fascia. No midsagittal connection was found between the alar and visceral Fasciae. Immunohistochemically, the alar Fascia was positive in focal areas for αSMA and S100 proteins but negative for fast and slow myosin. CONCLUSION The alar Fascia is an independent and constant coronal Fascial layer between the carotid sheaths. It contains neurovasculature and may limit the spread of retropharyngeal infections into the thorax as well as facilitate normal physiological functions of the cervical viscera.
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Blocking around the transversalis Fascia: behind the scene.
Minerva Anestesiologica, 2019Co-Authors: Francesco Vasques, Carla Stecco, Raffaele De Caro, Raffaele Mitri, Pierfrancesco Fusco, A. U. BehrAbstract:BACKGROUND The transversalis Fascia plane and the quadratus lomborum blocks target the branches of T12-L1 nerves and provide analgesia in patients undergoing surgery involving the corresponding dermatomes. The transversalis Fascia is believed to contribute to determine the spread of local anesthetic in such blocks. Nonetheless, the anatomy of this Fascia and its possible role in these blocks still have to be precisely defined. METHODS We conducted a series of 10 dissections and full-thickness specimens were obtained from one side for the microscopic analysis. RESULTS Macroscopic study showed failed to identify a distinguishable Fascial structure between the Fascia of the transversus abdominis muscle and the peritoneum. Microscopic examination showed the presence of a further Fascial layer (0.1-0.2 mm), ascribable to transversalis Fascia. Transversalis Fascia and transversus abdominis epimysium posteriorly diverge: transversus epimysium goes posteriorly to quadratus lomborum to joint the oblique internal aponeurosis, while transversalis Fascia continues in front to quadratus lomborum. So, a little Fascial triangle (2-3 mm) is formed on the lateral border of quadratus lomborum, defined by transversalis Fascia and transversus abdominis. Inside this triangle, T12 and L1 nerves are present. CONCLUSIONS Considering the thinness of the transversalis Fascia and the small size of the triangular space that contains the target nerves, this is most likely a virtual, ideal rather than realistic injection site. Accordingly, it is probable that the local anesthetic is injected in the much wider retroperitoneal space and reaches the nerves by spreading backwards through the thin transversalis Fascia.
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Morphometric and dynamic measurements of muscular Fascia in healthy individuals using ultrasound imaging: a summary of the discrepancies and gaps in the current literature
Surgical and Radiologic Anatomy, 2018Co-Authors: Caterina Fede, Veronica Macchi, Raffaele De Caro, Nathaly Gaudreault, Carla SteccoAbstract:Purpose The objectives of this work was to conduct a comprehensive state-of-the art review of the current literature to identify any gaps or discrepancies and summarize the main challenges for obtaining a homogeneous evaluation of muscular Fascia in healthy individuals. Methods An electronic document search using key words and MeSH terms was performed with various databases. Two independent investigators were tasked with the screening of articles and data extraction. A critical appraisal of what is known was then conducted. Results The literature search identified 65 articles related to healthy facia in the various databases consulted and 20 articles were kept for the review. The thickest portion of the Fascia lata (the iliotibial tract) and the plantar Fascia are the most often studied muscular Fasciae whereas there is paucity of studies on Fascia related to other muscles in the body. Conclusion US imaging is suitable to complement physical examination and for evaluating treatment outcomes. However, the small number of studies and the heterogeneity of the methods did not allow us to establish normal reference values for muscular Fascia thickness and to provide strong recommendations about measurement protocols.
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Fascia thickness, aging and flexibility: is there an association?
