New Perspectives on the Organization of Living Tissue and the Ongoing Connective Tissue/Fascia Nomenclature Debate, as Revealed by Intra-Tissue Endoscopy That Provides Real-Time Images During Surgical Procedures

Intra-tissue endoscopy, providing real-time images at all scales, from macroscopic to microscopic, from inside living tissue during surgical procedures, has revealed the existence of a body-wide fibrillar architecture that extends from the surface of the skin to the cell. Different types of cells are housed within this fibrillar architecture and gather together to carry out specific functions. This challenges the commonly accepted notion of the organization of living matter that associates separate organs with connective tissue packaging. We are thus confronted with the global nature of the living human body and its vital processes. This paper sets out to describe the architecture of this fibrillar network which could be assimilated with the fascial tissue and which attributes a more constitutive role to connective tissue. It also demonstrates how movements within this fibrillar network can occur with minimal local distortion while maintaining tissue continuity. The authors propose that the gliding of tissues can be explained by the existence of a highly adaptable fibrillar network that enables the gliding of distinct anatomical structures such as tendons and muscles, without any dynamic influence on the surrounding tissues. The authors propose a new model of tissue movement based on the observation of a ubiquitous dynamic polyhedric fibrillar network with an apparently dispersed and complex pattern of organization, that forms fluid-filled microvolumes, and is found everywhere in the human body. Furthermore, this fibrillar network appears to act as a force absorption system, in addition to providing a framework or scaffolding for cells throughout the body. Observation during intra-tissue endoscopy suggests that this fundamental architectural organization extends into the extracellular matrix that is the natural environment of all cells in the living body, regardless of their size, location or specific function.