Use Of Fascia Lata Research Articles

Use of Fascia Lata as Matrix for Subpectoral Breast Reconstruction.

Matrices are used with increased frequency to assist with tissue expander or implant-based breast reconstruction. These devices usually have a high cost, especially when they are human-derived. We present the use of fascia lata for implant and expander-based subpectoral reconstruction. According to our review of the literature, this is the first report of the use of a patient's own fascia lata instead of a matrix.

Reconstruction of Anterior Skull Base After Cleaver Trauma: Combined Use of Fascia Lata and Middle Turbinate Flap in a Patient with Concha Bullosa.

This video article presents a 47-year-old male patient who presented to the emergency department after a cleaver bounced off the grinding wheel and lodged between his eyebrows. The patient complained of clear nasal drainage since the trauma. Computed tomography showed a comminuted displaced fracture starting from the right frontonasal recess and extending along the right ethmoid roof. The patient underwent surgery. The skull base defect was reconstructed with a free fascia lata graft in the first operation. In the second session, the reconstruction of the skull base was reinforced with a flap that was prepared from the middle turbinate with the concha bullosa. The patient was followed for eight months. The patient's symptoms resolved completely and there was no evidence of rhinorrhoea or any other complication at the control examination. No complications were seen on control magnetic resonance imaging.

Harvest of large fascia lata autograft: Outcomes in 108 patients.

Due to the reclassification of transvaginal mesh as a high-risk device, there has been renewed interest in the use of fascia lata in pelvic floor reconstruction. Here we report our experience in 108 patients who underwent large fascia lata harvest for pelvic organ prolapse (POP) repair. Our primary objective was to highlight the postoperative morbidity of the large fascia lata harvest in patients who underwent POP repair using fascia lata autograft. Surgery involved harvesting a fascia lata graft through a small lateral upper thigh incision and was used for either autologous transvaginal POP repair or autologous sacrocolpopexy. To prevent seroma, a temporary Jackson-Pratt drain was intraoperatively placed and a mild compression wrap was applied to the area for 4-6 weeks postoperatively. Patient demographics were obtained preoperatively, while physical exam findings and postoperative outcomes related to the fascia lata harvest were collected at sequential follow up visits. One-hundred eight patients underwent 111 large fascia lata harvests for either transvaginal or abdominal/robotic POP repair from July 2016 to January 2022. Mean follow-up was 19.6 months (range: 1-65) with 38 patients having 24 months or more of follow-up. Mean Visual Analog Pain (VAP) score was 1 (range: 0-10). Sixteen patients developed asymptomatic thigh bulges, 16 patients developed harvest site seromas (of which 14 resolved), and 59 patients experienced mild, non-bothersome paresthesia near the incision. Large fascia lata harvest offers a robust autograft for transvaginal or transabdominal POP repair with minimal morbidity. Harvest site complications are minor and typically resolve with expectant management. This technique can be safely utilized in patients who desire graft-augmented repair of POP without the use of synthetic mesh, allograft, or xenograft.

Fascia lata transabdominal pre-peritoneal repair in incarcerated inguinal hernia (FL TAPP) - A case report.

Introduction and importanceFascia Lata is one of the oldest materials used in the repair of inguinal hernia. It lost its popularity following the advent of meshes, mainly Tantalum and Marlex. However, the use of synthetic meshes in infected scenario is controversial. Biological meshes though started off as a potential reinforcement in contaminated fields did not show much benefit. In our case, we describe a successful technique where fascia lata was harvested and laparoscopically placed as a free graft in the preperitoneal plane for inguinal hernia repair.Case presentationA 58-year-old man presented with right inguinal hernia associated with pain of two days duration and vomiting. On ultrasound, he had acute cholecystitis and incarcerated omentum in the right inguinal region. Patient underwent a Trans-Abdominal Pre-Peritoneal (TAPP) laparoscopic repair of the inguinal hernia.Clinical discussionSynthetic meshes have been associated with complications such as mesh erosion, migration and chronic inguinodynia which is often difficult to treat. The deployment of mesh in contaminated fields is even more controversial as infection of the mesh always needs to be explanted or can lead to chronic sinus formation. Fascia lata, on the other hand can withstand infection better compared to synthetic meshes as it is biological and an autologous material.ConclusionTo our knowledge, it is the first described use of Fascia Lata in the pre-peritoneal space for Laparoscopic Inguinal Hernia repair. There have been reports of the use of Fascia Lata in Incisional hernias by a Japanese group. We describe the technique with favorable outcomes.

