Elastic Fibres in the subcutaneous tissue: Is there a difference between superficial and muscular fascia? A cadaver study

Pirri, Carmelo; Fede, Caterina; Petrelli, Lucía; Guidolin, Diego; Fan, Chenglei; De, Raffaele; Stecco, Carla

doi:10.1111/srt.13084

Cited by 27 publications

(23 citation statements)

References 35 publications

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“…The morphological features of the retinacula in the wrist and in the ankle studied showed similar features with the deep fascia, which tended to decrease in thickness, which was most evident in the iliotibial tract and extensor retinaculum of the ankle (Table 1). Moreover, in all-full thickness at 36th week of development, a precise organization of the deep fascia was seen, similar to those described in adults [18,19], while the samples collected around the joints did not present the thickening typical of the fascial reinforcements/retinacula, and only in those of the lower limb started to appear the organization in sublayers.…”

Section: Discussionsupporting

confidence: 80%

“…Finally, an analysis of our results showed that the quantity of elastic fibers, during gestation, is negligible. As reported by Pirri et al [19], "Elastic component, inside loose connective tissue, allows the fibrous layers to move with respect to the adjacent one and to return to initial", supporting the hypothesis that the movement, the load and the gravity stimulate their development in the deep fascia mixing their elastic capacity and of force transmission (Appendix A).…”

Section: Discussionsupporting

confidence: 72%

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Fetal Fascial Reinforcement Development: From “a White Tablet” to a Sculpted Precise Organization by Movement

Pirri

Petrelli

Pérez‐Bellmunt

et al. 2022

Biology

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Fasciae have received much attention in recent years due to their important role in proprioception and muscular force transmission, but few studies have focused on fetal fasciae development and there is no study on the retinacula. The latter are fascial reinforcements that play a key role in proprioception and motor coordination. Furthermore, it is still unclear if they are genetically determined or if they are defined by movements, and if they are present during gestation or if they appear only later in the childhood. We aim to identify their structural organization by qualitative and quantitative assessments to establish their role the myofascial development, highlighting their appearance and organization. Samples from the wrist retinacula, posterior forearm, ankle retinacula, anterior leg, iliotibial tract and anterior thigh of six fetus body donors (from 24th to 40th week of gestation) and histological sections were obtained and a gross anatomy dissection was performed. Sections were stained with hematoxylin-eosin to observe their overall structure and measure their thicknesses. Using Weigert Van Gieson, Alcian blue and immunostaining to detect Hyaluronic Acid Binding Protein (HABP), Collagens I and III (Col I and III) were realized to assess the presence of elastic fibers and hyaluronan. This study confirms that the deep fasciae initially do not have organized layers and it is not possible to highlight any reinforcement. The fascial development is different according to the various area: while the deep fascia and the iliotibial tract is already evident by the 27th week, the retinacula begin to be defined only at the end of pregnancy, and their complete maturation will probably be reached only after birth. These findings suggest that the movement models the retinacula, structuring the fascial system, in particular at the end of pregnancy and in the first months of life. The fasciae can be imagined, initially, as “white tablets” composed of few elastic fibers, abundant collagens and HA, on which various forces, u movements, loads and gravity, “write their history”.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 72%

Fetal Fascial Reinforcement Development: From “a White Tablet” to a Sculpted Precise Organization by Movement

Pirri

Petrelli

Pérez‐Bellmunt

et al. 2022

Biology

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“…These findings indicate that the superficial fascia in the arm and in forearm tends to be thicker posteriorly, indicating a greater role in organizing the subcutaneous tissue in these compartments [ 20 ]. Indeed, the superficial fascia, being a fibrous-elastic connective tissue with fat mingled, was observed to be double in the posterior region at different levels of arm, holding the subcutaneous tissue together and allowing it to maintain its integrity in the transfer of forces during the movement [ 22 ]. Moreover, the superficial fascia splits around major subcutaneous vessels and nerves [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Imaging of the Superficial Fascia in the Upper Limb: Arm and Forearm

