Lower Limb The Fascia Lata

Question 1

What is fascia?

Answer 1

A sheet of band of fibrous tissue lying deep to the skin that lines, invests and separates structures within the body.

Question 2

What are the three classifications of fascia?

Answer 2

Superficial fascia - blends with the reticular layer beneath the dermis.
Deep fascia - envelopes muscles, bones and neurovascular structures.
Visceral fascia - provides membranous investments that suspend organs within their cavities.

Question 3

Where does the fascia lata begin and end?

Answer 3

Begins proximally around the iliac crest and inguinal ligament and ends most distally to the bony prominences of the tibia (becomes the deep fascia of the leg).

Question 4

Where is the fascia lata at its thickest?

Answer 4

Along the superolateral aspect of the thigh, originating from the fascial condensation from the gluteus maximus and medius, and also from around the knee where the fascia recieves reinforcing fibres from tendons.

Question 5

Where is the fascia lata at its thinnest?

Answer 5

Where it covers the adductor muscles of the medial thigh.

Question 6

What does the deepest aspect of the fascia lata give rise to?

Answer 6

Three intermuscular septa that attach to the femur and divide the thigh musculature into three compartments: anterior, medial, and lateral.

Question 7

Which is the strongest intermuscular septum from the fascia lata?

Answer 7

The lateral intermuscular septum due to reinforcement from the iliotibial tract.

Question 8

What is the saphenous opening?

Answer 8

An ovoid hiatus just inferior to the inguinal ligament. It is a gap that serves as an entry point for efferent lymphatic vessels and the great saphenous vein, draining into the superficial inguinal lymph nodes and the femoral vein respectively.

Question 9

What is the cribriform fascia?

Answer 9

A covering of membranous tissue that covers the ovoid hiatus/ saphenous opening. It develops inferomedially from a sharp margin of the gap.

Question 10

When do femoral hernias develop?

Answer 10

When an out-puching of gastric viscera protrudes through the femoral canal.

Question 11

When does the femoral hernia become noticable?

Answer 11

When the protrusion exits superficially through the saphenous opening within the fascia lata, producing a swelling inferior to the inguinal ligament.

Question 12

Why must femoral hernias be clinically investigated?

Answer 12

There is a high risk of incarceration with femoral hernia, also to rule out other pathology like lymphadenopathy.

Question 13

What is the iliotibial tract?

Answer 13

Longitudinal thickening of the fascia lata in the lateral thigh, extending from the iliac tubercle to the lateral tibial condyle.

Question 14

What strengthens the iliotibial tract?

Answer 14

The fibres from the gluteus maximus strengthen is posteriorly.

Question 15

What are the three main functions of the iliotibial tract?

Answer 15

Movement - acts as an extensor, abductor and lateral rotator of the hip.
Compartmentalisation - forms the lateral intermuscular septum of the thigh.
Muscular sheath - sheath for the tensor fascia lata muscle.

Question 16

What is the tensor fascia lata?

Answer 16

A gluteal muscle that acts as a flexor, abductor, and internal rotator of the hip.

Question 17

Where does the tensor fascia lata muscle originate and insert?

Answer 17

Originates from the iliac crest, and descends down the superolaterla thigh. At the junction of the middle and upper thirds of the thigh, it inserts into the anterior aspect of the iliotibial tract.

Question 18

What does tightening of the tensor fascia lata do?

Answer 18

It forces the muscles groups closer together within their intermuscular septa towards the femur. This centralises muscle weight and limits outward expansion, reduces force for movement at the hip joint.

Question 19

How does the tensor fascia lata make muscle contraction more efficient?

Answer 19

It forces the muscle groups close together, and compresses deep veins to ensure adequate venous return to the heart from the lower limbs.

Question 20

What are the proximal attachments of the fascia lata?

Answer 20

Posterior - sacrum and coccyx.
Lateral - iliac crest.
Anterior - inguinal ligament, superior pubic rami.
Medial - inferior ishciopubic rami, ischial tuberosity, sacrotuberous ligament.

Question 21

What are the lateral attachments of the fascia lata?

Answer 21

Thickening of the fascia lata forms the iliotibial tract and receives tendon insertions superiorly from gluteus maximus and tensor fascia lata. It attaches to the lateral tibial condyle on the anterolateral tubercle.

Question 22

What are the inferior attachments of the fascia lata?

Answer 22

Ends at the knee joint and becomes deep fascia of the leg. Attaches to the bony prominences around the knee including the femoral and tibial condyles, patella, head of fibula, and the tibial tuberosity.

Question 23

What are the central attachments of the fascia lata?

Answer 23

Produces three intermuscular septa that attach centrally to the femur. Lateral septum joins to the lateral lip of the linea aspera and the medial and anterior septa attach to the medial lip. Attachments continue along the whole length of the femur to include the supracondylar lines.

Question 24

What is a fascia lata graft a popular choice for?

Answer 24

Dermatofasciotomy and debridement for facilitated tissue regeneration and healing.

Question 25

Why are fascia lata grafts used to treat dermatofasciotomy and debridements?

Answer 25

Because they have high concentration of connective tissue fibres and can be surgically harvester whilst leaving most fibres intact.

Question 26

What reconstructive surgery can fascia lata be used for?

Answer 26

Heart valve replacement, eyelid reparations, dura mater repair, and urinary incontinence treatment.

Question 27

Why is fascia lata a better transplanter than artificial products?

Answer 27

It is well vascularised upon transplantation, but artificial products require microvascular anastomosis.