Analysis Of Superficial And Deep Fascia On Each Site Of The Body
Diya' Hammoudeh, MD, Teruyuki Dohi, MD, PhD, Rei Ogawa, MD, PhD.
Nippon medical school, Tokyo, Japan.
PURPOSE: Previous research has demonstrated that reducing skin tension by the use of fascial/subcutaneous tensile reduction sutures could prevent and treat abnormal scarring. This so-called technique allows for dermal healing under low tension as dermis, particularly the reticular dermis, in high skin tension areas (e.g. anterior chest) was prone to continued inflammation hence was found to be the main stimulus for abnormal scaring. However, the exact anatomy and characteristics such as number and thickness of the subcutaneous fibrous membranes (Superficial and deep fascia) throughout the body sites are still lacking. Further knowledge of such details would help in the establishment of a fascial/subcutaneous tensile reduction suture protocol therefore decreasing the dermal inflammation -where feasible- on each of the body sites. METHODS: Ten volunteers were enrolled in this study. The study was approved by the ethical committee in our medical school. The subcutaneous tissue including the superficial and deep fascia on the trunk and limbs was analyzed using ultrasound as following: Anterior chest, abdomen, back region, lumbar region, gluteal region, upper limb and lower limb. Superficial fascia was found in the fat layer clearly as high absorption area by ultrasound. Number and thickness of superficial and deep fascia was measured in addition to dermal thickness and the percentage of superficial fascia to subcutaneous fat.
RESULTS: The subcutaneous fibrous membranes are more well developed, thicker and higher in number in trunk area as compared to limbs. It was suggested that thickness and amount of fibrous tissues are different by each body site and correlate with the tension applied to the tissue. Deep and superficial fascia were the most developed on the anterior chest wall among seven different regions. The average thickness on the midline of the anterior chest wall was 0.43 mm ± 0.07 with 2-3 layers of superficial fascia. Dermis was thickest on the back followed by the anterior chest wall.
CONCLUSION: Our results showed that cutaneous and/or subcutaneous fibrous tissues tend to be thick on the high tension sites such as the anterior chest wall and the back. It was suggested that the formation of abnormal scars could be suppressed by carefully observing the tension applied to the area to be operated, finding fibrous tissues to be sutured during the operation.
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