Experimental and Clinical Evidence Based Rationality of Incorporation of Deep Fascia in Tissue Transfer for Reconstructive Surgery

• Published in: Annals of the National Academy of Medical Sciences (India) 2016-10, Vol.52 (4), p.222-231
• Main Author: Bhattacharya, V.
• Format: Article
• Language: English
• Subjects: deep fascia; microcirculation; Original Article; reconstructive surgery
• ISSN: 0379-038X; 2454-5635
• DOI: 10.1055/s-0040-1712738

ABSTRACT Intense clinical research since 1984 through 93 parameters has unveiled the rationality of reconstructive procedures with several new concepts and innovative techniques of various compositions. Such extensive work has been done totally in our country popularizing the techniques amongst the plastic surgeons of the world. This presentation deals with the tissue constituents and vascular network of the deep fascia. This sustained research was conducted at inter-departmental, interfaculty and interinstitutional levels. Intense clinical research since 1984 through 93 parameters has unveiled the rationality of reconstructive procedures with several new concepts and innovative techniques of various compositions. Such extensive work has been done totally in our country popularizing the techniques amongst the plastic surgeons of the world. This presentation deals with the tissue constituents and vascular network of the deep fascia. This sustained research was conducted at inter-departmental, interfaculty and interinstitutional levels. Histology of deep fascia showed rich subfascial and suprafascial arterioles and capillaries. Intrafascial course of the perforating vessels from the subfascial plane to the suprafascial plane was visualized. Confocal microscopic analysis of fluorecenised deep fascia under 40X magnification showed longitudinally aligned collagen fibres and nuclei of multiple fibroblasts. Electron microscopic Y of deep fascia revealed (a) Elastic tissue and collagen fibres, (b) Lymphatic vessel, (c) Thin walled venule with single layer of muscle fiber, endothelial cell nucleus, Venules with multiple RBCs, mast cell with granules and capillary showing endothelium and endothelial cells. Angiography in experimental model and patients, demonstrated longitudinally oriented vascular network in deep fascia and fasciocutaneous flap. Live microcirculation and Lymphatic circulation in the human deep fascia was demonstrated first time in the world under 150 and 600 magnifications.