Layers of the abdominal wall: anatomical investigation of subcutaneous tissue and superficial fascia
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In recent times new surgical approaches have been developed, in which subcutaneous tissue is the primary object, such as flaps and fat removal techniques, but different descriptions and abundance of terminology persist in Literature about this tissue.
Aim and methods
In order to investigate the structure of abdominal subcutaneous tissue, macroscopic and microscopic analyses of its layers were performed in 10 fresh cadavers. Results were compared with in vivo CT images of the abdomen of 10 subjects.
The subcutaneous tissue of the abdomen comprises three layers: a superficial adipose layer (SAT), a membranous layer, and a deep adipose layer (DAT). The SAT presented fibrous septa that defined polygonal-oval lobes of fat cells with a mean circularity factor of 0.856 ± 0.113. The membranous layer is a continuous fibrous membrane rich in elastic fibers with a mean thickness of 847.4 ± 295 μm. In the DAT the fibrous septa were predominantly obliquely-horizontally oriented, defining large, flat, polygonal lobes of fat cells (circularity factor: mean 0.473 ± 0.07). The CT scans confirm these findings, showing a variation of the thickness of the SAT, DAT and membranous layer according with the subjects and with the regions.
The distinction of SAT and DAT and their anatomic differences are key elements in modern approaches to liposuction. The membranous layer appears to be also a dissection plane which merits further attention. According with the revision of Literature, the Authors propose that the term “superficial fascia” should only be used as a synonym for the membranous layer.
KeywordsSuperficial fascia Hypodermis Scarpa’s fascia Camper’s fascia Abdominoplasty Liposuction
The authors are grateful to Anna Rambaldo and Gloria Sarasin for their skilful technical assistance. They also thank Euganea Medica for support for the radiological study.
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.Camper P (1801) Icones herniarum editae a S. T. Soemmering. Varrentrapp et Wenner, Frankfurt am MainGoogle Scholar
- 5.Colles A (1811) A treatise on surgical anatomy. Gilbert & Hodges, DublinGoogle Scholar
- 7.Darrach W (1830) Drawings of the anatomy of the groin, with anatomical remarks. Littel, PhiladelphiaGoogle Scholar
- 9.Forster DS (1937) A note on Scarpa’s fascia. J Anat Pt 1:130–131Google Scholar
- 11.Godman JD (1823) Anatomical investigations. Phila J Med Phys Sci, 261. Carry & Lea, PhiladelphiaGoogle Scholar
- 12.Godman JD (1824) Contributions to physiological and pathological anatomy. Phila J Med Phys Sci. Carry & Lea, PhiladelphiaGoogle Scholar
- 13.Illouz YG (1996) History and current concepts of lipoplasty. Clin Plast Surg 4:721–730Google Scholar
- 15.Johnson D, Cormack GC, Abrahams PH, Dixon AK (1996) Computed tomographic observations on subcutaneous fat: implications for liposuction. Plast Reconstr Surg 2:387–396Google Scholar
- 16.Lockwood TE (1991) Superficial fascial system (SFS) of the trunk and extremities: a new concept. Plast Reconstr Surg 6:1009–1018Google Scholar
- 17.Martin BF (1984) The formation of abdomino-perineal sacs by the fasciae of Scarpa and Colles, and their clinical significance. J Anat Pt 4:603–616Google Scholar
- 18.Markman B, Barton FE Jr (1987) Anatomy of the subcutaneous tissue of the trunk and lower extremity. Plast Reconstr Surg 2:248–254Google Scholar
- 20.Mathes SJ (2006) Plastic surgery. Elsevier, PhiladelphiaGoogle Scholar
- 21.Moore KL, Dalley AD (2009) Clinically oriented anatomy, 5th edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
- 24.Nava M, Quattrone P, Riggio E (1998) Focus on the breast fascial system: a new approach for inframammary fold reconstruction. Plast Reconstr Surg 4:1034–1045Google Scholar
- 26.Standring S, Ellis H, Healy J, Johnson D, Williams A (2005) Gray’s anatomy, 39th edn. Churchill Livingstone, LondonGoogle Scholar
- 27.Sterzi G (1910) Il tessuto sottocutaneo (tela subcutanea). Luigi Niccolai, FirenzeGoogle Scholar
- 28.Testut L (1899) Traite′ d’anatomie humaine. Gaston Doin & Cie, ParisGoogle Scholar
- 29.Scarpa A (1809) Sull’ernie memorie anatomo-chirurgiche, 1st edn. Reale Stamperia, MilanoGoogle Scholar
- 30.Scarpa A (1819) Sull’ernie memorie anatomo-chirurgiche, 2nd edn. Stamperia Fusi e Compagno, PaviaGoogle Scholar
- 31.Tobin CE, Benjamin JA (1949) Anatomic and clinical re-evaluation of Camper’s, Scarpa’s, and Colles’ fasciae. Surg Gynecol Obstet 5:545–559Google Scholar
- 33.Worseg AP, Kuzbari R, Hubsch P, Koncilia H, Tairych G, Alt A et al (1997) Scarpa’s fascia flap: anatomic studies and clinical application. Plast Reconstr Surg 5:1368–1380 discussion 1381Google Scholar