Fascial And Membrane Technique: Comprehensive T...
Reconstruction of critical-size bony defects remains a challenge to surgeons despite recent technological advances. Current treatments include distraction osteogenesis, cancellous autograft, induced membranes (Masquelet procedure), polymeric membranes, and titanium-mesh cages filled with bone graft. In this article, the authors presents two cases in which critical-sized defects were reconstructed using a meshed fascial autograft encasing reamer-irrigator-aspirator (RIA) autograft and cancellous allograft. This article will discuss the clinical outcomes of the technique, comparison to other current techniques, and technical insight into the potential biological mechanism.
Fascial and membrane technique: comprehensive t...
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The main potential advantages of the author's technique include the following: 1) the need for only one operative session, 2) the use of a non-immunogenic graft source, and 3) the "moldability" of a Masquelet pseudomembrane while still offering the barrication/guide of other methods. The fascial graft obviates the need for a second procedure, as the patient's own corpus is a "one-stop shop" for the majority of the reconstruction. Patients who cannot follow-up either due to non-compliance or other circumstances may be suitable candidates for such a one-stage reconstruction. In both described patients, the fascial harvest was quick to perform, and neither patient had any post-operative morbidity or functional limitation from either the ITB or RIA bone graft harvest. Since the bony defect is treated acutely, there is no repeat insult to the soft tissue or bone due to a second procedure. The rationale for the various components of the reconstruction are as follows: the fascial membrane prevents tissue intravasation and serves as a bed/guide for periosteal regeneration; RIA bone graft serves as an osteogenic source of bone marrow stromal cells, and cancellous allograft serves as an osteoconductive scaffold. In the metatarsal reconstruction case, BMP-2 served as an osteoinductive agent. A minimal amount of cancellous allograft was used as "framework" for bone regeneration; thus, it is unclear what ratio of cancellous autograft to allograft is optimal. Although marrow stromal cells (i.e., bone marrow-derived mesenchymal stem cells) have been demonstrated in numerous other tissues, the role of the fascial membrane as a potential source of stem/progenitor cells is unknown. More importantly, as mentioned before, the true value of the membrane, whether polymeric, titanium, or biologic, seems to be its role as a barricade to tissue intravasation and as a bed for periosteal regeneration. The value of the periosteal cambium layer has been clearly demonstrated and membranes seem to improve bone regeneration. For example, Reyenders et al. have demonstrated that non-vascularized periosteal autografts enhance fracture healing of bone defects in a rabbit model, especially when the graft is in contact with intact periosteum [23].
As mentioned previously, polymeric membranes have both acute and long-term inflammatory effects, which have potentially hindered their widespread use. Based on the one-year post-operative CT performed on the second case, it appears that the fascial graft is still intact and not degraded.
Another potential limitation of the technique is possible morbidity associated with the fascial donor site. Although in these two patients there was no morbidity with the fascial graft harvest, studies with larger sample sizes are necessary to establish potential complications. Autologous tissue, if associated with low morbidity, is potentially more beneficial than allogeneic, immunogenic tissue; however, as mentioned before, commercial entities may be sought after for a flexible, collagenous membrane to traverse these defects. If these membranes are effective with no immunogenic reaction, they may preclude the potential morbidity associated with a fascial harvest.
This paper demonstrates a one-stage procedure using cancellous RIA autograft encased in a fenestrated fascial autograft as a biologic membrane to aid in reconstruction of critical-sized bony defects. The potential benefit of a fascial autograft membrane for critical-sized bony defects versus other current technologies was discussed. The authors' technique potentially warrants future research as another option in the surgeon's armamentarium in managing these difficult injuries.
Despite its presence everywhere throughout the body, the fascial system has received little attention in the imaging literature as it is regarded as a network of inert membranes barely involved by abnormal conditions [1]. In a previous article, we detailed how MRI patterns of involvement of the fasciae in systemic autoimmune diseases reflect the fascial anatomy [2]. Anyway, the fascial system may also be involved in localized disorders. Therefore, the current pictorial review aims to focus on traumatic disorders, infectious diseases, and neoplastic diseases involving the fasciae of the musculoskeletal system and their appearance at MRI.
The clavicle is the most frequently fractured bone in humans. General anesthesia with or without Regional Anesthesia (RA) is most frequently used for clavicle surgeries due to its complex innervation. Many RA techniques, alone or in combination, have been used for clavicle surgeries. These include interscalene block, cervical plexus (superficial and deep) blocks, SCUT (supraclavicular nerve + selective upper trunk) block, and pectoral nerve blocks (PEC I and PEC II). The clavipectoral fascial plane block is also a safe and simple option and replaces most other RA techniques due to its lack of side effects like phrenic nerve palsy or motor block of the upper limb. We present a comprehensive review of anatomy and RA techniques of clavicle surgeries. This review will help readers understand the functional anatomy and nature of clavicle fractures, and apply an algorithmic approach to procedure-specific blocks for complexly innervated structures like clavicle.
Structurally, the urogenital triangle is complex, with a number of fascial layers and pouches. Unlike the anal triangle, the urogenital triangle has an additional layer of strong deep fascia; the perineal membrane. This membrane has pouches on its superior and inferior surfaces.
Myofascial massage is a technique used to treat injuries and discomfort, reducing pain and increasing range of motion. Myofascial massage differs from other types of massage in that it targets the fascia - the membrane surrounding muscles - rather than the muscle itself. Since fascia completely encases every muscle in the body, imbalances in the fascia can have serious effects on your range of motion and comfort level. While other forms of massage can overlook the fascia, myofascial massage focuses specifically on releasing tension in this important membrane.
Visceral Manipulation (VM) was developed by renowned French Osteopath and Physical Therapist, Jean-Pierre Barral. Through organ-specific fascial mobilization, VM assists functional and structural imbalances throughout the body including musculoskeletal, vascular, nervous, urogenital, respiratory, digestive and lymphatic dysfunction. It evaluates and treats the dynamics of motion and suspension in relation to organs, membranes, fascia, and ligaments. VM increases proprioceptive communication within the body, thereby revitalizing a person and relieving symptoms of pain, dysfunction, and poor posture. 041b061a72