Search Results (59)

This study characterized collagen remodeling in an electron-beam-sterilized porcine acellular dermal matrix (E-PADM) by evaluating host response kinetics during wound healing. E-PADM (n = 6 lots/time point) was implanted in an abdominal wall bridging defect in nonhuman primates (N = 24). Histological, immunohistochemical, and biochemical assessments were conducted. Pro-inflammatory tissue cytokines peaked 1 month post-implantation and subsided to baseline by 6 months. E-PADM-specific serum immunoglobulin G antibodies increased by 213-fold from baseline at 1 month, then decreased to <10-fold by 6–9 months. The mean percentage tissue area staining positively for matrix metalloproteinase-1 plateaued at 3 months (40.3 ± 16.9%), then subsided by 6 months (16.3 ± 11.1%); tissue inhibitor matrix metalloproteinase-1 content plateaued at 1 month (39.0 ± 14.3%), then subsided by 9 months (13.0 ± 8.8%). Mean E-PADM thickness (1.7 ± 0.2 mm pre-implant) increased at 3 months (2.9 ± 1.5 mm), then decreased by 9 months (1.9 ± 1.1; equivalent to pre-implant). Histology demonstrated mild inflammation between 1–3 months, then a peak in host tissue deposition, with ≈75%–100% E-PADM collagen turnover, and fibroblast infiltration and neovascularization between 3–6 months. Picrosirius red staining revealed that mature E-PADM collagen was replaced by host-associated neo-collagen by 6 months. E-PADM implantation induced wound healing, which drove dermal E-PADM collagen remodeling to native, functional fascia-like tissue at the implant site. Full article

The effectiveness of ultrasound (US)-guided compared with blind corticosteroid injections for the treatment of plantar fasciitis (PF) remains uncertain. This meta-analysis aimed to evaluate the clinical benefits of US-guided over blind injections in patients with PF. A systematic search of PubMed, Embase, Web of Science, and Scopus was conducted, collecting articles published up to 20 April 2025. Randomized controlled trials comparing US-guided and blind corticosteroid injections for PF were included. The extracted outcome measures, i.e., visual analog scale (VAS), heel tenderness index (HTI), tenderness threshold (TT), and plantar fascia thickness, were assessed at short- (2–6 weeks) and long-term (≥12 weeks) follow-ups. Compared with the blind injection group, the US-guided group showed significantly greater improvement in TT at both short- and long-term follow-ups, as well as a greater reduction in plantar fascia thickness. However, no significant differences were found between the two groups in VAS and HTI scores. US-guided corticosteroid injections provide superior clinical benefits compared with blind injections in patients with PF, particularly in enhancing mechanical pain tolerance and reducing plantar fascia thickness. Nevertheless, these findings should be interpreted with caution due to the limited methodological quality of the included studies. Full article

Hypermobile Ehlers–Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD) are increasingly recognized as complex, multisystem connective tissue disorders characterized by joint hypermobility and instability, chronic pain, autonomic dysfunction, immune dysregulation, and structural fragility. Despite their clinical impact and prevalence, the underlying pathophysiology remains poorly understood, and diagnosis is frequently delayed or missed altogether. Emerging research highlights the fascia as a central player in the pathogenesis of these conditions. This narrative review synthesizes current molecular, histological, and biomechanical findings to propose a fascia-centered framework for understanding hEDS and HSD. Evidence from transcriptomic and imaging studies reveals consistent abnormalities in fascial thickness, interfascial gliding, myofibroblast activation, tendon elongation, and tissue stiffness—findings that mirror the functional impairments reported in clinical populations. We explore fascia as a dynamic tissue network and consider how dysregulation in these processes may contribute to the widespread symptoms seen in hypermobility disorders. By reframing hEDS and HSD as disorders of pathological fascial remodeling, this review offers an integrated model that connects molecular mechanisms with clinical expression. It underscores the urgent need for multidisciplinary research to define diagnostic biomarkers, clarify therapeutic targets, and support the development of more effective, personalized interventions. Full article

