Search Results (37)

Introduction. The superficial musculoaponeurotic system (SMAS) is fundamental for facial soft tissue support and surgical rejuvenation. Although its morphology in the midface and neck is well characterized, the structure of its cranial extension to the forehead remains a subject of terminological uncertainty. The aim of this study was to conduct a detailed histological and immunohistochemical examination of the forehead supporting structures to characterize their morphology and propose an expanded, region-specific classification of the SMAS. Material and methods. Full-thickness tissue specimens (n = 30) were obtained from five standardized facial regions (parotid, buccal, temporal, frontal, and cervical) from 12 male and 18 female body donors (aged 25–70 years). Specimens were processed for histological analysis using hematoxylin and eosin, van Gieson staining, and Masson’s trichrome. Immunohistochemical staining for S100 protein was used to identify neural structures. Morphometric analysis was performed on digitized sections to quantify interseptal distances and the depth of superficial nerve trunks. Results. The analysis confirmed the established SMAS types (I–V) in the cheek, parotid gland, and neck, confirming the validity of the method. Two distinct, sequentially arranged structures were identified on the forehead, proposed as new types. Type VI (neurovascular arborization) is a discrete fan-shaped structures with a central collagen core surrounding a neurovascular bundle, showing positive S100 staining. These structures, spaced approximately 2.2 mm apart, function as true retaining ligaments. Type VII (fibroseptal) SMAS patterns is vertically oriented, purely fibrous septa (retinacula cutis) connecting the aponeurosis to the dermis, devoid of neural elements, and spaced approximately 9.2 mm apart. Importantly, the superficial nerve trunks were located at an average depth of only 1.09 mm (range: 0.57–1.97 mm) from the skin surface. Conclusion. This study identified two novel SMAS patterns in the forehead—neurovascular arborization (type VI) and fibroseptal (type VII)—supporting the expanded functional seven-type classification of the SMAS. The extremely superficial location of the forehead nerves (average 1.1 mm) defines a critical “danger zone” for aesthetic procedures. These findings provide a refined anatomical basis for improving the precision and safety of both surgical and minimally invasive facial procedures. Full article

The palmaris longus (PL) remains insufficiently quantified in cercopithecoids (Cercopithecoidea), despite growing comparative data across primates. We examined adult archival material of the Anubis baboon (Papio anubis) to document PL presence, tendon configuration and topography, describe muscle–tendon morphometrics, and test for side-, sex- and size-related effects. A PL was present in all limbs. Two tendon configurations were observed: a single tendon inserting into the palmar aponeurosis (Type I, 87.0%) and a bifurcated tendon with both medial and lateral slips inserting into the palmar aponeurosis (Type II, 13.0%). No side- or sex-related differences were found in variant distribution. Males showed larger absolute values for selected measurements, but these differences were not independent of antebrachial size. PL lengths and interstyloid distances were strongly correlated with antebrachial size, indicating overall scaling with limb dimensions. These findings identify a species-level pattern in which PL is consistently present and predominantly unbranched, with only occasional distal bifurcation. The data establish a comparative anatomical baseline for Papio and broaden the available evidence on PL morphology in non-human primates. Full article

