Dr. Jean-Claude Guimberteau is a hand surgeon and the author of the famous film Strolling Under the Skin. The film shows for the first time the most fascinating images of living fascia. Using a special endoscopic camera, Dr. Guimberteau showed that there is a unique architectural system in human and that the tissue continuity is global. He believes that sharing these discoveries will incite people to get into this scientific world exploring living matter organization. His work become well known by bodyworkers when his film Strolling Under the Skin was shown in The First Fascia Congress in Boston in 2007. He then realised a sequel Skin Excursion at the 2nd Fascia Congress in Amsterdam 2009, and his 3rd film Muscle Attitudes at the 7th Interdisciplinary World Congress on Low Back & Pelvic Pain in LA 2010. Subsequently he released Interior Architectures and Skins, Scars and Stiffness at the 3rd Fascia Congress in Vancouver 2012. Now, we have a privilege to interview him for Terra Rosa e-mag.
Dr. Guimberteau, your work has provided brilliant images of living connective tissues that we haven’t seen before, and inspired many of manual therapists who are closely working with the skin and manipulating connective tissues. What led you to the discovery and study of the architecture of the connective tissue. Can you give us a background?
I was seeking a technical procedure to reconstruct flexor tendons, when I came upon the sliding system that I termed the MVCAS (Multimicrovacuolar Collagenic Absorbing System). I first used a microscope to understand how it was working. This tissue, which neatly ensures the efficacy of gliding structures and their independence, is composed of a network of collagen fibrils whose distribution seems to be totally disorganized and apparently illogical at a first sight. This impressed me because my Cartesian mind could not come to terms with the idea of chaos and efficiency co-exists perfectly. This was the starting point for an intellectual voyage that took me far from the beaten track and off into the largely unknown world of fractals and chaos.
* Note: Fractal is a geometric pattern that is repeated at every scale. If you zoom in on a fractal pattern it will look similar or exactly like the original shape. This property is called self-similarity.
Chaos in mathematics is “the irregular, unpredictable behavior of deterministic, non-linear dynamical systems” which is used to describe objects that are apparently disordered, however there is an underlying order in apparently random pattern.
How do you start making film of live connective tissues? Why this is not done previously?
First we start taking pictures during surgical tendon reconstructive procedures. The photos were taken during a planned surgery, thus there is a time limit of 30 minutes so that the surgical team were not disturbed during their work. Surgeries were performed either with a garrot (a stick used for tightening a bandage, in order to compress the arteries of a limb), which allows rather dull observation in terms of colour, or without a garrot which gives more lively images but is disturbed by blood extravasation (leakage). Then after, we extend to skin flaps and abdominal surgeries.
I don’t know why this has not been done previously but some of my experiences can explain that. For many years, I have performed microsurgery transplants and I have used microscope very often. Moreover, surgery is performed without bleeding using a tourniquet, so the observation is easier, and finally I love to understand the processes that have been going on.
What are the challenges in making these pictures using endoscopic camera?
The main challenge is to understand how tendon and skin are sliding, but also all these fascinating images have to be shared. They look so beautiful with their aesthetics, colours, varied and sparse shapes. Sharing them seems to be a good way to arouse the interest of people today.
What is the scale (magnification) we are looking at?
Generally magnification is 25 times.
In ‘Strolling Under the Skin’, you described the Sliding system and architecture of the connective tissue that looks chaotic in organisation composed of microvacuoles that are able to adapt itself to various stress. Can you briefly describe about this microvacuole form?
All the tissues observed were developed within the framework of multifibrillar architectures and resulting from the intertwining of fibrils : there are the microvacuoles which in fact are intra fibrillar micro volume, and which are the basic elements combining a polyhedral fibrillar frame enclosing multiple micro vacuolar spaces of varying sizes between 10 μm and 100 μm, with a gel inside.
* Note: 1 μm or micro meter is a millionth of a meter.
These microfibrils have a diameter of about ten to twenty microns and are made up predominantly of collagen type I and III. By intertwining, in an irregular fractal manner, they determine the volume of the microvacuole, which is filled with a glycosaminoglycan gel. By accumulation and superposition, these multi microvacuolar polyhedral patterns will build an elaborate form.
In ‘Muscle Attitudes’, you proposed that there is a global tissue continuity around or inside the muscle. Can you tell us the implication of this.
The essential implications of these microsopic and endoscopic observations are the fibrillar continuity. There is no break in the tissue continuity, be it within muscle, tendons, or around the arterial and venous structures and the structures surrounding the adipocytes. All these structures are formed in the same manner and are continuous. We have discovered the same continuity of tissue within the sub-cutaneous tissue in Strolling Under the Skin, the epidermis and dermis and the muscles. The concept of the organisation of living matter into stratified layers, hierarchical layers of sheaths, lamellae and strata cannot satisfy an anatomist who studies precise, endoscopic, functional anatomy. Even though they may be of different colours, textures and shapes, they are all linked to each other. This is a global tissue concept.
Which part of your work would you suggest that could be the most important relevance for manual therapists?
I think that our last movie Muscle Attitudes is the most appropriate for manual therapists, however Skin Excursion gives more detail on the intracutaneous connections. The physical links between these contractile and connective fibrillar structures from the surface of the skin to the deep muscle can explain some of the effects of manual therapy in a rational physiological and noncontroversial manner.
How do you see new technology will bring to the understanding of connective tissues?
I am sure that in the future the intra-body exploration will be one of the new frontier in scientific medical discovery and new technology will be the key point for this development.
What are your current projects?
We continue to explore using HD (high definition) technology and we will soon make a new movie on tendons anatomy and physiology. But for now, we want to show these films and images to all people because we have to share the beauty of human living matter thanks to a book and new videos.