Fascia

FASCIA (fascia), properly means bandage, in anatomy this term denotes connective tissue membranes, which cover various organs, mainly muscles. Its collagen fibers together with elastic ones, crossing each other in various directions, at the same time form separate layers; this layering of F. can be very often detected even macroscopically. In the mass of connective tissue there are numerous blood vessels, lymph spaces, gaps and vessels, and nerves also pass through; its vessels provide nutrition to muscles and organs and thereby determine the tissue exchange between them; F. also play a large role in pathological processes of the body; muscles are often attached to F. From a morphological point of view, various formations are understood under F. First of all, F. are called plates of loose fibrous connective tissue, which are located directly under the skin: this is the subcutaneous F. of the body (fascia superficialis corporis, s. f. subcutanea). In those cases when this plate is more dense, compact and thick, it receives the name of aponeurosis (aponeurosis). Under the superficial F. on the body is located a deeper F. (f. profunda): this F. most often separates groups of muscles from each other. In different parts of the body F. receive corresponding names. On the hairy part of the head the very dense aponeurotic plate is called the helmet (galea aponeurotica); it tightly fuses with the skin and is separated by loose cellular tissue from the bones. In the temple area the very dense aponeurotic plate is called the temporal F. (f. temporalis, s. aponeurosis temporalis); it actually consists of two layers, between which there is a fat layer; it starts from the temporal line (linea temporalis) along its entire length and attaches to the zygomatic arch; it covers the temporal muscle, the fibers of which also partly originate from it. Similarly, very dense is the parotid-masseteric F. (fascia parotido-masseterica, s. parotidea); it covers on one side the parotid gland, tightly fusing with the bundles of connective tissue that divide the gland into separate lobes, and on the other side with the external chewing muscle (m. masseter), connecting with its tendon. The facial muscles do not have F. In the neck area there is also a superficial cervical F. (f. colli superficialis), which is located directly under the subcutaneous fat layer, between the hyoid bone on one side and the clavicle and sternum (incisura sterni) on the other, to which it attaches; in its mass pass the muscle fibers of the superficial neck muscle (m. platysma, s. m. subcutaneus colli). Under it there is still a middle F. of the neck (f. colli media); in the form of a dense plate it starts from the hyoid bone and attaches to the inner surface of the manubrium of the sternum; thus between both cervical F. there is a space filled with fatty tissue (spatium aponeuroticum suprasternalis). Both these F. cover the neck muscles, dividing them into layers. Finally in the depth of the neck there is the deep F. of the neck, or prevertebral F. (fascia colli profunda, s. fascia praevertebralis), which covers the cervical part of the spine in front and m. longus colli and m. longus capitis. On the posterior surface of the neck the continuation of the superficial F. of the neck is distinguished as the nuchal F. (fascia nuchae); it lies over m. trapezius and m. rhomboideus. The superficial F. of the neck caudally passes into the superficial thoracic F. (f. pectoralis superficialis), which covers m. pectoralis major and m. serratus ant. In the thoracic area the coracoclavicular, or deep thoracic F. (f. coraco-clavicularis, s. coraco-pectoralis, s. clavi-pectoralis, s. pectoralis profunda) is also distinguished; it is located between the clavicle and the coracoid process, separates the minor pectoral and subclavian muscles from the major pectoral muscle and covers the subclavian artery and vein and the trunks of the brachial plexus. Further this coracoclavicular F. passes into the axillary F. (f. axillaris). On the abdominal wall of the body there is the superficial F. of the abdomen (f. abdominis superficialis), which is located along the midline between the subcutaneous fat layer on one side and the rectus abdominis sheath on the other, and on the lateral surfaces of the abdomen between the subcutaneous fat layer on one side and the external oblique muscle of the abdomen on the other. The perineum is covered by the superficial perineal F. (f. superfic. perinaei), which covers the muscles of the root of the penis and is located immediately under the skin. The deeper layer is called the