Hashiguchi Shin-Ichiro, Hayakawa Koji, Inoue Eiko, Han Aya, Iwanaga Joe, Tabira Yoko, Yamashita Akihiro, Rikimaru Hideaki, Kiyokawa Kensuke, Watanabe Koichi
From the Department of Plastic, Reconstructive, and Maxillofacial Surgery.
Hakusan Clinic.
Plast Reconstr Surg. 2023 Mar 1;151(3):569-579. doi: 10.1097/PRS.0000000000009975. Epub 2022 Nov 22.
In recent years, structures including the superficial musculoaponeurotic system and retaining ligaments that support the facial soft tissue have been clarified. However, these structures are very difficult to observe in their entirety by the standard gross anatomical procedure (ie, dissection from superficial to deep layers). Furthermore, accurate descriptions of these structures are rare in both anatomical and plastic surgery textbooks. The aim of this study was to clarify the facial fibrous structures in a gross anatomical view.
The authors' novel method used soft facial tissue and bone. The tissue was fixed in gelatin and sectioned at a thickness of 5 to 10 mm. Each section was placed on a wooden board; the bone was then pinned, and the skin was pulled outward with sutures to hyperextend the soft tissue. Subsequently, the loose connective tissue was torn and fat tissue was removed under a surgical microscope. After the removal of fat tissue, the fibrous facial structures (eg, the superficial musculoaponeurotic system and retaining ligaments) could be observed clearly.
The thickness of the sections allowed three-dimensional observation, such that a structure located deep within a section could be clearly observed. The expansion of soft tissue facilitated observation of the facial layer and fibrous structures, and the locations of nerves and vessels. Therefore, the facial layer structure was readily discerned.
This method is likely to be very useful in the field of plastic surgery because it enabled intuitive identification of facial layers and their characteristics.
The dissection method developed by the authors reveals the connected morphology of each tissue of the face, thus providing basic data for analyzing soft tissue changes due to aging and gravity. This will be useful for the development of anti-aging medicine.
近年来，包括支持面部软组织的表浅肌肉腱膜系统和固定韧带在内的结构已得到阐明。然而，通过标准的大体解剖程序（即从浅层到深层进行解剖）很难完整观察到这些结构。此外，在解剖学和整形外科学教科书中，对这些结构的准确描述也很少见。本研究的目的是在大体解剖层面上阐明面部纤维结构。
作者采用了一种新颖的方法，使用面部软组织和骨骼。将组织固定在明胶中，切成5至10毫米厚的切片。将每个切片放在木板上；然后用针固定骨骼，并用缝线向外牵拉皮肤以使软组织过度伸展。随后，在手术显微镜下撕开疏松结缔组织并去除脂肪组织。去除脂肪组织后，可以清楚地观察到面部纤维结构（如，表浅肌肉腱膜系统和固定韧带）。
切片的厚度允许进行三维观察，这样位于切片深处的结构可以清晰地观察到。软组织的伸展便于对面部层次和纤维结构以及神经和血管的位置进行观察。因此，面部层次结构很容易辨别。
这种方法在整形外科学领域可能非常有用，因为它能够直观地识别面部层次及其特征。
作者开发的解剖方法揭示了面部各组织的连接形态，从而为分析衰老和重力导致的软组织变化提供了基础数据。这将有助于抗衰老医学的发展。