Background: The structural integrity of the abdominal wall is critically dependent on the organization of aponeurotic tissue, a dense collagen-rich connective structure responsible for directional force transmission. While the clinical relevance of the aponeurosis is well recognized in abdominal wall reconstruction, its nano-scale structural organization remains insufficiently characterized. Atomic force microscopy (AFM) provides a suitable approach for investigating surface morphology and nano-architectural features of biological tissues. Methods: Human aponeurotic tissue samples were analyzed using atomic force microscopy operated in contact-mode deflection and topography imaging. Two-dimensional and three-dimensional surface topographies were acquired at the micrometer scale to assess nano-architectural organization. Areal surface roughness parameters (Sa, Sq, Sp, Sv, Sy) were calculated to quantify morphological heterogeneity. AFM deflection imaging was used to evaluate relative spatial variations in deflection imaging contrast under the applied scanning conditions across collagen-dense and interfibrillar regions. Results: AFM analysis revealed a well-organized fibrillar architecture with preferential orientation, consistent with the anisotropic organization of aponeurotic connective tissue. Deflection images demonstrated spatial heterogeneity in deflection contrast at the scanned scale, reflecting variations in the tip–sample interaction signal between collagen-dense and interfibrillar regions. Surface topography showed a continuous morphology with moderate height variations and smooth transitions between structural elements. Roughness parameters reflected a compact extracellular matrix organization within the scanned areas, without features suggestive of surface disruption. Conclusions: Atomic force microscopy enables detailed nano-scale structural characterization of human aponeurotic tissue and reveals spatial heterogeneity in deflection imaging contrast under specific contact-mode scanning conditions. These findings provide a baseline nano-scale descriptive reference dataset for macroscopically normal aponeurotic tissue, supporting future comparative investigations without implying validated mechanical differences or direct tissue–implant interaction analysis within the present study. Full article

Background: The history of radical hernia repair involves a period of intense surgical activity, influenced by factors of the time such as social development, hygiene, anesthesia, and antisepsis. Subcutaneous surgery, the initial option designed to avoid infections and peritonitis, was modified after the introduction of antisepsis, eventually leading to dissection surgery. Objective: We aim to analyze the publications from the period of radical hernia cures using current methodology, verifying when and how the transition occurred from subcutaneous surgery to dissection surgery. Methods: A literature review of the databases PubMed, LILACS, Cochrane Library, “Google” and university libraries is conducted. The following keywords were used: “anatomy and surgery”. A critical analysis of the known literature about this historical topic is carried out. Results: Under-vision dissection surgery, through incision of the aponeurosis of the external oblique muscle, began in England by Durham in 1866, almost 20 years before it was performed in France by Lucas-Championnière in 1885. Recurrences decreased after the introduction of the principle of closing the walls of the inguinal canal (Wood, 1860). The surgeon–anatomist Wood should be considered the first specialist in abdominal wall surgery, due to his extensive contributions from the pre-antiseptic era. The evolution of the radical cure of hernias was made possible by combining the knowledge of several countries: England, Germany, and Italy. Conclusions: Dissection surgery was initiated in England, Germany, and Italy, not in France. The influence of the French literature on the history of hernias is evident, to the detriment of the contributions of surgeons from other countries. Full article

Omphalocele is a congenital abdominal wall defect whose underlying muscular and fascial structural characteristics remain incompletely understood. This study aimed to investigate the anatomical and ultrastructural features of the abdominal wall in patients with omphalocele to provide additional insight into tissue organization at the defect margins. We report a series of 11 term-born patients diagnosed with omphalocele between 2024 and 2025 who were admitted to a pediatric surgery department for operative management. Following informed consent from legal guardians, two small intraoperative biopsies were obtained during surgical repair from the rectus abdominis muscle and its anterior aponeurosis, sampled from the supraumbilical and subumbilical regions. Tissue specimens were fixed within 48 h and analyzed using conventional histopathology and scanning electron microscopy to assess potential structural and ultrastructural alterations. The combined microscopic approaches allowed for a detailed evaluation of muscle and aponeurotic architecture in different abdominal regions. These observations contribute to a more comprehensive understanding of abdominal wall tissue characteristics in omphalocele and may support improved interpretation of the structural changes associated with this congenital condition. Full article

Background: Hand oligodactyly is a rare congenital malformation characterized by fewer than five digits. Although several clinical and radiological studies have been reported, detailed anatomical investigations remain scarce. This study aimed to describe the morphological characteristics of bilateral hand oligodactyly through dissection. Case Presentation: A bilateral hand oligodactyly with thumb and 3 fingers on each hand was found in a 77-year-old Korean female donor. The study was approved by the Institutional Review Board of Sungkyunkwan University (IRB No. SKKU 2023-02-012). Results: Diverse variations were observed in most structures of the hand, including the palmar aponeurosis, tendons of the flexor digitorum superficialis, the flexor digitorum profundus, and the flexor pollicis longus, lumbricals, interossei, and metacarpals. Connections between flexor and extensor tendons were also found, and each variation differed between the two hands. Conclusions: These structural differences highlight the developmental complexity of hand oligodactyly and offer valuable insights for facilitating appropriate surgical strategies. This study has also provided new insights into congenital anomalies that underscore their relevance in developmental biology. Full article

