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The e-mémoires of the Académie Nationale de Chirurgie

The multi microvacuolar collagenic dynamic absorbing system : a new concept

GUIMBERTEAU JC

Seance of wednesday 16 november 2005 (pas de sujet Principal)

Abstract

The mobility of our body structures is so intrinsic and natural to usthat we tend to take it for granted.The very fact of being able to pinch your skin and lift it, then let itgo and see it return to its initial shape and texture in just a few secondsmay seem banal enough until you begin to think of all theelements involved. The same is true when you bend your fingersand think of the movement of the flexor tendon across the palmwithout external translation.For decades, scientists thought that the skin was simply an elasticstructure with loose connective tissue and a more or less virtualspace. However, in biomechanical terms, this explanation is veryvague. These old concepts, developed more than 50 years ago, haveevolved thanks to the impact of research at the microscopic level,and the global, mesospheric concept has been abandoned.And yet, surgical dissection in vivo demonstrates that there are onlytissue connections, simply a histological continuum without anyclear separation between skin and hypodermis, the vessels, theaponeurosis and the muscles. In fact, visible everywhere are structureswhich ensure a gliding movement between the aponeurosis,the fat structures and the dermis.As they studied this system of gliding between the various organs,in particular at the level of the tendons, the authors noted the existenceof a type of system composed of cables and veil-like structuresthat they term the Multimicrovacuolar Collagen DynamicAbsorption System (MVCAS). This system looks totally chaotic inorganization and seems to function in a manner far removed fromtraditional mechanical structures.The functional unity of this sliding system is dependent upon apolyhedral three-dimensional crisscrossing in space of the microvacuoles,whose collagen envelope is type 1 or type 4 and whosecontent is made up of proteoglycoaminoglycans. The dynamic ofthis multimicrovacuolar system allows all of the subtle movementsthat occur within the body, thanks to its pre-stressed nature and themolecular fusion-scission-dilacerations that it is capable of. In thisway, the system is mobile, can move quickly and interdependently,and is able to adapt is plasticity.This notion of microvacuoles is a fascinating one because it providesan explanation for the system’s space-filling ability. The matteris composed of elements. However, although they seem to bearranged in a haphazard manner, this is not the case. In fact, theyoccupy space in an optimal manner. If we accept this notion ofmicrovacuoles, then it becomes possible to explain certain pathologies occurring with age, such as edema, obesity, aging and inflammation.This sliding system is to be found everywhere in the body andwould seem to be the basic network of tissue organization. For thisreason, it should be thought of in global terms.Since it constitutes the inseparable link and occurs in all livingstructures and at many levels, could it be that it the basic architecturaldesign of Life ?