Skip to main content

Advertisement

SpringerLink
Log in

Three-dimensional study of the skin/subcutaneous complex using in vivo whole body 3T MRI: review of the literature and confirmation of a generic pattern of organization

  • Review
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Purpose

With a view to developing a tool for predicting the behavior of soft tissues during plastic surgery procedures, we looked for the existence of homologies in the overall pattern of organization of the skin/subcutaneous tissue complex between various body parts, using high-resolution in vivo imaging methods and data available in the literature.

Methods

3T MRI scanning sequences were performed using appropriate radiofrequency coils on the face, thorax, breast, abdomen and lower extremity of six healthy volunteers. The radiological findings were segmented and converted into volumetric data.

Results

The superficial and deep adipose tissue was found to be clearly separated by an intermediate layer called stratum membranosum or superficial fascia. This continuous layer covered all the anatomical parts of the body examined. It was found to have several components in the trunk and limbs and to form a continuous layer with the superficial muscular aponeurotic system in the face. A retaining connective network consisting of superficial and deep retinacula cutis detected in all the regions investigated sometimes formed more densely packed structures playing the role of skin ligaments.

Conclusion

The results of a 3T MRI study on subcutaneous tissue showed the existence of a common pattern of organization of the skin–subcutaneous tissue complex in the various parts of the body studied. This general model is subject to quantitative variations and tissue differentiation processes promoting the sliding or contractility of the supporting tissue. Three-dimensional reconstructions were obtained by post-processing the MRI images and will be used to perform pre-surgical simulations by settings a generic model that can be adapted to the different localization of the human body in a procedural way.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Abu-Hijleh MF, Roshier AL, Al-Shboul Q, Dharap AS, Harris PF (2006) The membranous layer of superficial fascia: evidence for its widespread distribution in the body. Surg Radiol Anat 6:606–619

    Article  Google Scholar 

  2. Alghoul M, Codner MA (2013) Retaining ligaments of the face: review of anatomy and clinical applications. Aesthet Surg J 6:769–782

    Article  Google Scholar 

  3. Caggiati A (2000) Fascial relations and structure of the tributaries of the saphenous veins. Surg Radiol Anat 3–4:191–196

    Article  Google Scholar 

  4. Canovas F, Roussanne Y, Captier G, Bonnel F (2004) Study of carpal bone morphology and position in three dimensions by image analysis from computed tomography scans of the wrist. Surg Radiol Anat 3:186–190

    Article  Google Scholar 

  5. Captier G, Fauré P, Chamoun M, Bonnel F (2003) Organisation anatomique et biomécanique de la sole plantaire. Med Chir Pied 19:9–12

    Google Scholar 

  6. Chopra J, Rani A, Rani A, Srivastava AK, Sharma PK (2011) Re-evaluation of superficial fascia of anterior abdominal wall: a computed tomographic study. Surg Radiol Anat 10:843–849

    Article  Google Scholar 

  7. Cooper A (1840) On the Anatomy of the Breast. Longman

  8. Dumont T, Simon E, Stricker M, Khan JL, Chassagne JF (2007) Analysis of the implications of the adipose tissue in facial morphology, from a review of the literature and dissections of 10 half-faces. Ann Chir Plast Esthet 3:196–205

    Article  Google Scholar 

  9. Ferreira LM, Hochman B, Locali RF, Rosa-Oliveira LM (2006) A stratigraphic approach to the superficial musculoaponeurotic system and its anatomic correlation with the superficial fascia. Aesthet Plast Surg 5:549–552

    Article  Google Scholar 

  10. Flynn C, Taberner AJ, Nielsen PM, Fels S (2013) Simulating the three-dimensional deformation of in vivo facial skin. J Mech Behav Biomed Mater 28:484–494

    Article  PubMed  Google Scholar 

  11. Furnas DW (1989) The retaining ligaments of the cheek. Plast Reconstr Surg 1:11–16

    Article  Google Scholar 

  12. Gassner HG, Rafii A, Young A, Murakami C, Moe KS, Larrabee WF Jr (2008) Surgical anatomy of the face: implications for modern face-lift techniques. Arch Facial Plast Surg 1:9–19

    Google Scholar 

  13. Har-Shai Y, Bodner SR, Egozy-Golan D, Lindenbaum ES, Ben-Izhak O, Mitz V, Hirshowitz B (1996) Mechanical properties and microstructure of the superficial musculoaponeurotic system. Plast Reconstr Surg 1:59–70

    Article  Google Scholar 

  14. Har-Shai Y, Sela E, Rubinstien I, Lindenbaum ES, Mitz V, Hirshowitz B (1998) Computerized morphometric quantitation of elastin and collagen in SMAS and facial skin and the possible role of fat cells in SMAS viscoelastic properties. Plast Reconstr Surg 7:2466–2470

