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

Springer Science and Business Media LLC - Tập 28 - Trang 606-619 - 2006
M. F. Abu-Hijleh1, A. L. Roshier2, Q. Al-Shboul3, A. S. Dharap1, P. F. Harris4
1Department of Anatomy, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
2Institute of Biomechanics, University of Nottingham, England, UK
3Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
4Department of Anatomy, University of Manchester, England, UK

Tóm tắt

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.

Tài liệu tham khảo

Askar O (1963) The short saphenous vein. J Cardiovasc Surg (Torino) 4:126–137

Avelar J (1989) Regional distribution and behavior of the subcutaneous tissue concerning selection and indication for liposuction. Aesthetic Plast Surg 13:155–165

Basmajian JV (1980) Grant’s method of anatomy, 10th edn. Williams and Wilkins, Baltimore, p 123

Caggiati A, Ricci S (1997) The long saphenous vein compartment. Phlebology 12:107–111

Caggiati A, Macchiarelli G, Familiari G (1998) Topographical structural variations of the long saphenous vein and its age-related remodeling as revealed by correlated light and scanning electron microscopy. Phlebology 13:156–162

Caggiati A (1999) Fascial relationships of the long saphenous vein. Circulation 100:2547–2549

Caggiati A (2000) Fascial relations and structure of the tributaries of the saphenous veins. Surg Radiol Anat 22:191–196

Caggiati A (2001) Fascial relationships of the short saphenous vein. J Vasc Surg 34:241–246

Clemente CD (ed) (1985) Gray’s anatomy of the human body, 30th edn. Lea & Febiger, Philadelphia, PA, p57

Colles A (1811) A treatise on surgical anatomy: anatomy of the perineum. Gilbert and Hodges, Dublin (Tobin CE, Benjamin JA, 1949)

Congdon ED, Edson J, Yanitelli S (1946) Gross structure of subcutaneous layer of anterior and lateral trunk in the male. Am J Anat 79:399–429

Federative Committee on Anatomical Terminology (FACT) (1998) Terminologia anatomica: international anatomical terminology. Thieme, Stuttgart

Forster DS (1937) A note on Scarpa’s fascia. J Anat 72:130–131

Gardetto A, Dabernig J, Rainer C, Piegger J, Piza-Katzer H, Fritsch H (2003) Does a superficial musculoaponeurotic system exist in the face and neck? An anatomical study by the tissue plastination technique. Plast Reconstr Surg 111:664–672

Gardner E, Gray DJ, O’Rahilly R (1969) Anatomy—a regional study of human structure, 3rd edn. Saunders, Philadelphia, PA, pp 55–57

Graf R, Bernardes A, Rippel R, Araujo LR, Damasio RC, Auersvald A (2003) Subfascial breast implant: a new procedure. Plast Reconstr Surg 111:904–908

Hall-Craggs ECB (1990) Anatomy as a basis for clinical medicine, 2nd edn. Urban and Schwarzenberg, Baltimore-Munich, p 225

Hollinshead WH (1982) Anatomy for surgeons, vol. 1 The head and neck; vol. 2 The thorax, abdomen, and pelvis; vol. 3 The back and limbs, 3rd edn. Harper and Row, Philadelphia, PA, p324

Hollinshead WH, Rosse C (1985) Textbook of anatomy, 4th edn. Harper and Row, Philadelphia, PA, p 581

Kosinski C (1926) Observations on the superficial venous system of the lower extremities. J Anat 60:131–142

Lockwood TE (1991) Superficial Fascia System (SFS) of the trunk and extremities: a new concept. Plast Reconstr Surg 87:1009–1018

Markman B, Barton FE Jr (1987) Anatomy of the subcutaneous tissue of the trunk and lower extremity. Plast Recontr Surg 80:248–254

Mitz V, Peyronie M (1976) The superficial musculo-aponeurotic system (SMAS) in the parotid and cheek area. Plast Reconstr Surg 58:80–88

Moore KL, Dalley AF (2006) Clinically oriented anatomy, 5th edn. Lippincott, Williams and Wilkins, Philadelphia, PA, p 196

Owsley JO Jr (1983) SMAS-platysma face lift. Plast Reconstr Surg 71:573–579

Pessa JE, Desvigne LD, Lyons AE (1999) An early description of the superficial musculoaponeurotic system by Sir Charles Bell. Plast Reconstr Surg 103:1071–1072

Roger Z, Reynaldo LA, Scott Levin L (2002) Endoscopic access to the extremities: the principle of fascial clefts. J Orthop Trauma 16:264–271

Romanes GJ (1981) Cunningham’s textbook of anatomy, 12th edn. Oxford University Press, Oxford, p 275

Scarpa A (1809) Sull’ ernie memoire anatomico-chirurgiche. Della Reale Stamperia, Milano (Tobin CE, Benjamin JA, 1949)

Shah AC, Srivastava HC (1966) Fascial canal for the small saphenous vein. J Anat 100:411–413

Sinnatamby CS (1999) Last’s anatomy: regional and applied, 3rd edn. Churchill Livingstone, Edinburgh, p 173

Snell RS (1995) Clinical anatomy for medical students, 5th edn. Little, Brown & Co., Boston, p 136

Tobin CE, Benjamin JA (1945) Anatomical and surgical re-study of Denonvillier’s fascia. Surg Gynecol Obstet 80:373–383

Tobin CE, Benjamin JA (1949) Anatomic and clinical reevaluation of Camper’s, Scarpa’s, and Colles’ fasciae. Surg Gynecol Obstet 88:545–557

Wendell-Smith CP (1997) Fascia: an illustrative problem in international terminology. Surg Radiol Anat 19:273–277

Williams PLW, Bannister LH, Berry MM, Collins P, Dyson M, Dussek JE, Ferguson MWJ (eds) (1995) Muscle, Chapter 7. In: Gray’s anatomy, 38th edn. Churchill Livingstone, New York, pp 737–871

Worseg AP, Kuzbari R, Hubsch P, Koncilia H, Tairych G, Alt A, Tschabitscher M, Holle J (1997) Scarpa’s fascia flap: anatomic studies and clinical application. Plast Reconstr Surg 99:1368–1380

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