Journal of Anatomy, 2018Co-Authors: Jan Wilke, Veronica Macchi, Raffaele De Caro, Carla SteccoAbstract: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. All participants underwent standardized ultrasound-based thickness measurements of the deep Fasciae of the trunk and lower limb. Flexibility was assessed using sit and reach testing (hamstring extensibility) and the Schober test (lumbar flexion and extension). Systematic between-group differences of Fascia thickness and variable associations (i.e. Fascia thickness and flexibility) were detected using non-parametric data analyses. Young adults exhibited higher Fascia thickness of the anterior and posterior lower leg, anterior thigh and abdominal wall (+12.3-25.8%, P
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microscopic anatomy of the visceral Fasciae
Journal of Anatomy, 2017Co-Authors: Carla Stecco, Maria Martina Sfriso, Anna Rambaldo, Giovanna Albertin, Veronica Macchi, Andrea Porzionato, Raffaele De CaroAbstract:The term ‘visceral Fascia’ is a general term used to describe the Fascia lying immediately beneath the mesothelium of the serosa, together with that immediately surrounding the viscera, but there are many types of visceral Fasciae. The aim of this paper was to identify the features they have in common and their specialisations. The visceral Fascia of the abdomen (corresponding to the connective tissue lying immediately beneath the mesothelium of the parietal peritoneum), thorax (corresponding to the connective tissue lying immediately beneath the mesothelium of the parietal pleura), lung (corresponding to the connective tissue under the mesothelium of the visceral pleura), liver (corresponding to the connective tissue under the mesothelium of the visceral peritoneum), kidney (corresponding to the Gerota Fascia), the oesophagus (corresponding to its adventitia) and heart (corresponding to the fibrous layer of the pericardial sac) from eight fresh cadavers were sampled and analysed with histological and immunohistochemical stains to evaluate collagen and elastic components and innervation. Although the visceral Fasciae make up a well-defined layer of connective tissue, the thickness, percentage of elastic fibres and innervation vary among the different viscera. In particular, the Fascia of the lung has a mean thickness of 134 μm (± 21), that of heart 792 μm (± 132), oesophagus 105 μm (± 10), liver 131 μm (± 18), Gerota Fascia 1009 μm (± 105) and the visceral Fascia of the abdomen 987 μm (± 90). The greatest number of elastic fibres (9.79%) was found in the adventitia of the oesophagus. The connective layers lying immediately outside the mesothelium of the pleura and peritoneum also have many elastic fibres (4.98% and 4.52%, respectively), whereas the pericardium and Gerota Fascia have few (0.27% and 1.38%). In the pleura, peritoneum and adventitia of the oesophagus, elastic fibres form a well-defined layer, corresponding to the elastic lamina, while in the other cases they are thinner and scattered in the connective tissue. Collagen fibres also show precise spatial organisation, being arranged in several layers. In each layer, all the fibrous bundles are parallel with each other, but change direction among layers. Loose connective tissue rich in elastic fibres is found between contiguous fibrous layers. Unmyelinated nerve fibres were found in all samples, but myelinated fibres were only found in some Fasciae, such as those of the liver and heart, and the visceral Fascia of the abdomen. According to these findings, we propose distinguishing the visceral Fasciae into two large groups. The first group includes all the Fasciae closely related to the individual organ and giving shape to it, supporting the parenchyma; these are thin, elastic and very well innervated. The second group comprises all the fibrous sheets forming the compartments for the organs and also connecting the internal organs to the musculoskeletal system. These Fasciae are thick, less elastic and less innervated, but they contain larger and myelinated nerves. We propose to call the first type of Fasciae ‘investing Fasciae’, and the second type ‘insertional Fasciae’.
R. Schleip - One of the best experts on this subject based on the ideXlab platform.
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Clinical Relevance of Fascial Tissue and Dysfunctions
Current Pain and Headache Reports, 2014Co-Authors: W. Klingler, M. Velders, K. Hoppe, M. Pedro, R. SchleipAbstract:Fascia is composed of collagenous connective tissue surrounding and interpenetrating skeletal muscle, joints, organs, nerves, and vascular beds. Fascial tissue forms a whole-body, continuous three-dimensional viscoelastic matrix of structural support. The classical concept of its mere passive role in force transmission has recently been disproven. Fascial tissue contains contractile elements enabling a modulating role in force generation and also mechanosensory fine-tuning. This hypothesis is supported by in vitro studies demonstrating an autonomous contraction of human lumbar Fascia and a pharmacological induction of temporary contraction in rat Fascial tissue. The ability of spontaneous regulation of Fascial stiffness over a time period ranging from minutes to hours contributes more actively to musculoskeletal dynamics. Imbalance of this regulatory mechanism results in increased or decreased myoFascial tonus, or diminished neuromuscular coordination, which are key contributors to the pathomechanisms of several musculoskeletal pathologies and pain syndromes. Here, we summarize anatomical and biomechanical properties of Fascial tissue with a special focus on Fascial dysfunctions and resulting clinical manifestations. Finally, we discuss current and future potential treatment options that can influence clinical manifestations of pain syndromes associated with Fascial tissues.
