Like world explorers mapping uncharted territory, a group of scientists, researchers, therapists, and anatomy enthusiasts set out in January 2018 to bring us our first look at fascia in a way it’s never been seen. Their mission? To create the world’s first 3D human fascial net plastinated forms.
Led by fascia research scientist Robert Schleip, clinical anatomist John Sharkey, professor of anatomy Carla Stecco, and director of anatomy and plastination Vladimir Chereminskiy, the Fascial Net Plastination Project (FNPP) is taking place in collaboration with the Plastinarium in Guben, Germany, the world headquarters for the internationally acclaimed Body Worlds exhibition. Now, these pioneering methods that brought Body Worlds to the public will help bring fascial anatomy education to the masses as well.

The Problem with Fascia

Fascia is the human body’s primary force-transmission and proprioceptive system. As a tissue, fascia possesses an intricate architecture that is as visually captivating as it is complex. Strangely though, we have never seen it in its entirety, largely due to the surprising absence of fascia in the models, photographic images, and drawn illustrations commonly used to teach anatomy today.
It’s an understandable problem. Fascia covers up and hides from view much of its more famous “relatives”—nerves, muscles, organs, vessels, and bones—and has therefore been literally removed from the playing field for over 500 years of anatomical study.
“Anatomists feed on technicalities and on detail,” says FNPP’s John Sharkey. “The traditional method of teaching anatomy via dissection is uniform and systematic. The student of medical anatomy removes the skin and associated fascia in order to get a better look at the vessels, nerves, and organs that lie beneath. These structures are completely encased in fascia, making it virtually impossible to view them in the clean, antiseptic manner we see in modern anatomy texts.” The downside, Sharkey says, is that this approach places the emphasis on where. “Where is the superior mesenteric artery? Where is the celiac trunk? Where is Dandy’s vein? While this is essential for surgeons in training, it takes focus away from the associated fabric that unites and supports these structures, the very tissue that was removed—the fascia.”
While thousands of scientific studies have increased the global awareness of fascia’s importance, the general population, and even professional practitioners of movement and bodywork, are still unclear about exactly what it looks like, where it lives, and why it is important to them. As Jean-Claude Guimberteau writes in his book, Architecture of Human Living Fascia (Handspring, 2015), “Connective tissue is, in fact, the constitutive tissue. It does not only link the different parts together—it is the frame in which the parts are developed.”1
The problem describing the appearance of fascia is a vexing one because fascia varies greatly in texture and thickness; therefore, it can look like many different things. From the tough, durable fabric of the iliotibial band, to the delicate meningeal fascia of the nervous system, this mysterious and essential tissue needs to be holistically rendered in all three dimensions to be fully appreciated in its true form. The goal of the Fascial Net Plastination Project is to do just that.

What is the Fascial Net Plastination Project (FNPP)?

The FNPP is a collaboration of the Fascia Research Society, Somatics Academy, and the Gubener Plastinate (GmbH) in Guben, Germany, and is directed by Robert Schleip, PhD, John Sharkey, MSc, and Carla Stecco, MD. Follow their work at www.fasciaresearchsociety.org/plastination and www.facebook.com/fasciaplastination.

Notes from the Lab: Stepped Specimen

Our bodies are one continuous fabric. There are no layers that just fall off each other without some prodding, prying, or actual cutting. In that regard, you can say we only have one single layer. But when you take into account the densities, textures, and molecular and cellular components, you can differentiate several tissue layers in the body. One basic way to “divide the cake” is to break it down into these primary layers: skin, superficial fascia, deep fascia, muscle, organs, and bone.
By stepping this lower-leg dissection, we revealed organization from the skin down to the muscle tissue, making it easy to see and understand. Starting with the top layer on the far left, what you can see in this stepped image of the lower leg is the skin, a divided layer of superficial fascia, deep fascia below, and then the muscles, of which each have their own epimysium, perimysium, and endomysial fascia around and within them.

Mapping Uncharted Waters

A collaboration of the Fascia Research Society, Somatics Academy, and the Gubener Plastinate (GmbH), the FNPP is comprised of anatomists, bodyworkers, movement educators, acupuncturists, physical therapists, academics, professors, physicians, and dissection enthusiasts from around the world. Together, they hope to advance human fascia anatomy education through creation of the world’s first 3D human fascial net plastinated forms.
Plastination, invented in 1977 by scientist and anatomist Gunther von Hagens, MD, is the groundbreaking method of halting decomposition and preserving anatomical specimens for scientific study and medical education. A revolutionary method of cadaver tissue preservation, plastination permanently infuses the tissue with silicone rubber, enabling it to be viewed, touched, and studied with a level of detail and durability that was previously impossible. This method for displaying human anatomy for study and education grew to world fame and recognition through the Body Worlds international touring exhibitions.
Similar to the Body Worlds exhibits, the mission of the FNPP is to create permanently fixed human fascia specimens to help people understand the complex ubiquity of fascia, what it looks like, and where it is found. These specimens will be exhibited for the first time at the Fifth Fascia Research Congress in Berlin, Germany, in November 2018 (www.fasciacongress.org). This exhibition will mark the completion of the first phase of an ambitious, three-year plan to create the world’s first all-fascia, whole-body plastinates that will become a part of Body Worlds.
“To see this project finally coming to life, and with such an international team behind it, is almost unbelievable for me,” says Robert Schleip, PhD, director of FNPP. Adds FNPP’s Carla Stecco, MD, orthopedic surgeon and professor of human anatomy and movement sciences at the University of Padova, Italy: “This is a unique opportunity to get outside the laboratory and communicate the meaning of fascia in a direct way to all people—to show its continuity through the body, its resilience, and its perfect structure. This project will open the eyes of any who, until now, were not confident about the importance of fascia.”

