Denonvilliers fascia is a dense structure between the rectum and the genitourinary system, and plays as a barrier. In recent years, along with in-depth study of TME, scholars have taken many discussions on Denonvilliers fascia structure and the dissection plane. On the one hand, some consensus have been made on Denonvilliers fascia structure, but still needs to further clarify its microstructure. On the other hand, scholars have generally recognized the neurovascular bundles are on Denonvilliers fascia sides. They should be protected during rectal surgery, however, the details should be clarified. Based on "Fascial Surgery" theory, this article describes Denonvilliers fascia structure and clinical application combined with previous research and our research results.
Digestive System Surgical Procedures ; Dissection ; Fascia ; anatomy & histology ; Fasciotomy ; Humans ; Male ; Rectum ; anatomy & histology ; surgery

OBJECTIVETo investigate the long-time effects of nylon fixation at the internal and external canthus combined with skin graft for recurrent lower eyelids ectropion.

METHODSUnder local anesthesia, the cicatricial contraction was released to repostion the lower eyelid. Then nylon thread was implanted in the fascial tissue at the upper margin of tarsus and was fixed on the periosteum at the internal and external canthus. The skin graft was applied on the wound of lower eyelids.

RESULTS12 patients with lower eyelids ectropion at 19 sides were treated with primary healing. The patients were followed up for 6-24 months. All cases were satisfied with functional and cosmetic results. No complication and no recurrence happened.

CONCLUSIONSThe technique of nylon fixation at the internal and external canthus combined with skin graft is an effective method for recurrent lower eyelids ectropion.

Ectropion ; surgery ; Eyelids ; surgery ; Fasciotomy ; Humans ; Nylons ; Periosteum ; Skin Transplantation ; methods

OBJECTIVETo provide anatomic evidence for identification of "holy plane" between fascia propria and its adjacent fascia in total mesorectal excision.

METHODSA total of 26 pelvic specimens of adult male preserved in 10% formalin solution were used in this study. Twenty pelvis were employed for topographic anatomy, six for sectional anatomy.

RESULTSRectovesical septum was formed by the ventral part of the fascia propria and Denonvilliers' fascia, with no blood vessel and nerve coursed between two layers. Dorsal part of the fascia propria parallelled with the presacral fascia, with no blood vessel and nerve coursed between two layers in 80% of the pelvis. However, anatomic variations was encountered occasionally--with muscle-like tissue or fusion of presacral fascia interposed between them for 20%. The lateral space of rectum was between lateral part of the fascia propria and parietal fascia which witnessed pelvic nerve plexus and lateral ligament of the rectum traveling. Pelvic nerve plexus was categorized as two types according the relation between fascia propria and nerve plexus: fusion type accounting for 85% and rarefaction type for 15%.

CONCLUSION'holy plane' is sandwiched between the fascia propria and its adjacent fascia--ventrally Denonvilliers fascia, dorsally presacral fascia and laterally parietal fascia.

Adult ; Autopsy ; Fascia ; anatomy & histology ; Fasciotomy ; Humans ; Male ; Rectum ; anatomy & histology ; surgery

OBJECTIVETo evaluate a facial rhytidectomy technique to reduce the complications of temporal alopecia and incisional scar hyperplasia.

METHODSThe 82 aged patients were divided into 2 groups in random way: group A in 46 with the use of the three-point relief-tension suspension technique and group B in 36 as control. In group A, the two point of every relief-tension suture was located respectively in the subcutis of the hairline and fascia under the incision. The parallel three sutures formed a mechanical plane to make the relief suture more strong and permanent. The temporal alopecia and incisional scar was observed with the follow-ups after the operation.

RESULTSWith the 82 cases of facial rhytidoplasty, the complications of the temporal alopecia and incisional scars in group A were much less than in group B.

CONCLUSIONSThis technique could decrease the complications such as temporal alopecia and incisional scars, and get a good and long term effect of temporal lifting simultaneously.

Adult ; Fasciotomy ; Female ; Humans ; Male ; Middle Aged ; Petrous Bone ; surgery ; Rhytidoplasty ; methods

OBJECTIVETo investigate the technique and therapeutic effect for correction of sunken eyes combined with ptosis.

METHODSIn order to adjust the levator muscle tension and the relationship between levator aponeurosis and tarsus plate, multiple individualized treatment was selected, including levator aponeurosis restoration, levator aponeurosis plication, or shorten, or combination. Then the orbital fat was transferred to the depressed area, or autologous fat particles were collected and injected into the depressed area within the orbital fat fascia. After the orbital septum fascia was restored, the incision was closed primarily.

RESULTS15 cases (30 eyes) were treated. 11 cases were followed up for 6-40 months (average, 9.5 months) with satisfactory cosmetic and functional result. No recurrence of ptosis happened.

CONCLUSIONSOne-stage correction of sunken eyes combined with ptosis can be achieved with autologous fat injection or orbital fat transposition. Good cosmetic and functional result can be achieved.

Adipose Tissue ; transplantation ; Aged ; Blepharoplasty ; methods ; Blepharoptosis ; surgery ; Eyelids ; Fasciotomy ; Humans ; Oculomotor Muscles ; surgery ; Orbit

OBJECTIVETo study the relationship of mesorectum with fasciae and nerves in the pelvic cavity and to specify the proper planes of dissection in total mesorectal excision.

METHODSTwenty-four pelvises (12 males and 12 females) harvested from cadavers were studied by dissection.

