title: A long-distance fluid transport pathway within fibrous connective tissues in patients with ankle edema.
abstract: OBJECTIVE
  Although the microcirculatory dysfunctions of edema formation are well documented, the draining pattern of dermal edema lacks information. This study was to assess the potential drainage pathways of the interstitial fluid in patients with ankle edema using the anatomical and histological methods.
  
  
  RESULTS
  Four amputees of lower leg participated in this study. Fluorescent imaging agent was injected into lateral ankle dermis in one volunteered patient before the amputation and three lower legs after the amputation. Physiologically in the volunteer or enhanced by cyclical compression on three amputated limbs, several fluorescent longitudinal pathways from ankle dermis to the broken end of the amputated legs were subsequently visualized and studied using histological methods, laser confocal microscopy and electron microscopy methods respectively. Interestingly, the fluorescent pathways confirmed to be fibrous connective tissues and the presence of two types: those of the cutaneous pathway (located in dermis or the interlobular septum among adipose tissues within the hypodermis) and those of the perivascular pathway (located in connective tissues surrounding the veins and the arteries). The intrinsic three-dimensional architecture of each fluorescent pathway was the longitudinally running and interconnected fibril bundles, upon which, an interfacial transport pathway within connective tissues was visualized by fluorescein.
  
  
  CONCLUSIONS
  The current anatomical data suggested that a unique long-distance transport pathway composed of oriented fibrous connective tissues might play a pathophysiological role in draining dermal edema besides vascular circulations and provide novel understandings of general fibrous connective tissues in life science.
authors.affiliation: Beijing Hospital, Beijing, China.
authors.forename: Hongyi
authors.initials: H
authors.lastname: Li
authors.affiliation: Beijing Hospital, Beijing, China.
authors.forename: Chongqing
authors.initials: C
authors.lastname: Yang
authors.affiliation: Beijing Hospital, Beijing, China.
authors.forename: Kuiyuan
authors.initials: K
authors.lastname: Lu
authors.affiliation: Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
authors.forename: Liyang
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Beijing Hospital, Beijing, China.
authors.forename: Jiefu
authors.initials: J
authors.lastname: Yang
authors.affiliation: Beijing Hospital, Beijing, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Wang
authors.affiliation: Beijing Hospital, Beijing, China.
authors.forename: Dongge
authors.initials: D
authors.lastname: Liu
authors.affiliation: Beijing Hospital, Beijing, China.
authors.forename: Di
authors.initials: D
authors.lastname: Cui
authors.affiliation: Beijing Hospital, Beijing, China.
authors.forename: Mingjun
authors.initials: M
authors.lastname: Sun
authors.affiliation: Beijing Hospital, Beijing, China.
authors.forename: Jianxin
authors.initials: J
authors.lastname: Pang
authors.affiliation: National Centre for Nanoscience and Technology, Beijing, China.
authors.forename: Luru
authors.initials: L
authors.lastname: Dai
authors.affiliation: National Centre for Nanoscience and Technology, Beijing, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Han
authors.affiliation: National Centre for Nanoscience and Technology, Beijing, China.
authors.forename: Fulong
authors.initials: F
authors.lastname: Liao
mesh_terms: D000842:Ankle / Q000473:pathology*; D003238:Connective Tissue / Q000503:physiopathology*; D004487:Edema / Q000503:physiopathology*; D045604:Extracellular Fluid / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged
keywords: Connective tissues; interstitial fluid; vascular circulations