Background/Objectives: Immediate implant-based breast reconstruction is an established option for selected patients undergoing mastectomy. However, patients with large and ptotic breasts present specific reconstructive challenges, often requiring tailored approaches to minimize complications and optimize aesthetics. This pilot study aimed to evaluate the clinical feasibility and effectiveness of a mobile application developed to support intraoperative decision-making based on an institutional algorithm for breast reconstruction. It is also important to underline that this pilot study was exploratory in nature and primarily aimed at assessing feasibility and adherence to an app-based decision pathway, rather than comparative efficacy. Methods: We conducted a prospective observational study from October 2023 to December 2024 at the University Hospital of Sassari. Female patients with large and ptotic breasts undergoing immediate implant-based reconstruction were included. A mobile app, developed using MIT App Inventor 2, implemented our institution’s algorithm and guided surgeons through both preoperative and intraoperative decision-making. Surgical options included subpectoral, prepectoral with autologous fascial flaps, or prepectoral with acellular dermal matrix (ADM) reconstruction, depending on flap thickness and fascia integrity. Results: Sixteen patients (21 reconstructed breasts) were included. Surgical planning and execution followed app-generated recommendations in all cases, with no intraoperative deviations. Subpectoral reconstruction was performed in six patients, prepectoral with ADM in eight, and prepectoral with fascial flaps in two. The app was rated positively by all surgeons and facilitated consistent decision-making. Conclusions: The proposed mobile application, described in this pilot study, proved to be a feasible and effective decision-support tool for implant-based breast reconstruction in patients with challenging anatomy. It standardized surgical choices, supported training, and has the potential to enhance reproducibility and safety in complex reconstructive procedures. Full article

This study investigates the influence of probe angulation on echogenicity and thickness measurements of the deep fascia, addressing methodological challenges in musculoskeletal ultrasound examination. The anisotropic nature of connective tissues can lead to distortions, affecting US imaging accuracy and diagnostic reliability. Echogenicity and thickness variations were analyzed across different probe inclinations in both transverse and longitudinal orientations. Measurements at 0° were compared with −5° and +5° angles to assess their impact on imaging consistency due to 3D-printed support. Echogenicity differed significantly with probe angulation, in particular in transverse scan at 0°, which showed substantial variation at −5° (mean diff. = 55.14, p < 0.0001) and +5° (mean diff. = 43.75, p = 0.0024). Thickness measurements also varied, reinforcing that non-perpendicular probe angulation introduces distortions. The same results were reported for longitudinal scans. These findings highlight the need for the use of standardized scanning protocols to improve reliability. The protean nature of deep fascia anisotropy, highly sensitive to minimal changes in probe orientation, necessitates precise and consistent imaging to accurately reveal its structural organization. Optimizing probe orientation is essential for advancing fascial US diagnostics. Full article

Ultrasound (US) is rapidly gaining attraction among physicians for the evaluation of fasciae. Unlike traditional imaging, which often lacks specificity of pain localization, US examination stands out as a versatile tool, capable of detecting both structural and functional information. This unique capability allows for a comprehensive assessment of fasciae—the intricate connective tissue essential for human biomechanics. US examination offers a multiparametric approach for the assessment of thickness, echogenicity, stiffness, deformation and shear strain. This comprehensive examination is invaluable for identifying fascial pathologies that may not be detected during physical examination. In this study, we render and discuss common/elementary lesions of the fascia. Full article

Objectives: The objectives of this study were to develop a procedure to measure the cross-sectional area and thickness of tensor fasciae latae muscle, and examine the intra- and inter-rater reliability of this procedure in healthy participants. Methods: The cross-sectional area and thickness of tensor fascia latae were evaluated by sonography in 14 healthy subjects (28 lower extremities) in a single session. Two examiners conducted ultrasound examinations and performed the measurements independently. Each examiner was blinded to the measurements of the other examiner. For examination, the transducer was placed transversally to the thigh at the anterior superior iliac spine level and was moved caudally along the tensor fascia latae muscle, ensuring that the volume of the muscle was in the center of the image. The examiners took ultrasound images when the maximum size was reached. Results: The intra-rater reliability for tensor fascia latae measurements was excellent in both examiners (cross-sectional area: ICC2,2 = 0.905–0.969, SEM = 0.29–0.82 mm², MDC = 0.80–2.27; thickness: ICC2,2 = 0.965–0.985, SEM = 0.20–0.60 mm, MDC = 0.55–1.66; all p < 0.001). The inter-rater reliability was good for the cross-sectional area (ICC2,2 = 0.783, SEM = 0.77 mm², MDC = 2.13 mm²). The inter-rater reliability was poor for thickness measurements (ICC2,2 = 0.445, SEM = 2.12 mm, MDC = 5.87 mm) and 2.12 mm for thickness. Conclusions: The procedure developed for measuring the size of the tensor fascia latae muscle with ultrasound images has demonstrated feasibility and excellent intra-rater reliability. The inter-rater reliability was good and poor for cross-sectional area and thickness measurements, respectively. Full article