RESULTSThere were three planes surrounding the rectum as the visceral fascia, vesicohypogastric fascia and parietal fascia. The pelvic plexus and its branches situated between the visceral fascia and the vesicohypogastric fascia. Pelvic splanchnic nerves and hypogastric nerves were observed between the visceral fascia and the parietal fascia.

CONCLUSIONSThe posterior plane of total mesorectal excision lies between the visceral fascia and the parietal fascia. The lateral dissection should be conducted in a plane between the visceral fascia and the vesicohypogastric fascia. The proper planes for posterior and lateral resection can be identified by the hypogastric nerve and the pelvic plexus respectively.

Fascia ; anatomy & histology ; Fasciotomy ; Female ; Humans ; Male ; Mesentery ; anatomy & histology ; surgery ; Pelvis ; anatomy & histology ; surgery

OBJECTIVETo explore the efficacy of urethral dilatation with the renal sheath dilator under the ureteroscope in the treatment of male patients with urethrostenosis.

METHODSEighteen male patients with urethrostenosis underwent urethral dilatation with the renal sheath dilator. Under the ureteroscope, a zebra-guide wire was inserted through the stenosed urethra into the bladder and the stenosis was gradually dilated with the renal sheath dilator, followed by placing a Foley catheter of proper size for 1-4 weeks. For children, the renal sheath dilator was selected according to their age, while for adults, metal dilators (> or = F20) were used following dilatation with the F18 renal sheath dilator. All the patients were followed up for 6-24 months.

RESULTSThe operation was successfully performed in all the 18 cases, with no urethral false passage, urethral perforation or urethra tearing. Sixteen of the patients were cured, and the other 2 received urethroplasty for stenosis recurrence. The maximum flow rate was increased to 13.6-30.2 (18.1 +/- 3.5) mL/s after the operation.

CONCLUSIONUrethral dilatation with the renal sheath dilator under the ureteroscope is a simple, safe and effective method for the treatment of urethrostenosis.

Adolescent ; Adult ; Child ; Child, Preschool ; Dilatation ; methods ; Fasciotomy ; Humans ; Male ; Middle Aged ; Urethral Stricture ; surgery ; Young Adult

Anatomy is the foundation of surgical techniques. With the development of surgery, anatomy also divided into traditional anatomy, surgical anatomy and embryonic development anatomy. Complete mesocolic excision (CME) is one of classic radical operation for colon cancer, based on the modern anatomy. CME advocates correct operation plane, and describes the mobilization and separation of the colon together with the entire regional mesocolon. With the evolution of anatomy, the definition and content of CME-related anatomic landmarks such as mesentery, fascia and space have been changed. This article elaborates theses anatomical structures and their distribution, in order to improve the understanding of colorectal surgeons on CME-related traditional anatomy, surgical anatomy and embryonic developmental anatomy.
Colectomy ; Colonic Neoplasms ; surgery ; Digestive System Surgical Procedures ; Fascia ; anatomy & histology ; Fasciotomy ; Humans ; Mesentery ; Mesocolon ; anatomy & histology ; surgery

OBJECTIVETo evaluate a pudendal-thigh island flap for vaginal reconstruction.

METHODSForty-seven patients with congenital absence of vagina were undergoing the treatment. Based on the pedicle including the posterior labial neurovascular bundle, a pudendal-thigh island flap was designed and raised in the groin crease just lateral to the labia majora under the deep fascia. It was then transferred to the tunnel between the urethra and the anus for reconstruction of the vagina.

RESULTSFrom May of 1993 to July of 2001, 47 patients were successfully treated for the vaginal reconstruction with the flap. The results were satisfactory without complications.

CONCLUSIONThe above mentioned technique could be a safe and effect method for vaginal reconstruction with the advantages of reliable blood supply, good sensation and few complications. The areaes with the bilateral pudendal-thigh could be large enongh for the vaginal reconstruction without problem of the donor closure.

Fasciotomy ; Female ; Groin ; Gynecologic Surgical Procedures ; methods ; Humans ; Male ; Surgical Flaps ; Thigh ; Urethra ; Vagina ; abnormalities ; surgery ; Vulva ; abnormalities ; surgery

OBJECTIVETo discuss the treatment of congenital hypospadias in infancy.

METHODSAfter correction of chordee, the tubed oral mucosa was used to prefabricate urethra in penis as free graft. The urethral anastomosis was performed at the second stage. The scrotum fascia flap, pedicled with scrotal artery, was transferred to cover the penile defect.

RESULTSFrom Jan. 2007 to May 2010, 42 cases were treated. The tubed oral mucosa was 3.0-4.0 cm in length, and 0.6-0.8 cm in diameter. The maximum size of scrotum flap was 1.5 cm x 3.0 cm. Urethral fistula happened in two cases due to necrosis at the distal end of scrotal flap, which was healed spontaneously after dressing for 1-2 weeks. Primary healing was achieved in all the other cases. After operation, the 26 cases have been visited for 6 months to 3 years, no urethra fistula , narrow and the penis curved. There is an universal urinate for oneself and a good form.

CONCLUSIONSThe tubed oral mucosa can be used to prefabricate urethra, which is anastomosed at the second stage. The tubed oral mucosa combined with scrotal fascial flap which has a reliable blood supply, is very suitable for hypospadias in infancy.

Anastomosis, Surgical ; Child, Preschool ; Fasciotomy ; Humans ; Hypospadias ; surgery ; Infant ; Male ; Mouth Mucosa ; transplantation ; Scrotum ; surgery ; Surgical Flaps