Existence and Distribution of the Membranous Layer of Superficial Fascia in the Human Body

Marwan F. AbuHijleh, MD, PhD, MHPE

Professor and Chair, Department of Anatomy, Colle e of Medi!ine and Medi!al "!ien!es, Arabian #ulf $ni%ersity, Manama, P.&. 'o( ))*+*, ,in dom of 'ahrain. Phone- ..*+/0+)/*122 Fa(- ..*+/0+)+0.*. Email- marwanah3a u.edu.bh 'AC,#4&$5D A dis!rete membranous layer 6stratum membranosum6, in human sub!utaneous tissue is !lassi!ally des!ribed as !onfined to the lower anterior abdominal wall and perineum and referred to as "!arpa7s and Colles7 fas!iae, respe!ti%ely. E%iden!e for its e(isten!e elsewhere in the body is s!anty and therefore the present study was underta8en. ME9H&D" Disse!tion of si( embalmed adult !ada%ers :/ male and / female;, alon with ultrasound ima in on four li%in subje!ts :) male and ) female;, were !arried out to determine the e(isten!e, topo raphy, and thi!8ness of the membranous layer of superfi!ial fas!ia in 0. different re ions of the body. 4E"$<9" =n all si( !ada%ers, a !ontinuous layer of fibrous membrane in the superfi!ial fas!ia was found !onsistently in all the disse!ted re ions of the body and was also !onfirmed by ultrasono raphy :Fi ure, A > ';. 9he arran ement and thi!8ness of this membranous layer %aried a!!ordin to body re ion, body surfa!e, and ender. =t was thi!8er in the lower than in the upper e(tremity, on the posterior than anterior aspe!t of the body, and in females than in males. 9he mean thi!8ness of the membranous layer ran ed from /* to 01* ?m, bein thi!8est in the le and thinnest o%er the dorsum of the hand. 9he membranous layer was obser%ed to ha%e two or e%en three !omponents in re ions su!h as the breast, ba!8, thi h, and arm and was seen to split, formin spe!ial !ompartments around sub!utaneous major %eins of upper and lower e(tremities, with fibrous septa e(tendin to an!hor the %essel to the !ompartment wall :Fi ure, C > D;. =n !ontrast, small tributaries of the major %eins were seen to !ourse superfi!ial to the membranous layer in the subdermal fatty layer, thus la!8in fas!ial wrappin . C&5C<$"=&5" 9he membranous layer of the superfi!ial fas!ia is not restri!ted to the lower abdominal wall and perineum but has a mu!h wider distribution in many re ions of the body. Fun!tionally, the membranous superfi!ial fas!ia may play a role in the inte rity of the s8in and support for sub!utaneous stru!tures parti!ularly lar e %eins, by ensurin their paten!y. $nderstandin the topo raphi! anatomy of this fas!ial layer may help e(plain sub!utaneous tissue deformities and pro%ide the anatomi! basis for sur i!al !orre!tion. Furthermore, the results emphasi@e the !on!ept of !ontinuity of fas!ia between different re ions of the body.

:A; <ayered disse!tion of the male breast re ion :!hest wall;. 9he membranous layer :ml; forms a sin le !ontinuous layer in this disse!tion and the !orrespondin ultrasono ram :'; where it is sharply demar!ated from the surroundin hypoe!ho eni! fatty tissue layer :fl;. :C; <ayered disse!tion of the anterior le re ion. 9wo superfi!ial %eins are seen- a tributary %ein :t%; lies superfi!ial

to the membranous layer, and the major :lon saphenous; %ein :%; is en!losed in a !ompartment formed by the mus!ular fas!ia :mf; deeply and by the membranous layer :ml; superfi!ially. 9hese two fas!ial layers fuse peripherally delineatin a !ompartment resemblin an AE yptian eyeBCshape usin ultrasono raphy :D;. =n :D;, the main %ein is an!hored to the fibrous wall of its !ompartment by a !onne!ti%e tissue lamina :arrow;. s, s8inD m, mus!le.