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


  • V Bhattacharya Former HOD, Plastic Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.


Deep Fascia, reconstructive Surgery, Microcirculation.


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 inter-institutional levels.

Fresh cadaveric dissections, animal experimentations, and clinical research revealed crucial ï¬ndings applicable for resurfacing defects of different etiology and magnitude. The deep fascia covering the muscle is thought be an inert a avascular structure with protective function only. We have demonstrated for the ï¬rst time in the world the live vascular and lymphatic microcirculation in deep fascia proving it to be having dense vascular network. Therefore its incorporation during the reconstructive surgery enhances the vascularity allowing transfer of large dimension of tissue for reconstruction in cases of trauma, infection, cancer surgery, etc. It has proved the rationality of these procedures convincingly to the scientiï¬c world.

Histology of deep fascia showed rich subfascial and suprafascial arterioles and capillaries.Intrafascialcourse of the perforating vessels from the subfascial plane to the suprafascial plane was visualized. Confocal microscopic analysis of fluorecenised deep fascia under 40X magniï¬cation showed longitudinally aligned collagen ï¬bres and nuclei of multiple ï¬broblasts. Electron microscopic Y of deep fascia revealed (a) Elastic tissue and collagen ï¬bres, (b) Lymphatic vessel, (c)Thin walled venule  with  single layer of muscle ï¬ber, 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 ï¬rst time in the world under 150 and 600 magniï¬cations.

Keywords : Deep Fascia, reconstructive Surgery, Microcirculation.




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