    Article  Google Scholar 

  15. Herlin C, Doucet JC, Bigorre M, Captier G (2013) Computer-assisted midface reconstruction in Treacher Collins syndrome part 2: soft tissue reconstruction. J Craniomaxillofac Surg 7:676–680

    Article  Google Scholar 

  16. Herlin C, Gilles B, Subsol G, Captier G (2014) Generic 3D geometrical and mechanical modeling of the skin/subcutaneous complex by a procedural hybrid method. LNCS proceedings, ISBMS 2014 conference (in press)

  17. Herlin C, Lievain L, Qassemyar Q, Michel G, Assaf N, Sinna R (2013) Freestyle free perforator flaps for heel reconstruction. Ann Chir Plast Esthet 4:283–289

    Article  Google Scholar 

  18. Hong JP (2006) Reconstruction of the diabetic foot using the anterolateral thigh perforator flap. Plast Reconstr Surg 5:1599–1608

    Article  Google Scholar 

  19. Hong JP, Yim JH, Malzone G, Lee KJ, Dashti T, Suh HS (2014) The thin gluteal artery perforator free flap to resurface the posterior aspect of the leg and foot. Plast Reconstr Surg 5:1184–1191

    Article  Google Scholar 

  20. Knize DM (2007) The importance of the retaining ligamentous attachments of the forehead for selective eyebrow reshaping and forehead rejuvenation. Plast Reconstr Surg 3:1119–1120

    Article  Google Scholar 

  21. Kuhlmann M, Fear EC, Ramirez-Serrano A, Federico S (2013) Mechanical model of the breast for the prediction of deformation during imaging. Med Eng Phys 4:470–478

    Article  Google Scholar 

  22. Kumar P, Pandey AK, Kumar B, Aithal SK (2011) Anatomical study of superficial fascia and localized fat deposits of abdomen. Indian J Plast Surg 3:478–483

    Article  Google Scholar 

  23. Lancerotto L, Stecco C, Macchi V, Porzionato A, Stecco A, De Caro R (2011) Layers of the abdominal wall: anatomical investigation of subcutaneous tissue and superficial fascia. Surg Radiol Anat 10:835–842

    Article  Google Scholar 

  24. Li W, Ahn AC (2011) Subcutaneous fascial bands-a qualitative and morphometric analysis. PLoS ONE 9:e23987

    Article  Google Scholar 

  25. Lockwood TE (1991) Superficial fascial system (SFS) of the trunk and extremities: a new concept. Plast Reconstr Surg 6:1009–1018

    Article  Google Scholar 

  26. Macchi V, Tiengo C, Porzionato A, Stecco C, Vigato E, Parenti A, Azzena B, Weiglein A, Mazzoleni F, De Caro R (2010) Histotopographic study of the fibroadipose connective cheek system. Cells Tissues Organs 1:47–56

    Article  Google Scholar 

  27. Markman B, Barton FE Jr (1987) Anatomy of the subcutaneous tissue of the trunk and lower extremity. Plast Reconstr Surg 2:248–254

    Article  Google Scholar 

  28. Mazza E, Barbarino GG (2011) 3D mechanical modeling of facial soft tissue for surgery simulation. Facial Plast Surg Clin North Am 4:623–637

    Article  Google Scholar 

  29. McGregor IA, Jackson IT (1972) The groin flap. Br J Plast Surg 1:3–16

    Article  Google Scholar 

  30. Mendelson BC (2001) Surgery of the superficial musculoaponeurotic system: principles of release, vectors, and fixation. Plast Reconstr Surg 6:1545–1552

    Article  Google Scholar 

  31. Mirrashed F, Sharp JC, Krause V, Morgan J, Tomanek B (2004) Pilot study of dermal and subcutaneous fat structures by MRI in individuals who differ in gender, BMI, and cellulite grading. Skin Res Technol 3:161–168

    Article  Google Scholar 

  32. Moss CJ, Mendelson BC, Taylor GI (2000) Surgical anatomy of the ligamentous attachments in the temple and periorbital regions. Plast Reconstr Surg 4:1475–1490

    Google Scholar 

  33. Nash LG, Phillips MN, Nicholson H, Barnett R, Zhang M (2004) Skin ligaments: regional distribution and variation in morphology. Clin Anat 4:287–293

    Article  Google Scholar 

  34. Pilsl U, Anderhuber F (2010) The chin and adjacent fat compartments. Dermatol Surg 2:214–218

    Article  Google Scholar 

  35. Pilsl U, Anderhuber F, Rzany B (2012) Anatomy of the cheek: implications for soft tissue augmentation. Dermatol Surg 7:1254–1262

