Fascial nomenclature: Update on related consensus process

Abstract

The term fascia is increasingly used not only by anatomists but also by other professionals and authors in different health-oriented fields. This goes along with an inconsistent usage of the term, in which many different tissues are included by different authors causing an increasing amount of confusion. The Fascia Research Society acted to address this issue by establishing a Fascia Nomenclature Committee (FNC) with the purpose of clarifying the terminology relating to fascia. This committee conducted an elaborate Delphi process to foster a structured consensus debate among different experts in the field. This process led to two distinct terminology recommendations from the FNC, defining the terms "a fascia" and "the fascial system." This article reports on the process behind this proposed terminology as well as the implications for inclusion and exclusion of different tissue types to these definitions. Clin. Anat. 32:929-933, 2019. © 2019 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.

Keywords: Delphi technique; connective tissue; fascia; nomenclature; terminology.

Figure 1

(A) Example of a fascia dissection based on medically “precise” terminology. This dissection image was used in an otherwise excellent treatise on the iliotibial tract (ITT). Following the proposal of Gray's Anatomy (Standring, 2008) to distinguish between aponeuroses and fasciae, the authors chose to describe this tissue as an aponeurosis and therefore excluded all tissue portions with a non‐aponeurotic character. Unfortunately, this included one of the sturdiest portions of this structure: the connection to the lateral iliac crest, posterior of the anterior superior iliac spine. Notice the common thickening of the iliac crest at the former attachment of this ligamentous portion (located at a straight force transmission line from the knee over the greater trochanter), reflecting the very strong pull of this “ligamentous portion” of the ITT on the pelvis. TFL, tensor fasciae latae. (B) Dissection of the same structure based on the functional term “the fascial system.” The strong densification of the “ligamentous portion” of the ITT on this preparation can be easily recognized, indicated by the arrowhead. In addition, note the continuous transitions on the ITT between regions with a unidirectional and others with a multidirectional fiber orientation. The specimen is one of the first samples of the Fascial Net Plastination Projection of the Fascia Research Society, in which a three‐dimensional plastinated demonstration of “the fascial net” of the human body is attempted. (A) Illustration taken with permission from Benjamin et al. (2008). (B) Illustration ©http://fasciaresearchsociety.org/plastination, with support from Gubener Plastinate GmbH. [Color figure can be viewed at http://wileyonlinelibrary.com]

Figure 2

The nomenclature recommendations of the FNC are based on the understanding that the wider and more functional term “the fascial net” (which some authors replace by “fascial tissues”) describes a subset of tissues belonging to the connective tissue system of the body. Similarly, the term “a fascia” (also called “proper fascia” by some authors) describes a subset of tissues within the larger category of “the fascial system.”