urogenital diaphragm (f. perinaei profunda, s. f. trigoni urogenitalis, s. diaphragma urogenitale). It lines the urogenital triangle from the outside. On the back there is in the lower part the lumbar-dorsal F. (f. lumbo-dorsalis, s. aponeurosis lumbo-dorsalis); it actually consists of two layers-the superficial layer (lamina superfic. fasciae lumbo-dorsalis), which covers m. erector trunci, and a deeper layer, which is called lamina profunda fasciae lumbo-dorsalis, s. aponeurosis vertebralis, s. ligamentum lumbo-costale, s. ligamentum ilio-costale; this latter is located between the XII rib, the transverse processes of the lumbar vertebrae and the iliac crest; it covers m. sacro-spinalis, separating it from m. quadratus lumborum and m. psoas major. Further on the back there is in the upper part the serratus F. (f. serrata), which lies between mm. trapezius, rhomboidei and latissimus dorsi on one side and m. sacro-spinalis on the other. F. also cover the limbs, receiving here various names. Thus for the upper limb-the superficial F. of the arm and forearm (f. brachii and f. antebrachii), which are the direct continuation of the axillary F. (f. axillaris) and then pass into the dorsal and palmar F. of the hand (f. manus dorsalis and fascia palmaris, s. aponeurosis palmaris). Finally the dorsal and palmar interosseous F. of the hand (f. interossea dorsalis et volaris) are also distinguished, which cover the interosseous muscles of the hand and on the metacarpal bones fuse with their periosteum. For the lower limb the following F. are present: on the thigh-the wide F. of the thigh (f. lata femoris, s. f. femoralis, s. aponeurosis femoralis), which consists of superficial and deep layers (lamina superficialis et profunda) and covers all muscles of the thigh, the sartorius muscle lies between both layers; the wide F. of the thigh continues to the lateral condyle of the thigh under the name of tractus ilio-tibialis (Maissiat); a part of this F. above the oval fossa has a separate name-the sieve-like F., or F. of the oval fossa (f. cribrosa fossae ovalis, s. lamina cribrosa fasciae latae, s. superficialis, s. membrana cribriformis); this sieve-like F. passes into the inguinal ligament (ligamentum inguinale Poupartii); moreover in the femoral canal at its internal opening f. cribrosa, s. femoralis, s. interna, s. f. annuli cruralis, s. lamina cribrosa fasciae transversalis, s. septum cribriforme (Cloquet) is distinguished. This connective tissue mass fills the internal opening of the femoral canal and closes it from the side of the abdominal cavity, being separated from it by retroperitoneal cellular tissue and the parietal layer of the peritoneum. In addition from the wide fascia of the thigh its process-the pectineal F. (f. pectinea) originates, which covers the pectineus muscle. The wide fascia of the thigh passes directly into the fascia of the leg, in which superficial and deep layers (f. cruris superficialis et profunda, s. vagina tendinosa cruris superficialis et profunda, s. vagina tendinosa cruris, s. aponeurosis cruris) are distinguished. This fascia covers all muscles of the leg. Below it passes on the dorsal side into the dorsal F. of the foot (f. dorsalis pedis, s. fascia pedis) and on the plantar side-into the plantar F. (f. plantaris, s. aponeurosis plantaris). Finally the interosseous muscles of the foot are covered by the dorsal and plantar interosseous fasciae (f. interossea dorsalis et plantaris). The second group of F. consists of connective tissue plates that line internal cavities. Such a connective tissue plate, located externally on the parietal costal pleura, is called the intrathoracic F. (f. endothoracica, s. thoracica interna). Similarly the subserous plate of the parietal peritoneum is called the subperitoneal F., or proper F. of the abdominal cavity (f. subperitonealis, s. f. propria Velpeau). Moreover in the abdominal cavity the transverse F. (f. transversalis, s. transversa, s. endogastrica, s. endoabdominalis, s. intraabdominalis, s. abdominalis interna profunda, s. f. musculi transversi) is also distinguished; it is a rather dense connective tissue plate covering the transverse muscle of the abdomen from the side of the abdominal cavity, as well as the lateral walls of the abdominal cavity, and is separated from the peritoneum by the already mentioned proper F. of the abdominal cavity (Velpeau). Further in the pelvic area the following F. are present: under the peritoneum the pelvic F. (f. pelvis, s. hypogastrica). In it a part covering the organs of the pelvic cavity is distinguished; this is the internal pelvic F.