Background/objective: The palmaris longus muscle is a variable and often inconsistent muscle in the anterior compartment of the forearm. This fusiform-shaped muscle originates at the medial epicondyle of the humerus bone following a long and narrow tendon that inserts at the palmar aponeurosis. That tendon is used in reconstructive surgery, and for this reason, detailed information from an ultrasound is used to detect the tendon and the possible variations in the muscle. The present study aimed to investigate the palmaris longus muscle and its variations through ultrasound, anatomical, and histological analysis with clinical and surgical applications. Methods: A total of 72 upper limbs from 33 females and 39 males, 32 right and 40 left, were evaluated in ultrasound, anatomical, and histological studies. The main objective was to prove the existence of the palmaris longus muscle and its variations, as well as to measure the tendon for surgical applications. Results: Ultrasound analysis showed that it is possible to determine the existence of the muscle (76.4%) and its variations (23.6%), as well as its absence (15.3%). The anatomical results proved the ultrasound results. The width of the tendon was between 0.4 and 0.38 mm. by ultrasound and anatomical analysis. Also, normal palmaris longus tendons were not a direct cause of compression of the median nerve. Conclusions: It is important to confirm the existence and possible variations in the palmaris longus muscle and tendon through ultrasound before surgical reconstruction and for clinical diagnostics. Full article

Background and Objectives: The masseteric nerve (Mn) is increasingly used for facial reanimation because of its reliable location, high axon count, low donor morbidity, and favorable clinical outcomes. Precise topographic knowledge of the Mn relative to reproducible intraoperative landmarks is essential for safe dissection. This study investigated the intramuscular position of the Mn relative to two defined reference lines. Materials and Methods: Seventy-two hemicrania from 36 individuals (aged 54–99 years) embalmed postmortem using the Thiel method were examined. Measurements were referenced to two defined anatomical lines: the angle–canthus line (ACL), extending from the mandibular angle to the lateral canthus of the eye, and the articular eminence line (AEL), extending from the articular eminence to the base of the zygomatic temporal process. Results: The Mn crossed the ACL at an average distance of 39.9 ± 5.9 mm from the mandibular angle with up to four branches. The first intramuscular branch arose 15.6 ± 4.7 mm superior to the ACL. The Mn was located 4.9 ± 1.9 mm anterior to the articular eminence and 4.7 ± 1.5 mm inferior to the AEL, coursing at an average angle of 68.5 ± 11.6° to the AEL. The AEL and ACL provide reliable and clearly defined reference lines for locating the Mn and improve intraoperative reproducibility. The Mn followed a predictable oblique course and was consistently identified in the masseter muscle (Mm) beneath an intramuscular aponeurosis. Nerve diameter varied by site, underscoring the need for standardized measurement locations. Distal localization along the ACL may enable preservation of early intramuscular branches and reduce donor morbidity. Further studies should evaluate axon counts at defined points and clarify the relationship of the Mn to the masseteric artery for better intramuscular orientation during dissection. Conclusions: The Mn can be located within a 63 mm² area beneath the AEL at the masseter entry and more distally on the ACL. ACL-based access may protect the first intramuscular branch of the Mn and the temporal branch of the facial nerve (TBFN), and it represents a potential alternative for smile reconstruction for patients with preserved eye closure. Full article

