Scarpa\u27s fascia and clinical signs: the role of the membranous superficial fascia in the eponymous clinical signs of retroperitoneal catastrophe.

摘要

This article deals with the history of membranous superficial fascia (Antonio Scarpa, Abraham Colles), the history of clinical signs that use discoloration of the torso (Cullen\u27s sign, Grey Turner\u27s sign, Fox\u27s sign, Bryant\u27s sign) and then describes anatomical dissection studies to link the two.INTRODUCTION: The membranous superficial fascia (MSF) was described early in the 19th century, as was its role in the clinical sign of urethral disruption. Clinical signs of haemorrhage or leakage of pancreatic and biliary fluid into the retroperitoneum, which were described throughout the 20th century, all relied on circumscribed discolouration of the skin of the torso. The objective of this study was to relate the anatomy of the MSF to clinical signs of retroperitoneal catastrophe.METHODS: The MSF was dissected in the torso of seven embalmed cadavers to note its extent and its attachments. The attachments of the MSF were mapped to the areas of skin discolouration that are described in the clinical signs.RESULTS: The well known extent of the MSF in the inguinal region, its continuation into the perineum and its attachment to the fascia lata of the thigh were confirmed with our method of dissection. Dissection was continued superiorly, demonstrating continuation of the MSF over the entire torso with loose fibrous attachment of the MSF to the deep fascia. The MSF is firmly adherent to the midline of the abdomen except for the umbilicus, to a horizontal line below the clavicles and laterally in the abdomen to form pockets. The lines of firm adhesion correspond with the borders of the discoloured areas described in the clinical signs.CONCLUSIONS: Circumscription of discolouration seen in the eponymous clinical signs of retroperitoneal catastrophe is explained by confinement of coloured retroperitoneal fluid by the MSF and its deep attachments.