Elongation of the inferior rectus tendon with fascia lata graft for large vertical squint angles in patients with Graves’ orbitopathy

PurposeTo investigate the use of fascia lata (FL) grafts for inferior rectus muscle (IRM) tendon elongation in patients with large vertical squint angles with Graves’ orbitopathy (GO).MethodsIn this retrospective study, we included a consecutive series of 20 eyes of 13 patients with GO who underwent IRM tendon elongation with FL. Orthoptic and ophthalmologic examinations including measurement of the head posture, the extent of deviation in primary position (PP), elevation, motility, and binocular diplopia at the tangent of Harms were conducted preoperatively and after a mean postoperative time of 10.8 (5.0–35.0) months in all patients.ResultsThe mean total repositioning distance was 9.3 ± 3.6 (3.5–16.0) mm. Postoperatively, we found a significant increase in elevation (5.4 ± 2.4 vs. 2.7 ± 2.4 mm preoperatively, p = 0.011). A significant reduction in vertical squint angle (2.8 ± 3.7 vs. 20.2 ± 18.8 Δ preoperatively, p = 0.004), chin elevation (2.3 ± 3.7 vs. 12.9 ± 6.3° preoperatively, p < 0.001), extorsion in PP (0.1 ± 3.8 vs. 8.4 ± 7.8° preoperatively, p = 0.002), and in elevation (1.8 ± 4.8 vs. 11.1 ± 10.9° preoperatively, p = 0.004) occurred postoperatively. A mean dose–effect relation of 2.6 ± 2.9 Δ/mm was calculated. Postoperatively, the lower eyelid retraction was significantly increased (1.5 ± 1.4 vs. 0.4 ± 0.5 mm preoperatively, p = 0.005).ConclusionIRM tendon elongation with FL is a feasible and effective procedure without relevant risk for surgery-related complications.

Frontalis Sling Procedure for Blepharoptosis Following Trauma to the Head

Blepharoptosis is a relatively common condition and the treatment remains unpredictable as the choice of one of the many surgical options relies on the cause of the ptosis. We report a case of severe blepharoptosis, the surgical technique, the materials that were used the post-op outcomes. Frontalis suspension is a commonly used surgery that is indicated in patients with blepharoptosis and poor levator muscle function. This surgery connects the eyelid to the brow with a sling material and utilizes the power of the frontalis muscle to elevate the poorly functioning eyelid. In our, discussion we propose possible treatments in severe blepharoptosis such as resection and advancement of the levator aponeurosis, The Whitnall sling procedure, the frontalis muscle flap procedure, use of fascia lata, and Müller's muscle-conjunctival resection surgery. We elaborate on our predilection for use of the Frontalis sling procedure. Even though our patients may suggest that using general anesthesia is better for their comfort we prefer, and recommend the use of local anesthesia with intravenous sedation due to the advantage of the ease in balancing the lids during surgery. Deciding on which technique to use depends on many factors such as the operator experience, their comfort level with various techniques, the degree of ptosis of levator muscle function.

Single Layer and Double Layer Duraplasty for the Management of Persistent Cerebrospinal Fluid Rhinorrhea Following Frontal Sinus Trauma: A Retrospective Study.

Persistent cerebrospinal fluid (CSF) rhinorrhea is an infrequent complication of frontal sinus trauma. It often require craniotomy for dural repair and obliteration of sinus with well vascularized pericranial flap. The multilayer vascularized techniques have gained popularity over the years owing to low rate of postoperative CSF leaks. The study retrospectively analyzed 25 frontal sinus trauma patients (20 males, 5 females) of mean age 32 ± 10.23 years with persistent CSF rhinorrhea from January 2011 to December 2018. All patients underwent frontal craniotomy and duraplasty was done with pericranial flap alone in 14 patients (Group I) and in combination with fascia lata graft in 11 patients (Group II). The clinical outcomes of single and double layer dural reconstruction techniques in management of CSF leak were analyzed. The size of defects ranged between 3 to 28 mm. Significant association was present between defect size and reconstruction technique with large defects underwent double layer repair. Two patients developed CSF leak following repair with pericranial flap alone. The rate of successful closure of CSF fistula was 100% with double layer reconstruction technique. However, statistically no significant association was noted between postoperative CSF leak and reconstruction technique. There was no evidence of meningitis, subdural hematoma, intracranial abscess, and mucocele formation in all patients during follow-up of 50.7 ± 23.6 months. To conclude, pericranial flap is a reliable reconstruction material for management of post traumatic frontal sinus CSF leaks. Dual flap technique that combine the use of fascia lata provides comprehensive solution of CSF fistula repair.