Veronica Macchi - One of the best experts on this subject based on the ideXlab platform.
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Anatomical and histological study of the alar Fascia.
Clinical Anatomy, 2020Co-Authors: Michael Snosek, Veronica Macchi, Carla Stecco, Raffaele De Caro, R. Shane Tubbs, Marios LoukasAbstract:INTRODUCTION The alar Fascia remains one of the most variably described Fascial structure in the human body. Much disagreement persists in the literature and mainstream anatomical texts about its anatomy, function, and clinical significance. It is generally described as a coronally oriented Fascial sheet separating the retropharyngeal space anteriorly from the danger space posteriorly. The current study aimed to confirm the presence of the alar Fascia and delineate its anatomical characteristics, connections, and potential function through gross dissection and microscopic analysis. Possible clinical and surgical implications are considered. METHODS Twelve (12) cadaveric necks were dissected and examined histologically. Smooth muscle (αSMA), nerve (S100 protein), and myosin proteins were identified immunohistologically to characterize the composition and possible functions of the alar Fascia. RESULTS The alar Fascia was found in all specimens spanning between the carotid sheaths. Morphologically, it was not a delamination or derivative of the prevertebral Fascia. It extended from the base of the skull to the upper thoracic level (T2) where it fused with the visceral Fascia. No midsagittal connection was found between the alar and visceral Fasciae. Immunohistochemically, the alar Fascia was positive in focal areas for αSMA and S100 proteins but negative for fast and slow myosin. CONCLUSION The alar Fascia is an independent and constant coronal Fascial layer between the carotid sheaths. It contains neurovasculature and may limit the spread of retropharyngeal infections into the thorax as well as facilitate normal physiological functions of the cervical viscera.
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Morphometric and dynamic measurements of muscular Fascia in healthy individuals using ultrasound imaging: a summary of the discrepancies and gaps in the current literature
Surgical and Radiologic Anatomy, 2018Co-Authors: Caterina Fede, Veronica Macchi, Raffaele De Caro, Nathaly Gaudreault, Carla SteccoAbstract:Purpose The objectives of this work was to conduct a comprehensive state-of-the art review of the current literature to identify any gaps or discrepancies and summarize the main challenges for obtaining a homogeneous evaluation of muscular Fascia in healthy individuals. Methods An electronic document search using key words and MeSH terms was performed with various databases. Two independent investigators were tasked with the screening of articles and data extraction. A critical appraisal of what is known was then conducted. Results The literature search identified 65 articles related to healthy facia in the various databases consulted and 20 articles were kept for the review. The thickest portion of the Fascia lata (the iliotibial tract) and the plantar Fascia are the most often studied muscular Fasciae whereas there is paucity of studies on Fascia related to other muscles in the body. Conclusion US imaging is suitable to complement physical examination and for evaluating treatment outcomes. However, the small number of studies and the heterogeneity of the methods did not allow us to establish normal reference values for muscular Fascia thickness and to provide strong recommendations about measurement protocols.
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Fascia thickness, aging and flexibility: is there an association?
