From the Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School.
Plast Reconstr Surg. 2022 Nov 1;150(5):1035-1044. doi: 10.1097/PRS.0000000000009631. Epub 2022 Aug 22.
Key risk factors for hypertrophic scarring and surgical-site infections are high-tension wounds, fat necrosis, and dead space. All could be prevented by appropriate superficial fascia suturing. However, the as-yet poorly researched anatomy of the superficial fascia should be delineated. This study is the first to quantify the superficial fascia throughout the human body in vivo.
Ultrasound was used to analyze the superficial and deep fascia of 10 volunteers at 73 points on 11 body regions, including the upper and lower trunk and limbs. Number, thickness and percentage of superficial fascia layers, and deep fascia and dermis thickness, were measured at each point.
Seven hundred thirty ultrasound images were analyzed. Body regions varied markedly in terms of subcutaneous variables. Posterior chest had the thickest deep fascia and dermis and the highest average superficial fascia layer thickness [0.6 mm (95 percent CI, 0.6 to 0.7 mm)]. Anterior chest had the most superficial fascia layers [3.7 (95 percent CI, 3.5 to 3.8)]. Posterior and anterior chest had among the highest percentage of superficial fascia. Abdomen and especially gluteus had a low percentage of superficial fascia. Covariate analyses confirmed that posterior and anterior chest generally had higher superficial fascia content than gluteus and abdomen (both p < 0.001). They also showed that the dermis in the posterior and anterior chest increased proportionally to total fascia thickness.
The superficial fascia, deep fascia, and dermis tend to be thick in high-tension areas such as the upper trunk. A site-specific surgical approach is recommended for subcutaneous sutures.
Understanding the anatomical distribution of the superficial fascia and deep fascia will help surgeons optimize subcutaneous fasciae suturing, thereby potentially reducing the incidence of surgical-site infections and hypertrophic scars.
导致增生性瘢痕和手术部位感染的关键危险因素包括高张力伤口、脂肪坏死和死腔。所有这些都可以通过适当的浅筋膜缝合来预防。然而，浅筋膜的解剖结构尚未得到充分研究，需要进一步阐述。本研究首次对人体全身的浅筋膜进行了定量分析。
使用超声对 10 名志愿者的 11 个身体部位（包括上、下躯干和四肢）的 73 个点的浅筋膜和深筋膜进行了分析。在每个点测量浅筋膜和深筋膜的数量、厚度和百分比，以及真皮厚度。
共分析了 730 个超声图像。不同身体部位的皮下变量差异显著。后胸部的深筋膜和真皮最厚，平均浅筋膜层最厚[0.6 毫米（95%置信区间，0.6 至 0.7 毫米）]。前胸部的浅筋膜层最多[3.7（95%置信区间，3.5 至 3.8）]。后胸部和前胸部的浅筋膜比例最高。腹部，尤其是臀部的浅筋膜比例最低。协变量分析证实，后胸部和前胸部的浅筋膜含量通常高于臀部和腹部（均 p<0.001）。它们还表明，后胸部和前胸部的真皮与总筋膜厚度成正比增加。
上躯干等高张力区域的浅筋膜、深筋膜和真皮往往较厚。建议根据具体部位采用皮下缝合方法。
了解浅筋膜和深筋膜的解剖分布有助于外科医生优化皮下筋膜缝合，从而有可能降低手术部位感染和增生性瘢痕的发生率。