Hamburger Technique: Augmented Rotator Cuff Repair With Biological Superior Capsular Reconstruction

Despite profound advancements in arthroscopic rotator cuff repair (RCR) techniques, radiologic failure rates may be in excess of 60% with repairs of large and massive tears in the elderly population. One of the strategies to improve these healing rates has been “patch” augmentation of the cuff repair. At the same time, superior capsular reconstruction (SCR) has gained significant popularity as an option for irreparable rotator cuff (RC) tears. Some have also advocated performing SCR in addition to arthroscopic RCR to reinforce the repair and improve healing rates. Techniques involving the use of fascia lata, ECM patches, and long head of the biceps (LHB) for SCR to reinforce the cuff repair have all been elegantly described. In this article, we propose a technique that enables a combination of the aforementioned procedures and involves performing RCR with patch augmentation, as well as SCR using LHB. In doing so, the repaired RC is bordered by the patch over its bursal surface and the LHB on the articular surface (functioning as the superior capsule), thus giving us the name “Hamburger technique” (a 3-layered construct).

Cerebrospinal fluid composition after duraplasty with different substitutes in early and late postoperative periods (an experimental study)

Objective. To study cerebrospinal fluid (CSF) changes after the duraplasty with autologous fascia, collagen-based material and chitin-chitosan membrane in early and late postoperative periods. Materials and methods. Chitosan-based films were made out of 3 % solution of chitosan for the research. We used 200 kDa chitosan (deacetylation rate 80–90 %) to produce chitin-chitosan membrane by using solvent evaporation method. For enhancing mechanical properties and reducing the degradation, chitin particles were added to the chitosan solution. Chitosan and chitin ratio was 80/20. The chitin/chitosan solution in Petri dishes was being dried out during 3 days at room temperature. Cerebrospinal fluid composition has been studied after the duraplasty with autofascia, collagen-based material and innovative chitosan-based graft in early and late postoperative periods. The duraplasty was performed by applying these materials to 90 Chinchilla rabbits breed. Animals were divided into three groups: I group — duraplasty using the fascia lata autograft, II group — duraplasty with the collagen-based material, III group — duraplasty using the chitin-chitosan membrane. The animals in the II and III groups were divided into 2 subgroups: A — plasty without fixing the material, B — plasty with fixing the material using atraumatic suture. CSF composition was studied before and after the operation had been performed in 2 weeks, 2 and 6 months. Results. The results of our study demonstrated the increase in density and protein level, the decrease in рН and glucose level and the extreme increase of cells, mostly neutrophils after the use of fascia lata for dural closure. At the same time, there were no substantial changes after dural closure with artificial collagen- and chitosan-based materials, the CSF composition normalized in 2 months after operation. Conclusion. The use of autologous fascia for duraplasty leads to an acute response of the cerebrospinal fluid in the early postoperative period and to residual pleocytosis. The chitosan-based graft application was followed by no complications at 6 months after surgery and only slight CSF response in the early postoperative period. There wasn’t any significant difference in CSF composition in chitosan- and the collagen-based material usage. Given the lack of changes in SCF tests between suture and no suture graft fixation except for a slight increase in erythrocyte number in the early postoperative period, the choice of material fixation method is entirely dependent on the clinical situation and does not affect the cerebrospinal fluid state.

