Innervation of human superficial fascia

Abstract

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.

Detection of Lymphatic Vessels in the Superficial Fascia of the Abdomen

“…Below, the SF appeared as a thin fibrous layer ( Figure 1 b), with a membranous appearance and a multilayered structure of collagen bundles. The histological tangential section of the SF layer showed a net of irregularly arranged collagen fibers, interpenetrated by adipose clusters and crossed by a rich vascular pattern ( Figure 1 c), as already demonstrated and described in our previous works [ 23 , 28 ]. Beneath the SF, another layer of adipose tissue was visible—the DAT—with smaller, flatter, and less-defined adipose lobes than those of the SAT ( Figure 1 a).…”

“…According to Italian law, the parts of the body removed for therapeutic purposes during surgery that would otherwise be destined for destruction can be used for research. For each patient, 3 samples, of ~1 cm 2 were randomly collected from different areas of the abdominal region, at full thickness, from the epidermis to the DAT [ 23 ]. Moreover, from each subject, three additional samples of the superficial fascia were isolated from the surrounding adipose tissue.…”

Infrared thermographic changes after decompression surgery in patients with carpal tunnel syndrome

“…Damage to unmyelinated small fibers in the early stages of CTS may increase thermal variation in areas innervated by the same nerve through mechanisms such as sympathetic dysfunction, reactive vasoconstriction, and antidromic sensory fiber activation [ 25 ]. Furthermore, a neuroanatomic study recently identified superficial fascia to be innervated by autonomic and sensory nerve fibers, which suggests the role of superficial fascia stress in CTS [ 26 ]. We have reported in a previous study that as the severity of CTS worsens, the anisometry also gradually increases [ 21 ].…”

Digital Ischemia after Ultrasound-Guided Alcohol Injection for Morton’s Syndrome: Case Report and Review of the Literature

“…Chronic rigidity of this fascia increases the stiffness of the inter-metatarsal space, leading to entrapment of the CDPN. Further, the same authors have reported more recently that the deep fasciae are very well innervated [ 8 , 9 ], and their alteration can be a further source of neuropathic chronic pain. Hence, stiffness of fascia in the foot could also irritate the free nerve endings inside the fascial tissue, causing an additional source of nociceptive pain [ 10 , 11 ].…”