Fascia Lata Flashcards
What is fascia defined as?
A sheet or band of fibrous tissue lying deep to the skin that lines, invests and separates structures within the body
What are the general classifications of fascia?
Superficial
Deep fascia
Visceral
What does superficial fascia do?
Blends with the reticular layer beneath the dermis
What does deep fascia do?
Envelopes muscles, bones and neurovascular structures
What does visceral fascia do?
Provides membranous investments that suspend organs within their cavities
What is the fascia lata?
A deep fascial investment of the whole thigh musculature
What is fascia lata analogus to?
A strong, extensible and elasticated stocking
Where does the fascia lata begin most proximally?
Around the iliac crest and inguinal ligament
Where does the fascia lata end most distally?
The bony prominences of the tibia
What happens to the fascia lata at the bony prominences of the tibia?
It continues to become the deep fascia of the leg (crural fascia)
How much does the width of the fascia lata vary at different regions of the thigh?
Considerably
Where is the fascia lata thickest?
Along the superolateral aspect of the thigh, originating from the fascial condensations from the gluteus maximus and medius
Around the knee
What happens to the fascia lata around the knee?
It receives reinforcing fibres from tendons
Where is the fascia lata thinnest?
Where it covers the adductor muscles of the medial thigh
What does the deepest aspect of the fascia lata give rise to?
Three intermuscular septa that attach centrally to the femur
What do the three intermuscular septa of the fascia lata do?
Divides the thigh musculature into three compartments, anterior, medial, and lateral
Which intermuscular septa is strongest?
The lateral
Why is the lateral intermuscular septa strongest?
Due to reinforcement from the iliotibial tract
What is present in the fascia lata?
The saphenous opening
What is the saphenous opening?
An ovoid hiatus
Where is the saphenous opening found?
Just inferior to the inguinal ligament
What does the saphenous opening serve as?
An entry point for efferent lymphatic vessels, and the great saphenous vein
What do the efferent lymphatic vessels drain into?
The superficial inguinal lymph nodes
What does the great saphenous vein drain into?
The femoral vein
What covers the saphenous opening?
A covering of membranous tissue called the cribriform fascia
How does the saphenous opening develop?
Inferomedially from a sharp margin of the gap (the falciform margin)
When do femoral hernias develop?
When an out-pouching of gastric viscera protrudes through the femoral canal
When does the protrusion of gastric viscera become noticeable?
When it exits superficially through the saphenous opening within the fascia lata, producing a swelling inferior to the inguinal ligament
What is necessary when a femoral hernia presents?
To investigate promptly
Why is it important to investigate femoral hernias promptly?
Due to the high risk of incarceration
To rule out other pathology, such as lymphadenopathy
What is the iliotibial tract?
A longitudinal thickening of the fascia lata
How is the iliotibial tract strengthened posteriorly?
By fibres from the gluteus maximus
Where is the iliotibial tract located?
Laterally in the thigh, extending from the iliac tubercle to the lateral tibial condyle
What are the main functions of the iliotibial tract?
Movement
Compartmentalisation
Muscular sheath
How is the iliotibial tract involved with movement?
Acts as an extensor, abductor, and lateral rotator of the hip
Additional role in providing lateral stabilisation to the knee joint
How is the ITT involved in compartmentalisation?
The deepest aspect of the ITT extends centrally to form the lateral intermuscular septum of the thigh, and attaches to the femur
What does the ITT form a sheath for?
The tensor fascia lata muscle
What is the tensor fascia lata?
A gluteal muscle
What does the tensor fascia lata act as?
A flexor, abductor and internal rotator of the hip
Additional role in tensing the fascia lata
Where does the tensor fascia lata orginate?
From the iliac crest
Where does the tensor fascia lata descend?
Down the superolateral thigh
Where does the tensor fascia lata insert?
Into the anterior aspect of the iliotibial tract, at the junction of the middle and upper thirds of the thigh
What happens when the tensor fascia lata is stimulated?
It tautens the iliotibial band, and braces the knee, especially when the opposite foot is lifted
Makes muscle contraction more efficient in compressing deep veins
What happens when the fascia lata is pulled taut?
It forces the muscle groups closer together within their intermuscular septa towards the femur. This action centralises muscle weight and limits outward expansion, which in turn reduces the overall force required for movement at the hip joint
What does the compression of deep veins ensure?
Adequate venous return to the hear from the lower limbs
What proximal attachments does the fascia lata form?
Multiple superior attachments around the pelvis and hip region- posterior, lateral, anterior and medial
What is the proximal posterior attachment of the fascia lata?
Sacrum and coccyx
What is the proximal lateral attachment of the fascia lata?
Iliac crest
What is the proximal anterior attachment of the fascia lata?
Inguinal ligament
Superior pubic rami
What is the medial anterior attachment of the fascia lata?
Inferior ischiopubic rami
Ischial tuberosity
Sacrotuberous ligament
Proximally, what is the fascia lata continuous with?
Regions of deep and superficial fascia at its superior aspect
What does the deep iliac fascia do?
Descends from the thoracic region at the diaphragm, covers the entire ilacus and psoas regions, and blends with the fascia lata superiorly
What blends with fascia lata just below the inguinal ligament?
Superficial fascia from the inferior abdominal wall (Scarpa fascia) and perineal region
What does the lateral thickening of fascia lata form?
The iliotibial tract
What does the lateral thickening of fascia lata receive?
Tendon insertions superiorly from the gluteus maximus and tensor fascia lata
What happens to the widened band of fibres from the lateral thickening of the fascia lata?
They descend the lateral thigh and attaches to the lateral tibial condyle on the anterolateral (Gerdy) tubercle
Where does the fascia lata end inferiorly?
The knee joint
What does the fascia lata become at the knee joint?
The deep fascia of the leg (the Crural fascia)
Where are fascia lata attachments made at the knee?
At the bony prominences around the knee, including the femoral and tibial condyles, patella, head of fibula and the tibial tuberosity
What does the deep aspect of the fascial lata produce?
Three intermuscular septa
Where do the three intermuscular septa attach centrally?
To the femur
What does the lateral intermuscular septa join?
The lateral lip of the linea aspera
What do the medial and anterior intermuscular septa attach to?
The medial lip of the linea aspera
How to the attachments of the intermuscular septa to the linea aspera lips continue?
Along the length of the femur to include the supracondylar lines
What can dermatofasciotomy and debridement leave?
Large wound sites that require post-operative grafts to facilitate tissue regeneration and healing
Why is a fascia lata graft a popular choice/
As the iliotibial tract provides a particularly high concentration of connective tissue fibres, and can be surgically harvested whilst leaving the majority of fibres in tact
What have advancements have been made in the use of fascia lata in reconstructive surgery?
Heart valve replacements
Eyelid reparations
Dura mater repair
Urinary incontinence treatment (fascia lata sling)
What is the main advantage of using fascia lata as opposed to an artificial product?
It is well vascularised upon transplantation, whereas the later requires microvascular anastomosis