Background: Organ transplant recipients are at a significantly higher risk of developing skin cancer compared to the general population, particularly cutaneous squamous cell carcinoma. Approximately 3–8% of these carcinomas are located on the scalp. Scalp reconstruction is particularly challenging, especially for large excisions, due to the thickness of the scalp, the inelastic aponeurosis of the galea, and the integrity of the hair-bearing scalp. Additionally, in organ transplant recipients, the presence of numerous comorbidities and the increased risk of infection due to immunosuppressive therapy make management more complex. Based on our experience and the existing literature, we aim to describe possible reconstruction methods and discuss the combined management of medical and immunosuppressive therapy. Method: We present our experience with seven kidney transplant patients who underwent excision of cutaneous squamous cell carcinoma with a diameter larger than 3 cm. The crane technique involves three key steps. First, the tumor is excised with wide margins of disease-free tissue. Next, a pericranial flap is rotated and positioned to cover the exposed cranial bone. Finally, a bilayer dermal substitute is applied to create a microenvironment that supports skin graft implantation. Results: The crane technique was used for six patients. In one case, an O-Z rotation flap was used. All patients modified their immunosuppressive therapy, with those receiving antiproliferative therapy switching everolimus after surgery. Conclusions: When combined with a post-operative modification of the immunosuppressive regimen, the crane technique could be considered a feasible, safe, and effective approach to managing large cSCC of the scalp in fragile patients. Full article

Recent interest in musculoskeletal connective tissues like tendons, aponeurosis, and deep fascia has led to a greater focus on in vivo medical imaging, particularly MRI. Given the rapid T₂* decay of collagenous tissues, advanced ultra-short echo time (UTE) MRI sequences have proven useful in generating high-signal images of these tissues. To further these advances, we discuss the integration of UTE with Diffusion Tensor Imaging (DTI) and explore image processing techniques to enhance the localization, labeling, and modeling of connective tissues. These techniques are especially valuable for extracting features from thin tissues that may be difficult to distinguish. We present data from lower leg scans of 30 healthy subjects using a non-Cartesian MRI sequence to acquire axial 2D images to segment skeletal muscle and connective tissue. DTI helped differentiate aponeurosis from deep fascia by analyzing muscle fiber orientations. The dual echo imaging methods yielded high-resolution images of deep fascia, where in-plane spatial resolutions were between 0.3 × 0.3 mm to 0.5 × 0.5 mm with a slice thickness of 3–5 mm. Techniques such as K-Means clustering, FFT edge detection, and region-specific scaling were most effective in enhancing images of deep fascia, aponeurosis, and tendon to enable high-fidelity modeling of these tissues. Full article

The aim of the present study was to assess the association between muscle thickness and the superficial and deep aponeurosis thickness of the hamstrings. Ultrasound images were captured from the semitendinosus (ST) and biceps femoris long head (BFlh) of fifty young individuals (28 males and 22 females). Measurements were taken at six sites along the thigh in prone position. Superficial and deep aponeurosis and muscle thickness were evaluated across the entire length of the ST and BFlh using a computational image segmentation approach, which generated approximately ~360 data points per participant. There was significant interindividual variability in superficial (coefficient of variation, CV: 19.37–31.40%) and deep aponeurosis thickness (CV: 21.22–31.82%). Correlation analysis revealed a limited association between muscle and superficial aponeurosis thickness, with no significant correlations (r = −0.21 to 0.22, p > 0.05) observed across regions. However, moderate positive correlations were found for deep aponeurosis thickness in the proximal region of the BFlh (r = 0.43, p = 0.002) and in the middle (r = 0.34, p = 0.014) and distal–middle region of the ST (r = 0.35, p = 0.022). No consistent relation between muscle and aponeurosis thickness was observed, suggesting that aponeurosis morphology varies independently of muscle size. This variability may impact the mechanical strain distribution, emphasizing the need for individualized assessments in hamstring injury prediction. Full article

Plantar fasciopathy is a very common musculoskeletal complaint that leads to reduced physical activity and undermines the quality of life of patients. It is associated with changes in plantar fascia structure and biomechanics which are most often observed between the tissue’s middle portion and the calcaneal insertion. Sonographic measurements of thickness and shear wave (SW) elastography are useful tools for detecting such changes and guide clinical decision making. However, their accuracy can be compromised by variability in the tissue’s loading history. This study investigates the effect of loading history on plantar fascia measurements to conclude whether mitigation measures are needed for more accurate diagnosis. The plantar fasciae of 29 healthy participants were imaged at baseline and after different clinically relevant loading scenarios. The average (±standard deviation) SW velocity was 6.5 m/s (±1.5 m/s) and it significantly increased with loading. Indicatively, five minutes walking increased SW velocity by 14% (95% CI: −1.192, −0.298, t(27), p = 0.005). Thickness between the calcaneal insertion and the middle of the plantar fascia did not change with the tissues’ loading history. These findings suggest that preconditioning protocols are crucial for accurate SW elastography assessments of plantar fasciae and have wider implications for the diagnosis and management of plantar fasciopathy. Full article