Pirri

Guidolin

et al. 2022

Diagnostics

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The superficial fascia has received much attention in recent years due to its important role of compartmentalizing the subcutaneous tissue. Ultrasound (US) imaging, owing to its high definition, provides the possibility of better visualizing and measuring its thickness. The aim of this study was to measure and compare, with US imaging, the thickness of superficial fascia in the arm and forearm in different regions/levels. An observational study has been performed using US imaging to measure superficial fascia thickness in the anterior and posterior regions at different levels in a sample of 30 healthy volunteers. The results for superficial fascia thickness revealed statistically significant differences (p < 0.0001) in the arm between the anterior and posterior regions; in terms of forearm, some statistically significant differences were found between regions/levels. However, in the posterior region/levels of the arm, the superficial fascia was thicker (0.53 ± 0.10 mm) than in the forearm (0.41 ± 0.10 mm); regarding the anterior regions/levels, the superficial fascia of the arm (0.40 ± 0.10 mm) was not statistically different than the forearm (0.40 ± 0.12 mm). In addition, the intra-rater reliability was good (ICC2,k: 0.88). US helps to visualize and assess the superficial fascia inside the subcutaneous tissue, improving the diagnosis of fascial dysfunction, and one of the Us parameters to reliably assess is the thickness in different regions and levels.

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“…The Superficial Fascia (SF, 700 μm thickness, Pirri et al, 2022 ) was collected in the abdominal region (from three volunteer patients who were undergoing abdominoplasty at the Plastic and Reconstructive Surgery Unit of the University of Padua), and in the hip area (from six volunteer patients undergoing elective surgical procedures at the Orthopaedic Clinic of the University of Padua).…”

Section: Methodsmentioning

confidence: 99%

Innervation of human superficial fascia

et al. 2022

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The superficial fascia has only recently been recognized as a specific anatomical structure. Furthermore, whereas it is actually recognized that the innervation of the deep/muscular fascia plays a key role in proprioception and nociception, there are very few studies that have analyzed these characteristics in the superficial fascia. In this work, our group analyzed two different anatomical districts (abdomen and thigh), from volunteer patients, undergoing surgery procedures. Each sample was processed for histological analysis by Hematoxylin&Eosin, and by immunohistochemistry stainings (in 5-micron-paraffin embedded section and in cryosectioned free floating samples), with antibodies specific for nerve fibers: S100 antibody for myelinating and non-myelinating Schwann cells, PGP9.5 antibody as pan-neuronal marker, tyrosine hydroxylase for autonomic innervation. The results revealed a huge innervation: the nervous structures were found above all around blood vessels and close to adipocytes, but they penetrated also in the connective tissue itself and are found in the midst of fibro-adipose tissue. The tissue is pervaded by both thin (mean diameter of 4.8 ± 2.6 μm) and large nerve fiber bundles of greater diameter (21.1 ± 12.2 μm). The ratio S100/TH positivity was equal to 2.96, with a relative percentage of autonomic innervation with of 33.82%. In the light of these findings is evident that the superficial fasciae have a clear and distinct anatomical identity and a specific innervation, which should be considered to better understand their role in thermoregulation, exteroception and pain perception. The knowledge of the superficial fascia may improve grading and developing of different manual approach for treatments of fascial dysfunctions, and the understanding of how some factors like temperature or manual therapies can have an impact on sensitivity of the fascia.

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Elastic Fibres in the subcutaneous tissue: Is there a difference between superficial and muscular fascia? A cadaver study

Cited by 27 publications

References 35 publications

Fetal Fascial Reinforcement Development: From “a White Tablet” to a Sculpted Precise Organization by Movement

Fetal Fascial Reinforcement Development: From “a White Tablet” to a Sculpted Precise Organization by Movement

Ultrasound Imaging of the Superficial Fascia in the Upper Limb: Arm and Forearm

Innervation of human superficial fascia

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