Post-stroke spasticity significantly impairs upper limb function and quality of life. Ultrasound-guided botulinum toxin-A (BoNT-A) injections have become a cornerstone of management, enhancing precision and safety. This paper offers a comprehensive guide for clinicians on ultrasound-guided BoNT-A injections for distal upper limb muscles. Each muscle is detailed in terms of its role in spasticity management, ultrasound identification with key anatomical landmarks, clinical relevance, and injection strategies. Motor points, traditionally identified through anatomical studies or electromyography (EMG), are precisely localized using a musculoskeletal ultrasound by targeting the point of maximum muscle thickness, often corresponding to the motor point. The authors present their clinical method, developed at Elias University Hospital (EUH), to refine BoNT-A injection practices. This approach enhances efficacy, reduces dosage requirements, and improves patient outcomes. The paper also explores unique ultrasound characteristics of spastic muscles, such as their relationship with peripheral nerves, adjacent vascular and muscular structures, and intra- and intermuscular fascia, to guide clinicians in targeting functional muscle tissue. This guide is illustrated with representative ultrasound images and clinical diagrams and provides practical insights into anatomical relationships and injection techniques. Part I focuses on distal upper limb muscles, with Part II addressing proximal upper limb muscles. 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

In recent years, the interest in the comprehension of the fasciae has significantly grown, together with the necessity of finding a consensus for a terminology of the fasciae in the research and clinical fields. Furthermore, it is becoming necessary to categorize the various types of fascia (superficial, deep, visceral, neural) since they possess different anatomical characteristics, and are implicated in different pathophysiological pathways. While in the past we have described the deep/muscular fascia, the aim of this work is to summarize and catalog the information relating to the human superficial fascia (thickness, cellular end extracellular matrix component, innervation, vascularization). Full article

Background: Lymphedema represents a frequent cause of disability for patients undergoing oncological treatments and, being a chronic, non-reversible pathology, requires targeted and continuous rehabilitation treatments. To date, the studies available on the use of ultrasound in patients with lymphedema mainly report descriptive data; therefore, with this study, we wanted to describe in a more objective way the typical ultrasound alterations found in these patients, measuring the thickness of the different superficial structures, and defining subcutis echogenicity. Methods: 14 patients affected by secondary lymphedema of the upper limbs were enrolled in this cross-sectional observational study (12 had breast cancer and 2 with melanoma as their primary diagnosis). All patients were classified as stage II according to the ISL classification. Patients were examined between March and July 2023 with a clinical and an ultrasound evaluation. Ultrasound evaluation was performed following a protocol and took into consideration thickness of the cutis, subcutis, superficial and deep fascia, and subcutis echogenicity. Results: The cutis of the affected limbs was thicker in the distal anterior region of the arm and throughout the anterior region of the forearm. The subcutaneous tissue was thicker in the posterior region of the distal arm and throughout the forearm, including the dorsum of the hand and excluding only the proximal posterior region of the forearm. Fascial structures did not demonstrate statistically significant differences in thickness between pathological and healthy limbs, despite undergoing significant changes from a qualitative point of view (loss of the trilaminar skin appearance and the development of anechoic areas due to fluid accumulation around the hyperechoic adipose lobule). A statistically significant difference in the echogenicity of subcutaneous tissue was found at the distal anterior region of the arm and at the entire anterior forearm. Conclusions: High-resolution ultrasound has been confirmed to be a tool capable of supporting the diagnosis of lymphedema and identifying the most compromised regions of the limb. A tailored rehabilitation plan can be developed based on the non-uniform alterations in subcutaneous tissue, where some areas are affected earlier than others. This compartmentalization should be considered in lymphedema staging and management. Ultrasound may provide early detection of these changes, guiding a more precise therapeutic approach. Full article