Over the past decade, there has been a notable increase in research focused on ultrasound imaging of thoracolumbar fascia (TLF). Nevertheless, published papers’ results about the application of US imaging in TLF examination are still sparse. Background and Objevtives: Hence, this systematic review was performed aiming to firstly investigate the use and the methodology of ultrasound imaging to assess pathologic and healthy TLF. Secondarily, we aim to assess intra- and inter-observer reproducibility of US imaging in TLF assessment. Materials and Methods: The search was done on PubMed and Web of Science database from inception to April 2024. Furthermore, the references of included papers were thoroughly checked to find eligible publications. The MeSH keywords used were: “Thoracolumbar fascia”, “Ultrasound Imaging”, “Ultrasound”, “Ultrasonography”, and “Ultrasound examination”. Results: Studies were aimed primarily at TLF diagnosis, treatment monitoring, or evaluating movement-related changes, underscoring the diverse clinical applications. The US parameters assessed included TLF thickness, echogenicity, stiffness, deformation, shear strain, and displacement, providing comprehensive insights into TLF features. Conclusions: Advanced US imaging holds promise as a reliable tool in musculoskeletal assessment, offering insights into TLF pathology/disfunction, treatment outcomes, and movement dynamics. Full article

Plantar fasciitis is the most common cause of chronic heel pain. It is characterized by localized inflammation and degeneration of the proximal part of the plantar aponeurosis. Treatment is mainly conservative. Herein, a 54-year-old woman with chronic heel pain was diagnosed as having plantar fascia rupture by ultrasound, probably after extracorporeal shock wave therapy. Corticosteroid injection was avoided after ultrasound imaging. Plantar fascia rupture after extracorporeal shock wave therapy is an unexpected complication. This case report highlights the importance of ultrasound imaging for both diagnosis and injection guidance in patients with plantar fasciitis. Full article

Background and Objectives: Preeclampsia has been linked to an inflammatory response that may be brought on by endothelial cell dysfunction. This paper investigates the pathomechanism of syncytiotrophoblast basement membrane (STBM) damage and Placental Protein 13 (PP13) release, which may have a role in systemic endothelial dysfunction in preeclampsia. Materials and Methods: This comparative cross-sectional study involves 54 preeclampsia patients (27 early-onset preeclampsia and 27 late-onset preeclampsia) and 27 pregnant women with normal blood pressure. An enzyme-linked immunosorbent assay was performed to evaluate maternal blood levels of PP13. Following birth, a portion of the placenta was collected for transmission electron microscope (TEM) and immunohistochemical (IHC) analysis. The data were analyzed using STATA version 15. Results: PP13 expression in the placental syncytiotrophoblast was significantly lower in the early-onset preeclampsia, compared to late-onset preeclampsia and normotensive pregnancy, group (p < 0.001). In contrast, serum PP13 levels were found to be the highest in the early-onset preeclampsia group, although no significant difference were found in mean maternal serum levels of PP13 between the three groups. The decreased PP13 expression in placental syncytiotrophoblast can be attributed to the greater extent of damage in the STBM in early-onset preeclampsia that leads to the release of a larger amount of PP13 into maternal circulation. The hypothesis aligns with the TEM analysis results. Preeclamptic pregnancies showed placental syncytiotrophoblast aponeurosis, whereas normotensive pregnancies did not. Placental lesions and STBM shedding were found to be more pronounced in early-onset preeclampsia compared to late-onset preeclampsia. Conclusions: PP13 and STBM damage may play a role in systemic endothelial dysfunction in preeclampsia. Full article