The Role of Fascia Lata Graft in Treatment and Camouflage of Nasal Dorsum Irregularities

AbstractBackground: Nasal dorsal irregularities after rhinoplasty are troublesome for both patient and surgeon, especially in patients with thin dorsal skin, which may be seen after improper hump reduction and multiple surgeries. Many types of grafts have been used for nasal contouring, augmentation and cam-ouflage as diced cartilage, fascia, dermal grafts, alloderm and banked allograft.Methods: We report the use of Fascia Lata (FL) graft for dorsalcontouring and camouflage in 20 patients who underwent rhinoplasty between May 2015 to September 2016. There were 12 male and 8 female patients, with ages ranging from 18 to 43 years (mean age: 30.35). Of the 20 patients, 12 underwent primary rhinoplasty, while 8 were secondary cases. An informed consent was obtained from all patients for the use of FL graft. The graft was harvested from the right lateral thigh. A simple method was used to placethe graft over the nasal dorsum. Post-operative follow-up period was 16 months. Clinical evaluation was made by inspection, palpation and photographic documentation.In addition, a questionnaire related to patient satisfaction and donor-site morbidity.Results: All patients had satisfactory aesthetic results, andno apparent irregularities were observed over the nasal dorsum. The questionnaire resultsshowed that all patients, but one, were satisfied with surgery, and were not concerned aboutdonor-site scar; however, one patient had donor-site morbidity.Conclusions: This study conclusively shows that it is a reliable, simple method for camouflaging any post-operative dorsalirregularities, particularly in patients with thin nasal skin.

Fascia lata as an alternative in dental treatments

Introduction: Fascia lata is the most extreme section of the thigh’s aponeurosis. It is a thick and resistant membrane possessing elasticity, flexibility and memory. It is presently used in the medical world to treat abdominal defects, urinary incontinence, and palpebral ptosis. In dentistry it is used in guided tissue regeneration, root coverage, ridge increase and socket (alveolus) preservation. Method: An electronic search was conducted in the following databases: Medline, PubMed and SciELO, with the term fascia lata. Full texts in English and Spanish were included in timeline spanning from 1983 to 2015. Main characteristic selected for these texts was they explored use of fascia lata and medical and dental areas. Discussion: Limiting situations arose during the execution of this project due to the scarcity found in articles and research papers and documented clinical cases targeting use of fascia lata ion dental areas. Conclusions: Fascia lata is a resorbable, biocompatible material, well tolerated by the recipient bed; when used in medical and dental specialties it exhibits characteristics of accuracy (security) and long duration.

Inducement of tissue regeneration of harvested hamstring tendons in a rabbit model.

ObjectivesThe objective of this study was to determine if the use of fascia lata as a tendon regeneration guide (placed into the tendon canal following harvesting the semitendinosus tendon) would improve the incidence of tissue regeneration and prevent fatty degeneration of the semitendinosus muscle.Materials and MethodsBilateral semitendinosus tendons were harvested from rabbits using a tendon stripper. On the inducing graft (IG) side, the tendon canal and semitendinosus tibial attachment site were connected by the fascia lata, which was harvested at the same width as the semitendinosus tendon. On the control side, no special procedures were performed. Two groups of six rabbits were killed at post-operative weeks 4 and 8, respectively. In addition, three healthy rabbits were killed to obtain normal tissue. We evaluated the incidence of tendon tissue regeneration, cross-sectional area of the regenerated tendon tissue and proportion of fatty tissue in the semitendinosus muscle.ResultsAt post-operative week 8, the distal end of the regenerated tissue reached the vicinity of the tibial insertion on the control side in two of six specimens. On the IG side, the regenerated tissue maintained continuity with the tibial insertion in all specimens. The cross-sectional area of the IG side was significantly greater than that of the control side. The proportion of fatty tissue in the semitendinosus muscle on the IG side was comparable with that of the control side, but was significantly greater than that of the normal muscle.ConclusionsTendon tissue regenerated with the fascia lata graft was thicker than naturally occurring regenerated tissue. However, the proportion of fatty tissue in the semitendinosus muscle was greater than that of normal muscle.Cite this article: K. Tabuchi, T. Soejima, H. Murakami, K. Noguchi, N. Shiba, K. Nagata. Inducement of tissue regeneration of harvested hamstring tendons in a rabbit model. Bone Joint Res 2016;5:247–252. DOI: 10.1302/2046-3758.56.2000585.

