Abstract
Mammals rapidly heal wounds through fibrous connective tissue build up and tissue contraction. Recent findings from mouse attribute wound healing to physical mobilization of a fibroelastic connective tissue layer that resides beneath the skin, termed subcutaneous fascia or superficial fascia, into sites of injury. Fascial mobilization assembles diverse cell types and matrix components needed for rapid wound repair. These observations suggest that the factors directly affecting fascial mobility are responsible for chronic skin wounds and excessive skin scarring. In this review, we discuss the link between the fascia’s unique tissue anatomy, composition, biomechanical, and rheologic properties to its ability to mobilize its tissue assemblage. Fascia is thus at the forefront of tissue pathology and a better understanding of how it is mobilized may crystallize our view of wound healing alterations during aging, diabetes, and fibrous disease and create novel therapeutic strategies for wound repair.
Highlights
The Fascia Research Society [1] defines fascia anatomically as: “a sheath, a sheet, or any other dissectible aggregations of connective tissue that forms beneath the skin to attach, enclose, and separate muscles and other internal organs”
Subcutaneous fascia is rich in glycosaminoglycans, with a prevalence of hyaluronic acid, which plays a key role in providing hydration and viscosity to the fascial tissue, since it has the unique capacity of binding large quantities of water [7,33,34]
We have found that the collective migration of fascial fibroblasts enables the fascial matrix to be mobilized into open wounds, and subsequently the mobilized fascial matrix undergoes substantial modifications into mature scars in wounds [50,51]
Summary
The Fascia Research Society [1] defines fascia anatomically as: “a sheath, a sheet, or any other dissectible aggregations of connective tissue that forms beneath the skin to attach, enclose, and separate muscles and other internal organs”. A broader terminology of the “fascial system” extends to all fibroelastic soft, collagen containing, loose and dense fibrous connective tissues that permeate the body. It includes elements such as superficial and deep fascia, epineurium, joint capsules, meninges, myofascial expansions, periostea, retinacula, septa, visceral fascia, adventitia and neurovascular sheaths, aponeuroses, and all the intramuscular and intermuscular connective tissues including endo-, peri-, and epimysium [1]. The exact mesodermal origins of the fascial system are unclear, as is the question of whether it has single or multiple origins This is an important distinction because rather than a single homogeneous connective tissue layer, the fascial system encompasses various layers at different depths, forming a mechanical matrix that stabilizes and maintains tissue and organ strength and pliancy.
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