    Article  Google Scholar 

  36. Ponten B (1981) The fasciocutaneous flap: its use in soft tissue defects of the lower leg. Br J Plast Surg 2:215–220

    Article  Google Scholar 

  37. Prendergast PM (2012) Anatomy of the face and neck. In: Shiffman MA, Di Giuseppe A (eds) Cosmetic surgery. Springer, Berlin

    Google Scholar 

  38. Querleux B, Cornillon C, Jolivet O, Bittoun J (2002) Anatomy and physiology of subcutaneous adipose tissue by in vivo magnetic resonance imaging and spectroscopy: relationships with sex and presence of cellulite. Skin Res Technol 2:118–124

    Article  Google Scholar 

  39. Rohrich RJ, Pessa JE (2007) The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg 7:2219–2227

    Article  Google Scholar 

  40. Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ (2009) The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg 5:1529–1544

    Article  Google Scholar 

  41. Schaverien MV, Pessa JE, Rohrich RJ (2009) Vascularized membranes determine the anatomical boundaries of the subcutaneous fat compartments. Plast Reconstr Surg 2:695–700

    Article  Google Scholar 

  42. Som PM, Ann A, Stuchen C, Tang CT, Lawson W, Laitman JT (2012) The MR imaging identification of the facial muscles and the subcutaneous musculoaponeurotic system. Neurographics 2:35–43

    Article  Google Scholar 

  43. Sommer G, Eder M, Kovacs L, Pathak H, Bonitz L, Mueller C, Regitnig P, Holzapfel GA (2013) Multiaxial mechanical properties and constitutive modeling of human adipose tissue: a basis for preoperative simulations in plastic and reconstructive surgery. Acta Biomater 11:9036–9048

    Article  Google Scholar 

  44. Stecco C, Macchi V, Porzionato A, Duparc F, De Caro R (2011) The fascia: the forgotten structure. Ital J Anat Embryol 3:127–138

    Google Scholar 

  45. Stecco C, Tiengo C, Stecco A, Porzionato A, Macchi V, Stern R, De Caro R (2013) Fascia redefined: anatomical features and technical relevance in fascial flap surgery. Surg Radiol Anat 5:369–376

    Article  Google Scholar 

  46. Stuzin JM, Baker TJ, Gordon HL (1992) The relationship of the superficial and deep facial fascias: relevance to rhytidectomy and aging. Plast Reconstr Surg 3:441–449

    Article  Google Scholar 

  47. Wendell-Smith CP (1997) Fascia: an illustrative problem in international terminology. Surg Radiol Anat 5:273–277

    Article  Google Scholar 

  48. Zwanenburg RL, Werker PM, McGrouther DA (2013) The anatomy and function of Cleland’s ligaments. J Hand Surg Eur 5:482–484

    Google Scholar 

Download references

Acknowledgments

The authors are grateful to the volunteers and the radiology technical team for their help in MRI acquisitions.

They also thank Mrs Witt for the quality of the illustrations.

Conflict of interest

The authors declare that they have no conflicts of interest. This study was not supported by any grants.

Author information

Authors and Affiliations

  1. Department of Plastic and Craniofacial Pediatric Surgery, Hospital of Lapeyronie, University of Montpellier-Nîmes, 371 avenue du doyen Gaston Giraud, 34295, Montpellier, France

    Christian Herlin & Guillaume Captier

  2. Department of Plastic and Reconstructive Surgery, Wound Healing, Burns, Hospital of Lapeyronie, University of Montpellier-Nîmes, 371 avenue du doyen Gaston Giraud, 34295, Montpellier, France

    Christian Herlin

  3. Department of Radiology, Hospital of Nîmes, University of Montpellier-Nîmes, Place du Pr Robert Debre, 30029, Nîmes, France

    Alina Chica-Rosa, Francesco Macri & Jean Paul Beregi

  4. Laboratory of Informatics, Robotics and Microelectronics of Montpellier, CNRS/University of Montpellier, 161, rue Ada, 34090, Montpellier, France

    Gérard Subsol & Benjamin Gilles

  5. Laboratory of Anatomy, University of Montpellier-Nîmes, 2, rue de l’Ecole de Médecine, 34000, Montpellier, France

    Guillaume Captier

Authors
  1. Christian Herlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alina Chica-Rosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gérard Subsol
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Benjamin Gilles
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francesco Macri
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jean Paul Beregi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Guillaume Captier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christian Herlin.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Herlin, C., Chica-Rosa, A., Subsol, G. et al. Three-dimensional study of the skin/subcutaneous complex using in vivo whole body 3T MRI: review of the literature and confirmation of a generic pattern of organization. Surg Radiol Anat 37, 731–741 (2015). https://doi.org/10.1007/s00276-014-1409-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-014-1409-0

Keywords

Search

Navigation