Notes from the Lab: Squidging

As Beverly Johnson and I worked across from each other, slowly pulling the superficial fascia away from the deep fascia of the abdomen, we used only blunt dissection, meaning no tools were used to divide the layers other than our hands. The process clearly revealed several things:
1. Our layers are really not “layers.” What I saw, I would describe as a continuous fabric with different textures.
2. We are “stitched” through and through with threadlike nerves and vessels. Often, we had to stop to clip the threads that went through all the layers.
3. There is a dramatic change in texture and color between the two types of fascia here. The golden, billowy, bubbly texture of the superficial fascia stood in deep contrast to the glistening, silvery, intersecting lines of collagen in the deep fascia.
I love knowing that this natural wonder of beauty lives hidden in every single one of our bellies! I was truly in awe.
After dissection, we used two different methods to pretreat the abdominal superficial fascia to find out which one would plastinate better. The first was to simply create the prosection, leaving it to the temperature and chemical fat-removal process during plastination. The second was removing the fat before plastination. This was a laborious procedure involving pressing a special pin-covered tool into and through the entire layer, creating exit routes for the adipose that fills in the Bubble-Wrap-like spaces. That was followed by manual squeezing, squishing, and massaging the tissue until the adipose was removed. This was a sensitive and labor-intensive process, aptly nicknamed “squidging” by FNPP Scientific Advisory Board member Gil Hedley, PhD. However, for all that effort, the untreated plastination turned out much better than its fat-free counterpart. This image is of the plastinated un-squidged piece, which really reveals its beauty.

Terms

Dissect—To separate into pieces, to expose the parts of something for scientific examination.
Plastinarium—The only one of its kind worldwide, the Plastinarium combines the moving experience of a Body Worlds exhibition with an opportunity to witness firsthand some of the practical steps of plastination in the working laboratory where plastinates are created. It also houses the administrative headquarters and educational facility, and has been located in Guben, Germany, since 2006.
Plastinate—Cadavers or cadaver tissue that has gone through the process of plastination.
Plastination—The process of permanently infusing tissue with silicone rubber.
Prosection—An anatomical specimen that has been dissected for demonstration and teaching.

Lofty Goals

Beginning in late 2017, FNPP determined the most realistic steps required to achieve the group’s ultimate goal—creating whole-body plastinates to show the human fascial net in its entirety. The team decided to start with smaller prosections of superficial and deep fascia, put them through the process of plastination, and gauge the results. Taking smaller steps at this early stage would allow the necessary learning curve to prepare for larger projects down the road. The international call went out for contributors to join the team for the first phase of this ambitious endeavor, and a zealous team quickly formed for a five-day gathering in Germany.
The team first gathered in Germany’s Plastinarium Exhibition Hall in January 2018. Schleip told the group, “You are all like brave explorers in search of the North Pole who willingly set out on a journey with no guarantees of success or survival!” Indeed, the success of the FNPP’s first project was a big unknown, just as easily ending in failure as in success. Harder still, was that given the lengthy plastination process, it would be months before any results would be known to the team.
These uncertainties arose from the process itself. Once dissected, the fascia specimens spend almost six months soaking in several low- and high-temperature acetone baths, followed by a vacuum-sealed bath of liquid silicone rubber. It is in this latter bath that the acetone is extracted and gradually replaced with the liquid plastic. After they are fully infused, the specimens must be positioned into a final, recognizable shape. They are then subjected to a gas-curing process to harden them and produce the final silicone, rubber-infused plastinates.
Once the initial dissection work was complete and the first curing process began, the team headed home, returning to Guben in June to see the results. By then, the January specimens had finished their initial stages of plastination and were now ready for positioning.
Now that they were fully saturated with liquid silicone, the pieces of plastinated fascia were sticky and gooey, though they did seem to drain excess liquid and perhaps even started to stretch a bit closer to their original size and volume as the team worked with them. Team members had to invent molds to position the plastinated specimens into their final shape. This took some creativity, as they used tubes, metal rods, plastic foils, cloth, pins, and even a plastic bottle for recreating an elbow. The irony of this was not lost on the team. The process they had gone through in January was being reversed and they were now adding elements (instead of taking tissue away), to give the fascia the necessary support for the gas-curing phase.

