The second annular pulley: A histologic examination

Ellis, Frank D.; Seiler, John G.; Sewell, Charles W.

doi:10.1016/s0363-5023(05)80281-3

Cited by 18 publications

(13 citation statements)

References 8 publications

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“…As in his study, we did not find a continuous cellular layer facing the flexor tendons. This is contrary to the findings of Katzman et al (1991) and of Ellis et al (1995), who described the annular and cruciform pulleys in both normal and trigger finger as having a “third cellular layer” located in the inner portion of the pulleys and formed by synovial cells.…”

Section: Discussioncontrasting

confidence: 93%

“…Previously, there has been controversy over the normal and pathological structural findings of the A1 pulley. Many authors have described this pulley as having only two layers (Doyle, 1990; Lundborg and Myrhage, 1977; Sampson et al, 1991) while others have reported three layers in adults (Ellis et al, 1995; Eskeland et al, 1977; Katzman et al, 1998, 1999; Moutet, 2002) and in the embryonic hand (Sbernardori et al, 2000), with the inner one having a continuous synovial cellular layer (Cohen and Kaplan, 1987). A few authors have also described the presence of “chondrocyte-like cells” with a positive cytoplasmic reaction for S-100 protein in normal and trigger fingers (Katzman et al, 1999; Sampson et al, 1991).…”

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confidence: 99%

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Histopathology of the A1 Pulley in Adult Trigger Fingers

Sbernardori

Bandiera

2007

J Hand Surg Eur Vol

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The histopathology of the central parts of 40 A1 pulleys from adult patients with primary trigger fingers was studied using light and transmission electron microscopes and the findings were compared with those in a control series of 10 normal A1 pulleys. The evaluation of the normal A1 pulley revealed a bi-laminar structure. The deepest layer was composed of dense normal connective tissue. The outermost layer was formed by loose connective tissue. In trigger digits, it was possible to identify a tri-laminar structure. The deepest layer was composed of irregular connective tissue, formed by small collagen fibres and abundant extracellular matrix. A considerable amount of chondroid-metaplasia was present in this layer. The middle layer contained dense, normal connective tissue with some fibrocytes. The outermost layer was formed of loose connective tissue. In conclusion, there was an additional layer in the A1 pulley in pathological cases which was not present in normal pulleys.

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Section: Discussioncontrasting

confidence: 93%

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confidence: 99%

Histopathology of the A1 Pulley in Adult Trigger Fingers

Sbernardori

Bandiera

2007

J Hand Surg Eur Vol

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“…Although there are no synoviocyte-like cells present on the deep fascia yet the deep fascia has capability to secrete hyaluronic acid. [1314]…”

Section: Discussionmentioning

confidence: 99%

Detail microscopic analysis of deep fascia of lower limb and its surgical implication

Bhattacharya¹,

Barooah²,

Nag³

et al. 2010

Indian J Plast Surg

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Background:The knowledge regarding the structural details of deep fascia remains inadequate. It was described to be relatively avascular having predominantly protective function. Anatomical and surgical studies revealed that it had associated vascular arcade and hence incorporated it to ascertain additional vascularity to the flaps. However, not much importance has been directed towards the detailed study of the various constituents of deep fascia in order to explain its physiological and clinical implications. Therefore, this study was undertaken to unveil these details.Materials and Methods:Fifty fresh specimens of human deep fascia overlying the gastrocnemius muscle were analyzed regarding the (i) vasculature, (ii) matrix, and (iii) other structural elements. The deep fascia was procured in three forms; (a) both the layers, (b) superficial layer, and (c) deep layer. Detail study was conducted by light, confocal, and electron microscopy.Results:Under light microscopy, blood vessels including capillaries were seen associated with both the layers. Perforators traversing the intra-fascial plane could be visualized. Confocal microscope optical sections showed well-organized bright fluorescent collagen fibers and nuclei of various cells. Electron microscopic evaluation revealed many interesting constituents which are relatively unknown to the anatomist and clinicians. There were arterioles, capillaries, venules, lymphatics, nerves, mast cells, and myofibroblasts apart from collagen and elastic fibers.Conclusion:The detail structural analysis of deep fascia provided the clue to its rich vascularity and other structural constituents. They all contribute to enhance the vascularity and maintenance of the physiological functions of fasciocutaneous, adipofascial, and fascial flaps, frequently used for reconstructions. Thus, incorporation of deep fascia in the flaps during reconstruction is highly beneficial for ensuring optimal vascularity.

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“…8 Our longitudinal histologic sections of the A1 annular pulleys of normal digits has allowed us to observe 3 distinct layers: an outer areolar, wellvascularized layer, continuous with the membranous tendon sheath (zone III); a middle layer, thicker, containing chondrocyte-like cells and collagen fibers oriented perpendicular to the long axis of the flexor tendons (zone II); and an inner unicellular or bicellular layer (zone I) in contact with the flexor tendons. Ellis et al 14 studied the A2 pulley and reported 3 layers. Katzman et al 15 also found 3 layers at the A5 pulley.…”

Section: Discussionmentioning

confidence: 99%