Histological Comparison of the Human Trunk Skin Creases

The Role of the Elastic Fiber Component

Andreas Mallouris, MD, PhD; Despoina Kakagia, MD, PhD; Andreas Yiacoumettis, MD, PhD; Thivi Vasilakaki, MD, PhD; Aggeliki Drougou, MD; Maria Lambropoulou, MD, PhD; Constantinos Simopoulos, MD, PhD; Alexandra K. Tsaroucha, MD, PhD

Disclosures

ePlasty. 2016;16 

In This Article

Results

Microscopic evaluation of skin specimens revealed normal dermis and appendages in all cases. In all sections of the inframammary crease specimens, no breast parenchyma was present. In the subcutaneous tissue, there was a well-defined network of dense collagen fibers that create a beehive pattern of the subcutaneous fat (Fig 3). This pattern is denser in the deeper sites in relation to the fascia of the underlying muscle (Figs 4, 5a, and 5b). The collagen fibers network has a broad base of attachment to the dermis. In the sections from the medial sites of the crease, the beehive pattern has the same structure as that described earlier but appears looser. However, it becomes denser in the deeper sites. In the sections of the lateral sites of the crease, the beehive pattern is equally well organized, with broad base attachments of the collagen bundles to the dermis (Fig 6). In some of the cases, the bundles are thinner than those at the other sites. The elastic fibers participate in the formation of the collagen pattern and radiate in a relatively parallel pattern in the reticular dermis and in a perpendicular fashion in the papillary dermis (Fig 7).

Figure 3.

Inframammary crease. Masson trichrome stain ×25. The subdermal fat and the fibrocollagen bundles, stained in blue, are arranged in a beehive pattern. The collagen bundles originate from the muscle fascia.

Figure 4.

Inframammary crease. Masson trichrome stain ×25. The collagen fibers originate from the muscle fascia and continue their course in the fibrocollagen bundles in a beehive pattern.

Figure 5.

Inframammary crease. (a) Reticulin stain ×25. (b) Reticulin stain ×200. The collagen type III fibers are stained in black and radiate from the underlying muscle fascia.

Figure 6.

Inframammary crease. Hematoxylin and eosin ×25. The fibrocollagen bundles of the subdermal tissue are attached to the dermis with a broad base.

Figure 7.

Inframammary crease. Orsein stain ×25. The elastic fibers have a parallel pattern in the reticular dermis and a perpendicular pattern in the papillary dermis.

In the subcutaneous tissue of the infragluteal crease, there is a well-defined network of dense collagen fibers that create a beehive pattern. The collagen bundles are thick and dense, well-organized, and characterized by the presence of a significant number of fibroblasts, particularly at the sites reflecting the center of the crease (Fig 8). In sections of the specimens from the medial and lateral sites of the crease, the collagen pattern is thinner, the presence of fibroblasts is not as significant as in the central sites of the crease, and the participation of the reticular fibers is less. The elastic fibers are thick in the collagen pattern, denser in sections that reflect from the center of the crease. They radiate into the dermis in a parallel pattern in the reticular dermis and in a perpendicular fashion in the papillary dermis.

Figure 8.

Infragluteal crease. Hematoxylin and eosin stain ×100. The subcutaneous fat and the dense and thick fibrocollagen bundles are arranged in a beehive pattern.

The findings from the anterior axillary fold specimens show a less organized pattern structure of fibrocollagenous bundles compared with the earlier described structure of the inframammary and infragluteal creases. The bundles are fragmented and not in a parallel pattern. There is absence of any organized structure of the elastic fibers in the dermis along the anterior axillary fold (Fig 9).

Figure 9.

Infragluteal crease. Hematoxylin and eosin stain ×25. The fibrocollagen bundles are less organized without broad attachments of the fibers to the dermis.

In the specimens of the inguinal crease, there is a beehive pattern of fibrocollagen network that is thinner than the structure of the inframammary and infragluteal creases. The bundles are organized in a looser pattern (Fig 10). The elastic fibers are long and run along the collagen bundles in a parallel course into the reticular dermis (Fig 11).

Figure 10.

Inguinal crease. Masson trichrome stain ×25. The fibrocollagen bundles are thinner and less dense than in the inframammary and infragluteal creases.

Figure 11.

Inguinal crease. Orsein stain ×25. The elastic fibers are long and linear at the fibroelastic bundles and have a parallel distribution to the dermis.

The skin specimens superior and inferior to the skin creases assert that collagen and elastic fibers have a rather random pattern compared with the well-organized network of the fibroelastic bundles in the skin of the creases sites. The elastic fibers are fewer and have a parallel pattern in the dermis (Fig 12a) in the skin inferior and superior to the infragluteal crease and are fewer in number and placed in a parallel pattern in the dermis (Fig 12b) in the skin superior and inferior to the inframammary crease.

Figure 12.

(a) Skin superior to the inframammary crease. Hematoxylin and eosin stain ×25. There is no beehive pattern of the collagen bundles with the subcutaneous fat tissue. (b). Skin inferior to the inframammary crease. Orsein stain ×100. The elastic fibers that are stained in black distribute in a random pattern.

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