A Biomechanical Comparison of Fan-Folded, Single-Looped Fascia Lata With Other Graft Tissues as a Suitable Substitute for Anterior Cruciate Ligament Reconstruction

The purpose of this study was to evaluate the initial biomechanical properties of a fan-folded, single-loop construct of fan-folded fascia lata allograft in comparison to other graft tissues currently being used for anterior cruciate ligament (ACL) reconstruction. Eighteen fascia lata specimens were harvested from 11 donors and fan folded through a proprietary process. Bone-patellar tendon-bone (BPTB), tibialis anterior, tibialis posterior, and peroneus longus tendons were harvested from 4 additional donors. All soft-tissue grafts were tested to failure in an MTS machine (MTS Systems, Eden Prairie, MN) in a single-looped fashion. BPTB grafts were similarly clamped in freeze grips. The ultimate load to failure and stiffness were calculated for each graft type tested. The mean ultimate load to failure was 3,266 N and stiffness was 414 N/mm for the single-looped fascia lata grafts (n = 18). There was no significant difference for ultimate load to failure and stiffness between the fascia lata and tibialis anterior (3,012 N and 342 N/mm, respectively), tibialis posterior (3,666 N and 392 N/mm, respectively), and peroneus longus (3,050 N and 346 N/mm, respectively) tendons. The fascia lata grafts performed significantly better (P < .001) than BPTB (1,404 N and 224 N/mm, respectively). A single-loop construct of fan-folded fascia lata allograft has, on biomechanical testing, initial ultimate tensile strength (3,266 N) and stiffness values equivalent to or better than several other graft tissues currently used in ACL reconstruction, including BPTB (1,403 N), tibialis anterior (3,012 N), tibialis posterior (3,666 N), and peroneus longus (3,050 N). In the face of potential allograft tissue shortages and increasing constraints on health care expenditures, the use of fascia lata has the potential to be a readily available graft for ACL reconstruction that performs as well as other grafts and at a comparable or lower cost.

Fascia lata graft for nasal dorsal contouring in rhinoplasty

Nasal dorsal irregularities are troublesome for both patient and surgeon, especially in patients with thin nasal dorsal skin. Many types of grafts have been used for nasal contouring; however, in this article, we report the use of fascia lata (FL) graft for dorsal contouring and camouflage in 63 patients who underwent rhinoplasty between May 2004 and December 2005. There were 26 male and 37 female patients, with ages ranging from 18 to 43 years (mean age: 28.7). Of the 63 patients, 49 underwent primary rhinoplasty, while 14 were secondary cases. An informed consent was obtained from all patients for the use of FL graft. The graft was harvested from the right lateral thigh. A simple method was used to place the graft over the nasal dorsum. Postoperative follow-up period was between 14 and 26 months (mean: 20). Clinical evaluation was made by inspection, palpation and photographic documentation. In addition, a questionnaire related to patient satisfaction and donor-site morbidity was sent to patients 1 year after surgery. All patients had satisfactory aesthetic results, and no apparent irregularities were observed over the nasal dorsum. The questionnaire results showed that all patients, but one, were satisfied with surgery, and were not concerned about donor-site scar; however, one patient had a donor-site morbidity. This study conclusively shows that TLF graft is a reliable, simple method for camouflaging any postoperative dorsal irregularities, particularly in patients with thin nasal skin.

Correction of Blepharophimosis with Silicone Implant Suspensor

Blepharophimosis is a rare autosomal-dominant syndrome involving the periorbital region. It is characterized mainly by eyelid ptosis, palpebral phimosis, telecanthus, and epicanthus inversus. Ten patients ranging in age from 2 to 22 years who presented with blepharophimosis were retrospectively studied over the past 14 years; they had an average follow-up of 7 years and 5 months. They were treated at the Division of Plastic Surgery of the Faculty of Medicine, University of São Paulo. Eight patients presented with the complete form, including epicanthus, telecanthus, and severe palpebral ptosis, and two presented with the incomplete form. The epicanthi and telecanthi were corrected with Mustardé's technique, and the ptosis was treated by frontalis suspension with a soft, preformed silicone device called the silicone implant suspensor. The results were classified as good, fair, and poor, according to the postoperative position of the upper eyelid in relation to the scleral limbus, medial canthus position, and residual epicanthal fold. The results were assessed as good in seven cases and fair in three. The silicone eyelid suspensor was effective in improving the patients' difficult condition. It was a better alternative than the use of fascia lata, because it permitted an easier readjustment of the eyelid margin and it offered the possibility of creating a well-defined palpebral fold, which is usually absent in this group. The results were maintained with long-term follow-up. The silicone suspensor was safe and long-term results were good in both children and adults.

