The connective tissue found throughout the body, from the bones to the skin, tendons and nerves, plays an essential structural role—and it’s also responsible for the mobility and flexibility of living tissue.
Anatomical observations made
In fact, the simple act of being able to lift the skin and see it re-drape and revolve back to the same position, immediately recovering its original shape and texture, is certainly very banal—but many questions remain when you think of all the elements involved in this process.
The feeling is the same when the fingers are in flexion and then in extension and you think of all the structures involved to perform the progression of the flexor to the palm without external changes on the palmar skin.
No Clear Separation
For decades, scientific explanations have been limited to the notion of the concept of elasticity or the existence of loose connective tissue: stratified, hierarchical layerings with some virtual space between them. All these biomechanical explanations are very vague.
[Watch a video from Jean Claude Guimberteau, MD, on fascia, here.]
These concepts based on observations from the last century have never been debated and are considered as acquired truths. For over 50 years, scientific research has gone to a microscopic level and dropped general anatomy to a mesoscopic level. (The mesoscopic world lies between the macroscopic, or what we can seek with the naked eye, and the microscopic, or unseen.) The classical doctrine is: Connective tissue is connective, the link between the vital organs—and as it seems mobile, ensures mobility and elasticity.
Furthermore, this connective tissue is not considered as noble—and is neglected by surgeons and anatomists—because it is not dense and is very fragile to dissect. (Surgical dissections used in these areas such as separation or undermining are easier.) For example, very often with his index finger, the surgeon collapses these structures that allow access to the bony structures.
What we call surgical planes—a plane of dissection that preserves most of the neurovascular structures—are created by the surgeon’s scissors and undermining, but physically do not exist. In fact, careful observation reveals that connections consist in a real connective tissue histological continuity without any clear separation between the skin and subcutaneous tissue, vessels, fascia and muscle.
During all those hours of surgical observations, using a contact endoscope, shooting video sequences of high resolution of the connective tissue and sliding systems, it becomes noticeable that there is much neglected connective tissue that is essential, if not structural. Further, this tissue is not a secondary tissue, filling gaps between organs without essential function, nor a simple package tissue as traditionally thought.
The World Under the Skin
I have carefully studied this tissue organization for 15 years, searching to understand how it was composed. I have found a world of fibers and fibrils of different diameters, veils and forms consisting of ropes, shrouds, cables and sails. I have called this fibrillar scaffold the multimicrovacuolar collagenic absorption system because it enables sliding with the diffusion of a force without fibrillar breaks. This system is a chaotic and irregular organization, operating far from traditional mechanical analysis.
Through intratissular endoscopic technology, you can see that the world under the skin is not in regular order, as many would like to think. This interior architecture is made of myriad collagen fibrils, framed in an irregular and fractal manner and woven in the three dimensions of space.
On the biomechanical point of view, this network has interconnections whose behavior is non-linear and allows optimum adaptation to mechanical stress. Between each connection of this system arises a micro-volume, the functional unit, or space, that has been named microvacuole whose shape is fractal, irregular and polyhedral. These microvacuoles act as a power-absorbing system and can respond in all three dimensions of space.
This connective tissue not only connects the body parts, but also seems to help shape them. As seen in all structures of life and on many levels, the question arises: Is this fibrillar network—or, the shape and scope of collagen fibers in the body—the architectural way for structuring life? Is it the notion of tissular intracorporeal continuity tissue, and not spare parts attached to each other?
This notion of microvacuole is very fascinating, because it helps explain the ability to fulfill the intracorporeal space. Indeed, it enables us to understand how water spreads within the body, thanks to the microvacuolar volumes. Moreover, it gives an explanation to the resistance of the intracorporeal tension to gravity.
The structure and the function of the microvacuole allows it to work in a state of organized chaos. It can change, respond, help body fluids travel, and fill important spaces in the body. But this new scientific approach requires us to discuss and debate some standards of current knowledge.
Lifting the Veil on Connective Tissue
In conclusion, the connective tissue that is found throughout the body, from the bones to the skin, tendons and nerves, plays an essential structural role, but is also responsible for mobility and flexibility. The concept of form, the distribution of water in the body and disease states, are also explained by this structural theory. It could actually be the constitutive component tissue, rather than the connective tissue, in which cells would develop specific activities. For once, it would be a real paradigm shift.
The anatomical model described by Vesalius and our elders must now be reconsidered in the light of current scientific thinking that integrates life sciences with modern physics and new mathematics. The classical linear model of Platonic harmony—based on a predetermined order—turns out to be inadequate, and it cannot help us to understand complexity because it favors order and stability.
The study of our microanatomy and fibrillar architectural network through the observation of living matter by intratissular endoscopy has encouraged me to leave my traditional academic world to study the science of complexity and of chaotic, non-linear systems.
The study of complex non-linear systems, such as ecosystems, allows us to address complex natural phenomena that are unstable and cannot be accounted for by classical mathematics and physics. There is still much to discover about human anatomy—but new technological advances and theories in the fields of physics and mathematics have allowed us to lift a corner of nature’s veil.
About the Author
Jean-Claude Guimberteau, MD, is co-founder and scientific director of the Institut Aquitain de la Main, and past president (2011-2012) of the French Society for Plastic and Reconstructive Surgery. He worked in microsurgery and transplantation. This article was submitted to MASSAGE Magazine on behalf of Upledger Institute International.