Journal of Anatomy, 2018Co-Authors: Jan Wilke, Veronica Macchi, Raffaele De Caro, Carla SteccoAbstract: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. All participants underwent standardized ultrasound-based thickness measurements of the deep Fasciae of the trunk and lower limb. Flexibility was assessed using sit and reach testing (hamstring extensibility) and the Schober test (lumbar flexion and extension). Systematic between-group differences of Fascia thickness and variable associations (i.e. Fascia thickness and flexibility) were detected using non-parametric data analyses. Young adults exhibited higher Fascia thickness of the anterior and posterior lower leg, anterior thigh and abdominal wall (+12.3-25.8%, P
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microscopic anatomy of the visceral Fasciae
Journal of Anatomy, 2017Co-Authors: Carla Stecco, Maria Martina Sfriso, Anna Rambaldo, Giovanna Albertin, Veronica Macchi, Andrea Porzionato, Raffaele De CaroAbstract:The term ‘visceral Fascia’ is a general term used to describe the Fascia lying immediately beneath the mesothelium of the serosa, together with that immediately surrounding the viscera, but there are many types of visceral Fasciae. The aim of this paper was to identify the features they have in common and their specialisations. The visceral Fascia of the abdomen (corresponding to the connective tissue lying immediately beneath the mesothelium of the parietal peritoneum), thorax (corresponding to the connective tissue lying immediately beneath the mesothelium of the parietal pleura), lung (corresponding to the connective tissue under the mesothelium of the visceral pleura), liver (corresponding to the connective tissue under the mesothelium of the visceral peritoneum), kidney (corresponding to the Gerota Fascia), the oesophagus (corresponding to its adventitia) and heart (corresponding to the fibrous layer of the pericardial sac) from eight fresh cadavers were sampled and analysed with histological and immunohistochemical stains to evaluate collagen and elastic components and innervation. Although the visceral Fasciae make up a well-defined layer of connective tissue, the thickness, percentage of elastic fibres and innervation vary among the different viscera. In particular, the Fascia of the lung has a mean thickness of 134 μm (± 21), that of heart 792 μm (± 132), oesophagus 105 μm (± 10), liver 131 μm (± 18), Gerota Fascia 1009 μm (± 105) and the visceral Fascia of the abdomen 987 μm (± 90). The greatest number of elastic fibres (9.79%) was found in the adventitia of the oesophagus. The connective layers lying immediately outside the mesothelium of the pleura and peritoneum also have many elastic fibres (4.98% and 4.52%, respectively), whereas the pericardium and Gerota Fascia have few (0.27% and 1.38%). In the pleura, peritoneum and adventitia of the oesophagus, elastic fibres form a well-defined layer, corresponding to the elastic lamina, while in the other cases they are thinner and scattered in the connective tissue. Collagen fibres also show precise spatial organisation, being arranged in several layers. In each layer, all the fibrous bundles are parallel with each other, but change direction among layers. Loose connective tissue rich in elastic fibres is found between contiguous fibrous layers. Unmyelinated nerve fibres were found in all samples, but myelinated fibres were only found in some Fasciae, such as those of the liver and heart, and the visceral Fascia of the abdomen. According to these findings, we propose distinguishing the visceral Fasciae into two large groups. The first group includes all the Fasciae closely related to the individual organ and giving shape to it, supporting the parenchyma; these are thin, elastic and very well innervated. The second group comprises all the fibrous sheets forming the compartments for the organs and also connecting the internal organs to the musculoskeletal system. These Fasciae are thick, less elastic and less innervated, but they contain larger and myelinated nerves. We propose to call the first type of Fasciae ‘investing Fasciae’, and the second type ‘insertional Fasciae’.
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Fascia redefined: anatomical features and technical relevance in Fascial flap surgery
Surgical and Radiologic Anatomy, 2013Co-Authors: Carla Stecco, Antonio Stecco, Veronica Macchi, Andrea Porzionato, Cesare Tiengo, Robert Stern, Raffaele De CaroAbstract:Fascia has traditionally been thought of as a passive structure that envelops muscles, and the term “Fascia” was misused and confusing. However, it is now evident that Fascia is a dynamic tissue with complex vasculature and innervation. A definition of Fascia as an integral tissue has been provided here, highlighting the main features of the superficial and deep Fasciae. Wide anatomic variations and site-specific differences in Fascial structure are described, coupled with results of our extensive investigations of Fascial anatomy. This will enable surgeons to make better decisions on selecting the appropriate Fascia in the construction of Fascial flaps. The use of the superficial or deep Fasciae in the creation of a Fascial flap cannot be selected at random, but must be guided by the anatomical features of the different types of Fasciae. In particular, we suggest the use of the superficial Fascia, such as the parascapular fascio-cutaneous free flap or any cutaneous flap, when a well-vascularized elastic flap, with the capacity to adhere to underlying tissues, is required, and a fascio-cutaneous flap formed by aponeurotic Fascia to resurface any tendon or joints exposures. Moreover, the aponeurotic Fascia, such as the Fascia lata, can be used as a surgical patch if the plastic surgeon requires strong resistance to stress and/or the capacity to glide freely. Finally, the epimysial Fascia, such as in the latissimus dorsi flap, can be used with success when used together with the underlying muscles. Clearly, extensive clinical experience and judgment are necessary for assessment of their potential use.