A Novel Technique of Harvesting Temporalis Fascia Autografts for Correction of Recurrent Blepharoptosis

Patients with poor levator function require ptosis correction by a sling procedure. A variety of synthetic materials are available for this suspension, but there is a recognized complication rate. Autografts are less prone to infection and extrusion than alloplastic materials. Harvesting temporalis fascia has a number of advantages over the use of fascia lata and outcomes have been effective. Although we recommend the use of autogenous material for slings whenever possible, if alloplastic materials are used and subsequently fail, then temporalis fascia is our preferred solution. We describe a novel technique of harvesting the temporalis fascia and present 4 patients (6 eyelids) with failed silicone slings who were managed with temporalis fascia autograft. Follow-up ranged from 5 to 32 months. The average improvement in palpebral aperture was 3.6 mm (78%).

Reconstruction of chronic distal biceps tendon rupture with use of fascia lata combined with a ligament augmentation device: A report of 3 cases

J Shoulder Elbow Surg 2002;11:633-6

Scleral Fixation of Posterior Chamber Intraocular Lenses Using Fascia Lata to Cover the Knots

To describe the use of fascia lata to cover the polypropylene knots of scleral fixated posterior chamber intraocular lenses (PCIOL). Fascia lata was used to cover the knots of scleral fixated PCIOL in 5 eyes with significant scleral thinning. Four of the 5 eyes had the PCIOL insertion and the fascia lata patching in the same setting. The fifth eye previously had scleral fixated PCIOL with late suture erosion through a partial thickness scleral flap. There was no suture exposure or graft thinning throughout a follow-up period of 8 to 16 months. The eyes tolerated the fascia lata well with no early or late postoperative complications. Fascia lata provides an effective means to cover the knots of scleral fixated PCIOL, especially in aphakic patients with significant scleral thinning.

Cadaveric fascia lata sling: analysis of five recent adverse outcomes

Objectives. To report a series of adverse outcomes of urethral sling procedures that used allograft fascia lata and to review the literature regarding the use of this material in genitourinary reconstruction. Methods. Five neurologically normal patients presented to our center between August 1999 and October 1999 with complaints of recurrent incontinence or voiding dysfunction after undergoing urethral sling procedures at outside institutions that used fascia lata allografts. All patients underwent a thorough evaluation, including history and physical examination, voiding cystourethrography, and urodynamic studies. Sections of fascia were removed for histology in 2 patients at the time of operation. Results. Three patients were diagnosed with de novo bladder outlet obstruction, 1 with recurrent urethral hypermobility, and 1 with intrinsic sphincteric deficiency. Histology of cadaveric fascia demonstrated collagen with almost complete absence of cellularity. There was no evidence of capillary or fibroblast ingrowth. All patients underwent reoperation and have had clinical improvement with short-term follow-up. Conclusions. Although distressing, the present series of adverse outcomes may simply reflect an overall increase in the number of sling procedures being performed nationally. Although decreased operative time and morbidity have been attributed to the use of fascia lata in urethral sling procedures, it is essential to ensure that long-term safety and efficacy will not be jeopardized before accepting it as a new standard of care.

Fascia Lata in Penile Reconstructive Surgery: A Reappraisal of the Fascia Lata Graft

Various surgical techniques and innovations have been applied to manage complex penile deformities. As an adjunct to penile reconstructive surgery, use of fascia lata, the superficial connective tissue structure of the thigh, may also be considered. Herein, four case reports are described in which fascia lata was applied: penile deformity associated with multiple unsuccessful penile prosthesis surgeries; penile prosthesis migration alter phalloplasty ; partial penile loss after ablative penile cancer surgery: and penile fibromatosis (Peyronie's disease). Fascia lata was autogenously obtained from the lateral thigh in all cases and used for, respectively, corporoplasty, penile prosthesis fixation, penile elongation, and tunica albuginea grafting. Surgeries were successful in every instance, and each patient reported satisfactory neophallic appearance and function postoperatively. The functional anatomy of the fascia lata was investigated further with lower extremity cadaveric dissections. For penile reconstructive surgery, fascia lata offers an autogenous source, it can be expeditiously obtained causing minimal morbidity, and it serves as a viahle graft material with good tensile strength. Its application derives from, and may extend to, other reconstructive surgeries.