(f. endopelvina, s. fascia musculi levatoris ani interna, s. f. pelvis parietalis, s. f. pelvis visceralis, s. f. recto-vesicalis, s. f. Ty-relli); in addition, a part covering the lateral walls of the pelvis and the pelvic diaphragm is also distinguished in it—this is the superior fascia of the pelvic diaphragm (f. diaphragmatis pelvis sup., s. fascia musculi levatoris ani externa, s. pars parietalis fasciae pelvis, s. aponeurosis musculi levatoris ani sup., s. perinaealis sup., s. ischio-rectalis). Finally, in the perineal area, besides the superficial fascia of the already mentioned muscle (f. superfic. perinaei), which in turn consists of several layers (the number of which varies according to different authors), there are two more fasciae covering the urogenital triangle—these are the superficial, or inferior fascia of the urogenital diaphragm (f. diaphragmatis urogenitalis inf., s. Collesi, s. Macalister, s. ischio-prostatica, s. aponeurosis ischio-rectalis, s. perinaealis) and the superior, or deep fascia (f. diaphragmatis urogenitalis sup., s. f. Collesi, s. perinaei profunda propria, s. subpubica, s. ligamentum pubo-ischiadicum prostatae, s. triangulare urethrae, s. aponeurosis pubio-rectalis, s. lateralis prostatae). The third group of fasciae consists of those connective tissue plates that cover certain organs and receive separate corresponding names. These include: Tenon's fascia of the eyeball (f. bulbi Tenoni, s. capsula-bulbi, s. aponeurosis orbito-orbicularis, s. taenia vaginalis bulbi, s. vagina bulbi), which covers the eyeball posteriorly with a dense plate; fascia of the tongue (f. linguae), which is located under its mucous membrane and firmly fuses with it as well as with the more deeply located muscles of the tongue; bucco-pharyngeal fascia (f. bucco-pharyngea), which covers both the outer surface of the masticatory muscle and the wall of the pharynx (its constrictors) in the form of a thick fibrous plate; its anterior part is also called the buccal fascia (f. buccalis); fascia of the pharynx (f. pharyngis interna) represents the submucous membrane of the pharynx; pharyngo-basilar fascia (f. pharyngo-basilaris, s. membrana pharyngo-basilaris, s: tunica pharyngo-basilaris, s. aponeurosis pharyngis, s. aponeurosis pharyngo-basilaris) is a connective tissue plate that connects the superior constrictor of the pharynx with the base bone; fascia salpingo-pharyngea Schwalbe represents the membranous lamina of the auditory tube (lamina membranacea tubae auditivae); f. propria recti Gerota are the fibers connecting the rectum with the pelvic surface of the sacrum; fascia renum, synonym capsula adiposa renis; fascia prostatae, s. ligamentum pelvio-prostaticum capsularis, s. capsula pelvio-prostatica represents a part of the intrapelvic fascia that tightly surrounds the prostate gland from all sides; f. penis, s. sphincter praeputii penis are the loose connective tissue located under the skin on the male penis; a similar fascia on the clitoris is called f. clitoridis, etc. The fourth group of fasciae consists of connective tissue formations that cover the muscles of the body from all sides, forming around them sheaths (see Muscular system, muscles and auxiliary apparatuses); in addition, plates of connective tissue in many places of the body separate the muscles of the body into separate layers. Finally, the word fascia is incorrectly used in the doctrine of the brain, where f. dentata hippocampi, s. serrata Tarini, s. gyrus marginalis Schwalbe, s. corpus detrticulatum are called rudimentary gyri of the temporal lobe and f. dentata cinerea, s. gyrus marginalis internus Schwalbe are the gray matter of the dentate nucleus of the cerebellum; fascia dentata Giacomini, s. Retzii are called the anterior end of the dentate fascia.

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