Deep Layer Of Superficial Fascia Research Articles

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A Novel Perineal Nerve Block Approach for Transperineal Prostate Biopsy: An Anatomical Analysis-based Randomized Single-blind Controlled Trial

OBJECTIVETo develop and validate a novel perineal nerve block approach for transperineal prostate biopsy. PATIENTS AND METHODSFive adult male cadavers were dissected to delineate the superficial and deep branches of the perineal nerve. Afterwards, 90 out of 115 patients were selected and randomly assigned to receive periprostatic, periapical triangle, or branches of perineal nerve (BPN) block. The primary outcome was the maximal pain intensity associated with transperineal prostate biopsy, which was assessed by the 10-point visual analog scale. The secondary outcomes included the number of biopsy with visual analog scale of ≥4 in each biopsy procedure, and the incidences of complications. RESULTSOn the horizontal line of the upper anal border, the locations of the superficial branch of perineal nerve on the left and right sides were 1.87 ± 0.05 cm and 1.86 ± 0.06 cm, respectively; and the deep branch were 2.15 ± 0.07 cm and 2.16 ± 0.06 cm, respectively, from the midline, and lied between the deep layer of superficial fascia and prostate capsule. The number of cases finally enrolled in data analysis in periprostatic block, periapical triangle block, and BPN block groups were 26, 27, and 30, respectively. The maximal pain intensities were 3.4 (3.1-3.7), 3.3 (3.0-3.6), and 1.8 (1.5-2.2) in the 3 groups, respectively, and the numbers of biopsy with the pain intensity of ≥4 were 4.0 (3.2-4.9), 4.2 (3.3-5.2), and 0.7 (0.1-1.2), respectively. There were 4, 3 and 4 cases developing hematuria, and 1, 1 and 2 burdened with urine retention after biopsy in the 3 groups, respectively. CONCLUSIONCollectively, BPN block is a safe, effective and repeatable local anesthesia approach for transperineal prostate biopsy.

Cruroplasty or medial tight lift SURGERY the experience of our department

Medial thighplasty is a surgical technique that’s reduce excess skin and fat in the medial part of the thighs and improve in the same time the skin quality and tone. Because of the changes which occur with age and weight loss, the skin and subcutaneous tissue of the medial thigh region show relaxation from the loss of tone and elasticity, with inevitable ptosis of the tissues. Medial contouring of the thigh is frequently requested to improve appearance and function of medial thigh deformities, following massive weight loss or aging process. This surgical procedure can be associated with a significant rate of complications especially postoperative edema and scar migration, improved by performing simultaneous liposuction and anchorage sutures to guard against the effect of heavy skin flaps. A total of 13 female patients presented during the period from January 2014 to March 2019 complaining of moderate to severe thigh laxity with or without lipodystrophy. In 10 patients medial transverse thigh lift was performed, when the laxity was particularly in the upper half of the tight. Whereas, in the other three patients a vertical thigh lift was chosen considering the location of the laxity that toke the whole tight. In both groups an aggressive liposuction was performed and systematic anchorage suture to the colles fascia. All patients recovered well in 2 weeks and showed improvement of thigh contour. No Scar downward displacement or no skin necrosis or seroma was encountered neither labial distortion. The objectives of this article are to expose the modern techniques of face lift of the thigh, to specify the expected results with their limits, as well as to highlight the various complications with their management.

The anatomic re‐description of Colles fascia using large mount histology

The anatomic re‐description of Colles fascia using large mount histology

Abstract: Clinical, Biomechanical and Anatomic Investigation of Colles’ Fascia and Pubic Ramus Periosteum for Use During Medial Thighplasty

DISCLOSURE/FINANCIAL SUPPORT: None of the authors has a financial interest in any of the products, devices, or techniques mentioned in this manuscript. INTRODUCTION: Medial thighplasty is a procedure where patients may attain superior mobility, hygiene, and cosmesis. Most surgeons utilize attachment of the superficial fascial system (SFS) of the thigh flap to Colles’ fascia while others attach the SFS to the pubic ramus periosteum. Due to a high complication profile, we aim to elucidate the clinical, biomechanical, and anatomic qualities of the Colles’ fascia versus pubic ramus periosteum. MATERIALS AND METHODS: We performed a 17-year retrospective review documenting major and minor clinical complications, a biomechanical analysis of sutures placed in different tissue layers of the thigh, and a histologic analysis surrounding the ischiopubic ramus. Separate suture pull out strength testing was done on cadervic tissue using an Admet MTEST Quattro with #1 Vicryl suture and tissue grips at a displacement rate of 2.12mm/s. Simultaneous displacement and force was measured at regular intervals between the pubic sympysis and the ischial tuberosity in both the Colles fascia and in the deeper periosteal tissue layers of the thigh. A histologic analysis was performed at three points along the ischiopubic ramus using paraffin embedded large mount tissue sections stained with hemotoxylin, Eosin, and Gomori’s Trichrome. RESULTS: Thirty-nine patients underwent medial thighplasty with a 46.16% complication rate. Suture pull out force of the suspected superficial Colles fascia sites were on average 72.8% less than values from the deeper periosteum tissue. Anchor points in the Colles’ fascia elongated 17.4% further prior to failure than those in the periosteum.There was noticable variability between anchor points and across samples. The histologic sections suggest that Colles’ fascia from the different regions of the ischiopubic ramus vary considerably both in continuity and collagen fiber content. The periosteal and muscular fascial layers were more continuous histologically with direct attachments into the pubis and ischium. CONCLUSION: Anchoring of the SFS to the periosteum did not improve the complication profile when compared to the literature. Both the biomechanical and histologic analyses demonstrate that the Colles’ fascia is highly variable in composition with coincident variability in tissue strength, which may account for the high complication profile of this procedure. Our results require further study to identify the optimal surgical technique for medial thighplasty.

THE GORDON GORDON‐TAYLOR MEMORIAL LECTURE: SURGICAL GIANTS AND GIANTS AMONG SURGEONS – THE CASE OF ABRAHAM COLLES

Sir Gordon Gordon-Taylor was a surgical giant and a giant among surgeons. There's a distinction between the two. Surgical giants are technical geniuses who pave the way for others and set the standards against which others can measure their performance. Giants among surgeons contribute other things to the science and practice of surgery and sometimes to fields outside surgery. By these measures, Abraham Colles was not a surgical giant. He thought, wrote and taught about his interests. He enhanced the reputation of Irish surgery. In retrospect, his science and his ethics seem flawed by modern standards, but by the measures of his own time he was a model investigator and a man of outstanding moral probity. He is remembered for the eponymous Colles's fracture and for Colles's fascia and ligament. He held the Chair of Anatomy and Surgery in Dublin for 32 years and drew the admiration and affection of his contemporaries, colleagues and students. He was a giant among surgeons, and his name deserves commemoration.

Scrotal lymphangioma

Congenital malformations of the intrascrotal lymphatic system may form cystic masses. A case of a lymphangioma arising in Colles fascia is presented. This rare clinical entity should be included in the differential diagnosis of cystic lesions of the external male genitalia. Total surgical excision is the treatment of choice.