Fibrous configuration of the fascia iliaca compartment: An epoxy sheet plastination and confocal microscopy study

Abstract

Background and Objectives: The underlying anatomical mechanism of the ultrasound-guided fascia iliaca compartment (FIC) block for anaesthesia and analgesia in the lower limb has not been illuminated and numerous variations were attempted to achieve an optimal needle placement. This study aimed to define the fibrous configuration of the FIC. Methods: A total of 46 adult cadavers were studied using dissection, latex injection, epoxy sheet plastination and confocal microscopy. Results: (1) The fascia iliaca originated from the peripheral fascicular aponeurotic sheet of the iliopsoas. (2) The FIC was a funnel-shaped adipose space between the fascia iliaca and the epimysium of the iliopsoas, had a superior and an inferior opening and contained the femoral and lateral femoral cutaneous nerves but not obturator nerve. (3) The estimated volume of the FIC in the cadavers was about 23 mls, of which about one third was below the level of the anterior superior iliac spine. Conclusions: This study revealed that the fascia iliaca was aponeurotic and may be less permeable for the local anesthetics. Conclusions: The FIC contained only the femoral and lateral femoral cutaneous nerves and communicated with the extraperitoneal space and femoral triangle adipose space via its superior and inferior opening, respectively.

Fascial thickness and stiffness in hypermobile Ehlers‐Danlos syndrome

“…(c) Examination the FI. The transducer was placed inferior to the anterior superior iliac spine medially and parallel to the inguinal ligament (Xu et al, 2020) The excess laydown of ECM may occur in response to inflammation (Hoheisel et al, 2015). The phenotypic presentation of hEDS is wide and is associated with multiple inflammatory-like conditions and symptoms.…”

“…The change in stiffness may reflect changes in ECM content, quality, and gliding that may contribute to pathologic hip mechanics previously reported in relationship to back pain (Sadeghisani et al, 2015). In addition, the lateral one-third of the FI gives rise to the transversus abdominis and internal oblique abdominis forming a conjoint tendinous sheet (Cramer, Darby, & Cramer, 2014;Xu et al, 2020) and is important for the stability of the lumbar region (Fan et al, 2018). Alteration of the stiffness in the FI may contribute to instability of the lumbar region through this complex fascial relationship and contribute to back pain.…”

The Five Diaphragms in Osteopathic Manipulative Medicine: Myofascial Relationships, Part 2

“…The outermost portion of the TF is the alba line where, at the level of the umbilical area, it merges with some fascial structures connected to the liver: round ligament or ligamentum teres hepatis; medial umbilical ligaments; median umbilical ligament or urachus [32]. The urachus at the inguinal ring merges below to strengthen the spermatic cord in the inguinal canal or to contribute to the formation of the common vaginal tunic [33]. Vestigial fascial folds or lateral umbilical folds can also be found [29].…”

“…TF encounters another structure called ligamentum venosum (between left portal vein and left hepatic vein) [34]. TF merges in part with the iliac fascia (deriving from the psoas and iliacus muscles) in its anteroinferior and anteromedially portion; near the inguinal ligament; TF and iliac fascia merge with pectineal fascia [33]. The pectineus muscle is in close contact with the pectineal ligament (ventrally and superiorly), which is connected to the inguinal ligament via the lacunar ligament; TF binds in the iliopubic portion to this complex [35].…”

“…There is a strong link between TF and IL. This relationship drags TF to involve the contralateral lower limb; the medial portion of the fascia lata derives from IL, whose fibers derive from TF [33,38]. The connective tissue system of TF is contacted caudally with the adductor longus muscle; the pyramidalis muscles are below the TF attack (which covers the anterior pubic ligament) at the level of the pubic symphysis and merge with the adductor longus muscle [38].…”