Background/Objectives: Lymphedema, a common source of disability among oncology patients, necessitates continuous targeted rehabilitation. Recent studies have revealed the role of connective tissue in this pathology; however, despite existing research on ultrasound (US) use in lymphedema, no studies have specifically addressed the use of ultrasound to assess fasciae in patients with lymphedema. This study aims to provide a more objective characterization of typical US alterations in these patients by quantifying the thickness of superficial and deep fasciae and comparing them with those of healthy volunteers. Methods: A cross-sectional study was performed using US imaging to measure the thickness of superficial and deep fascia in different regions and levels of the arm and forearm in a sample of 50 subjects: 25 chronic lymphedema patients and 25 healthy participants. Results: No significant difference in fascial thickness was observed between affected and unaffected upper limbs, but patients had notably thinner superficial fascia and deep fascia compared with healthy volunteers. The findings for superficial and deep fascia revealed statistically significant differences (p < 0.0001) in all regions and levels. Conclusions: This study demonstrates the effectiveness of US imaging as a non-invasive tool for detecting subtle fascial changes in chronic lymphedema patients, revealing thinner fasciae compared with those in healthy volunteers. These findings suggest a potential anatomical predisposition to lymphedema, highlighting the importance of incorporating detailed US assessments in diagnosis and management to improve early intervention and patient outcomes. Future studies could, therefore, investigate whether preventive fascia assessment might improve the early identification of individuals at risk. Full article

Background/Objective: Spasticity following stroke causes structural changes in the muscles and fascia, affecting the mobility and functional recovery of patients. Understanding these structural changes is critical to optimizing the rehabilitation strategies for patients. Therefore, in this study, we aimed to investigate the differences in crural and epimysial fascia thickness and muscle stiffness in the affected and unaffected lower limbs of chronic stroke patients with spasticity. Methods: A total of 88 patients with chronic stroke (mean age: 62.7 ± 10.2 years) were included in this study. Ankle range of motion, crural fascial thickness, and muscle stiffness in affected and unaffected lower limbs were assessed using ultrasound. Results: For the affected lower limbs, 59 patients (67.1%) exhibited a modified Ashworth scale score of 2, whereas 29 patients (32.9%) exhibited a score of 3. Ankle range of motion, fascia thickness, and muscle stiffness were also measured. The range of motion in ankle dorsiflexion and plantar flexion was significantly reduced on the affected side (p < 0.05). Crural fascia thickness was significantly greater in all regions of the affected side (anterior: 0.96 ± 0.14 vs. 0.72 ± 0.08 mm [p < 0.001]; lateral: 1.01 ± 0.14 vs. 0.75 ± 0.14 mm [p < 0.001]), and the epimysial fascia of the tibialis anterior muscle was similarly greater in the affected side (0.46 ± 0.07 vs. 0.34 ± 0.03 mm [p < 0.001]). However, no significant differences in muscle stiffness were observed between the affected and unaffected sides (p > 0.05). Conclusions: Overall, these findings revealed significant fascial thickening with only minimal changes in muscle stiffness on the affected side, highlighting the importance of controlling fascial changes for post-stroke spasticity management. Full article

Background/Objectives: Tendinopathy of the gluteus medius and minimus tendons is a primary source of lateral hip pain, ranging from interstitial and partial-thickness tears to complete tears. Treatments include muscle transfers, Achilles tendon allograft procedures, and primary repairs with allografts. This study evaluated the one-year outcomes of gluteus medius and minimus reconstruction using an open double-row technique with a partial tensor fasciae latae transfer for severe Trendelenburg post-total hip arthroplasty. Methods: A prospective study involving eight patients who underwent surgery from April to December 2023 was conducted. The surgery involved an open technique with double-row suture reinforcement and tensor fasciae latae autograft. Outcomes were measured using strength, the Harris Hip Score (HHS), 12-Item Short Form Health Survey (SF-12), Hip Outcome Tool (HOT), International Hip Outcome Tool (iHOT), and Visual Analog Scale (VAS). Follow-ups occurred at 1, 3, 6, 9, and 12 months postoperatively. Results: At an average follow-up of 7.17 months, significant improvements in both hip function and quality of life were observed. The SF-12 quality of life score increased from 27 preoperatively to 34 by month 12. Hip functionality, as measured by the HHS, showed a marked improvement from 48 to 94 points, particularly after six months. The HOT score for hip functionality rose by 23 points by the third month, reaching an average of 86 points. Similarly, the iHOT score increased from 20 to 83 points starting at month 3, reflecting substantial improvements in hip function. Statistically significant improvements were noted at as early as month 3 (p = 0.02), with highly significant gains by month 6 (p < 0.01), which remained stable through month 12 (p < 0.01). Conclusions: Reconstruction of the gluteus medius and minimus tendons using an open double-row technique with a partial tensor fasciae latae transfer significantly enhances hip function and quality of life. Over an average follow-up period of 7.17 months, patients experienced notable improvements. This technique is an effective option for treating lateral hip pain due to tendinopathy. Full article