Notes from the Lab: Cross-Section of the Leg

The deep fascia can be divided into two types: the aponeurotic fascia and the epimysial fascia. The aponeurotic fascia envelops various muscles and connects them, forming the compartments of the limbs. The epimysial fascia is specific for each muscle and defines its form and volume. The prosection pictured here is from the anatomical leg. You can see two bones present: the tibia and the smaller fibula. What is remarkable in this image is that even though all of the skin, superficial fascia, and muscle tissue were painstakingly removed, what still remains is quite a lot! Fascia can be thin—even gauzy in some areas—but it is easy to see here that it comprises a great deal of the stuff of which we are made.

Steps Forward

What happens next? The plastinated fascial specimens are undergoing the final gas-curing process in order to harden them. Then they will be placed in a well-ventilated space and aired for at least a week to be safe for handling. After that, they will be prepped for their big debut at the Fascia Research Congress.
Then begins the most ambitious part of the project as the Plastinarium crew embarks on a three-year project to create the world’s first 3D, full-body human fascial net plastinates. Three different plastinates are planned.
1. The Superficial Fascia—the Wedding Dress
The aim of this plastinate is to demonstrate the entire superficial fascia (or subcutaneous connective tissue) all in one piece. This is the “layer” (remember the fascia is one continuous tissue) that gives us our shape and curves. The superficial fascia is often largely ignored in terms of its importance, only acknowledged in weight-loss ads and rarely, if ever, discussed for its remarkable functions of structure, cushion, insulation, energy storage, and endocrine and immune support. This project will open a doorway to these important conversations.
2. The Deep Fascia—the Diving Suit
This project will include the fascia profunda layer that lies underneath the superficial fascia (or subcutaneous connective tissues) and envelops most of the body as a dense, fibrous connective tissue coating. While in some areas—such as the plantar fascia or the iliotibial band—it expresses considerable sturdiness, it is less densely developed in others.
3. The Deeper Structures Supporting the Skeleton—the Core Body
The project for these deepest structures may include the dura mater and meninges that support the brain and spinal cord, and the fascia of the mediastinum, pericardium, diaphragm, and pelvic floor. It also may include a representation of the muscular compartments (e.g., in the lower leg) that are created by fascial septae between major muscle groups.
The outcome of these ambitious plans will likely be partly guided by the discovery of what is possible as the project evolves. Says Schleip: “This is a dream coming true: exposing the interconnectedness and beauty of the human fascial net in the context of a Body Worlds exhibition so that thousands of visitors can learn of this wonderful, silky web underneath their own skin. The spirit of everyone involved in this project is phenomenal. What an exciting adventure to be a part of!”

Notes from the Lab: Respiratory Diaphragm and Pericardium

The truth about the respiratory diaphragm and the heart is that they do not exist within our bodies in isolation, which is what you can assume by looking at anatomical pictures. In reality, they are intimately connected and embryologically stitched together through their fascia. The fascial covering of the heart, the pericardium, is continuous with the fascia of the diaphragm. Fascial relationships are often omitted in drawings and dissections, which are highlighting the muscles and the organs instead of the connective tissue relationships.
 This is the only visceral fascial dissection we attempted thus far in the Fascial Net Plastination Project. First, we separated the respiratory diaphragm from the vertebral column, rib cage, and abdominal fascia surrounding it; from ligaments of the liver, stomach, spleen, and strong vascular network on the bottom; and from the respiratory apparatus on the sides and top of the heart, preserving only the aortic arch and superior vena cava. Next, we removed the heart from its pericardial fascial sack, which was quite an interesting process of “ungloving the heart.” We made several incisions in the central tendon of the respiratory diaphragm (where pericardium and diaphragm are one and the same structure) in order for the heart to be able to exit its sleeve.
By leaving the primary fascial connections intact, we were able to uncover the glistening pericardium encasing the heart and expose its remarkable continuity to the fascia of the respiratory diaphragm muscle. In the image on the left, the heart is still present in the pericardium, allowing you to see the natural shape, while the image on the right is just the protective and supportive pericardium on its own, illuminated from beneath. This image immediately brought to our minds a beautiful quote from Gil Hedley, PhD: “Your heart is made to be light.”
Says FNPP’s Tjasa Cerovsek Landes, “Open the heart and chest opening are common phrases in postural and movement classes. The prosection I worked on of the heart, pericardium, and respiratory diaphragm helped me understand that this language—along with its inherent conceptualizations—creates problems for effective, therapeutic interventions. The heart is saddled in its visceral fascia, which is harnessed to the sternum, anteriorly; to the vertebral column, posteriorly; to the lungs and vessels, laterally; to the thoracic outlet (first rib ring), superiorly; and inseparably, fascially married to the diaphragm, inferiorly … and believe it or not, that’s even omitting some connections! I hope as people see this prosection and the finished plastinated expression, that it will inspire them to continue to ponder and subsequently integrate new ways of communicating progressive releases of the thoracic basket.”

Note

1. Jean-Claude Guimberteau, Architecture of Human Living Fascia (Handspring, 2015): 172.