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• W2040729130 abstract "Sir: We read the most recent article regarding the subcutaneous fat compartments with great interest. This latest article from Drs. Rohrich and Pessa elucidates even more new information for plastic surgeons about the ligamentous facial fence,1 or retaining system of the face.2 This work has been immediately translatable to the clinical setting at our institution, with the fat compartment anatomy serving as a map for injection of autologous fat in a number of patients. In this article, the authors show that the membranous boundaries of the fat compartments contain perforating arteries. It is rightly concluded that this connective tissue retaining system provides stabilization and protection for the blood supply to the facial skin during facial expression. We would like to point out that this may be an underestimation of their purpose. Based on anatomical studies at the Baylor College of Medicine at the Texas Medical Center in Houston, it has become clear that these retaining membranes convey lymphatics as well. Specifically, we have identified precollecting lymph vessels3 in oblique retaining septae within the medial thigh specimens. We believe that this suggests that the retaining system plays a role in isolating infection, much as the fascial spaces of the neck do. Briefly, dissections using intradermal methylene blue injection in medial thigh lift discard specimens have revealed that the dye travels along until it reaches the dermis overlying these septae, and then goes straight down into the subcutaneous fat. Dye infiltrates the subcutaneous fat up to the retaining membrane, and selectively travels in the precollecting lymphatic vessels (Fig. 1). This is intellectually consistent, as methylene blue is used during sentinel lymph node biopsy to identify a tumor’s primary draining lymph node.4 Methylene blue is blocked by these membranes because its particle size is too large; however, the particle size enables it to selectively enter the precollecting lymphatic vessels. That is why the compartments are highlighted in the manner in which they are.Fig. 1.: Medial thigh dissection specimen demonstrates a retaining membrane containing methylene blue dye–filled precollecting lymphatics. Note the sharp demarcation of methylene blue staining from unstained fat.It would make sense that the lymphatic vessels are not different from perforating arteries, as they both develop from mesenchyme, formed by the union of mesenchymal spaces into vessels. Interestingly, in the article by Pan et al.,3 it can be noted in Figure 3 that there are main collecting lymphatic vessels running in the exact line of the medial cheek septum and inferior temporal septum. This further demonstrates the concept on which Schaverien et al. have elaborated: vessels follow the connective tissue framework of the body and radiate from fixed to mobile areas.5 It may also demonstrate that this system plays a role in isolation of infection and early presentation of infective material to the immune system. Dr. Rohrich, Dr. Pessa, and their team are to be congratulated on a thoughtful and informative series of investigations. We look forward to their next article and the contribution to clinical practice that it will deliver. Daniel A. Hatef, M.D. Larry H. Hollier, Jr., M.D. Baylor College of Medicine Houston, Texas" @default.
• W2040729130 created "2016-06-24" @default.
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• W2040729130 date "2009-07-01" @default.
• W2040729130 modified "2023-09-27" @default.
• W2040729130 title "Vascularized Membranes Determine the Anatomical Boundaries of the Subcutaneous Fat Compartments" @default.
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• W2040729130 doi "https://doi.org/10.1097/prs.0b013e3181a837f6" @default.
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