臨床婦人科産科76巻12号

2022年12月発行

今月の臨床 帝王切開分娩のすべて―この1冊でわかるNew Normal Standard

術式の工夫

帝王切開創部縫合時における浅筋膜の構造と見つけ方

著者： 草開妙¹ 谷村悟¹

所属機関： ¹富山県立中央病院産婦人科

ページ範囲：P.1221 - P.1226

文献概要

●ケロイド・肥厚性瘢痕を予防するために浅筋膜縫合による減張の有用性が示唆されている．

●皮下には脂肪だけでなく，浅筋膜を中心とした線維構造の立体的かつ機能的なネットワークが構築されている．

●皮下組織の2つの脂肪層を見分け，その間に引き込まれている浅筋膜を同定して縫合を行う．

参考文献

1）Harn HI, et al : The tension biology of wound healing. Exp Dermatol 28 : 464-471, 2019

2）Ogawa R, et al : The latest strategy for keloid and hypertrophic scar prevention and treatment : The Nippon Medical School（NMS） Protocol. J Nippon Med Sch 88 : 2-9, 2021

3）Ogawa R, et al : Clinical applications of basic research that shows reducing skin tension could prevent and treat abnormal scarring : the importance of fascial/subcutaneous tensile reduction sutures and flap surgery for keloid and hypertrophic scar reconstruction. J Nippon Med Sch 78 : 68-76, 2011

4）Ogawa R, et al : Keloids and hypertrophic scars can now be cured completely : recent progress in our understanding of the pathogenesis of keloids and hypertrophic scars and the most promising current therapeutic strategy. J Nippon Med Sch 83 : 46-53, 2016

5）Akaishi S, et al : The relationship between keloid growth pattern and stretching tension : visual analysis using the finite element method. Ann Plast Surg 60 : 445-451, 2008

6）赤石諭史，他 : 新しい皮膚切開線の提唱―ケロイド伸展ベクトルの分析．瘢痕・ケロイド4 : 95-99, 2010

7）Netter FH : Netter atlas of human anatomy : a systems approach. 8th ed. 1025, Elsevier, 2022

8）佐藤達夫：臓側筋膜の局所解剖―層構成の基本と各部位における分化―．日臨外医会誌56 : 2253-2272, 1995

9）Lancerotto L, et al : Layers of the abdominal wall : anatomical investigation of subcutaneous tissue and superficial fascia. Surg Radiol Anat 33 : 835-842, 2011

10）Benias PC, et al : Structure and distribution of an unrecognized interstitium in human tissues. Sci Rep 8 : 4947, 2018

11）Stecco C : Functional atlas of the human fascial system. pp23-53, Churchill Livingstone, 2015

12）Benjamin M : The fascia of the limbs and back―a review. J Anat 214 : 1-18, 2009

13）Caggiati, A : Fascial relations and structure of the tributaries of the saphenous veins. Surg Radiol Anat 22 : 191-196, 2000

14）Abu-Hijleh MF, et al : The membranous layer of superficial fascia : evidence for its widespread distribution in the body. Surg Radiol Anat 28 : 606-619, 2006

15）Langevin HM : Connective tissue : a body-wide signaling network? Med Hypotheses 66 : 1074-1077, 2006

16）Schleip R, et al（eds） : Fascia : the tensional network of the human body : the science and clinical applications in manual and movement therapy. pp39-46, Elsevier, 2021 Dec

17）Kawamata S, et al : Structure of the rat subcutaneous connective tissue in relation to its sliding mechanism. Arch Histol Cytol 66 : 273-279, 2003

18）van der Wal J : The architecture of the connective tissue in the musculoskeletal system-an often overlooked functional parameter as to proprioception in the locomotor apparatus. Int J Ther Massage Bodywork 2 : 9-23, 2009