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GLOBAL MECHANICAL RESULT A veritable firework display of fibrillar movement explains the global dynamic behavior of the fibrillar network. The fibrils intertwine, intersect, and overlap each other, but behave in a harmonious manner when traction is applied to the tissue. The fibrils align themselves in the direction of the force imposed on the tissue. The lengthening seems to be the primary response in dealing with the mechanical constraint and appears to play a leading role in facilitating movement. The combined division, sliding, and fractal organization of the fibrillary network ensures that the force is diffused throughout the network. The combination of lengthening, dividing, and sliding also permits mobility of the tissue in any direction and in three dimensions, and in particular during movement. These phenomena also explain how the applied force dissipates and loses its strength beyond a certain distance. The fact that these forces have no effect on the surrounding tissues demonstrates the energy-absorbing capacity of the fibrillar system. The combined action of these three distinct, yet closely related, types of fibrillary behavior enables the fibrillar network to adapt to the constraint in three dimensions, while at the same time dispersing and reducing the force of the constraint and also preserving the capacity of the structures to return to their resting positions. This astonishing fibrillary behavior involves the simultaneous movement of billions of fibrils. The dynamic potential of the combination of these three movements is incalculable. FROM CHAOS TO EFFICIENCY Through the course of my research, I experienced great difficulty in moving away from the tranquil certainty of rationality to enter a world of fractals and apparent often lengthen without revealing any hint of their internal architecture. Fibrils Migrate The migration of fibrils along other fibrils was another commonly seen phenomenon during my research. It is the existence of mobile junctions that enables one fibril to slide along another. In this way, energy is dispersed and absorbed throughout the fibrillar network. This ensures efficient distribution of the constraint as it is applied to the tissue. Fibrils Divide During stronger traction, the fibril is capable of dividing into two, three, or four smaller fibrils. This means the distribution of energy is spread across several fibrils simultaneously, and is thus absorbed more efficiently. Fibrils Are Linked and Fixed Sometimes interfibrillar crossings, or links, are stable and do not seem to be dynamically involved. This real and distinct stability explains the overall permanence of the form during movement, and suggests a structure with a predetermined architecture and behavior that are not entirely random. Other links are not visible but reveal that they must exist when new fibers appear mid-sequence. Fibrils Within Fibrils Observation at high levels of magnification reveals a network of interwoven fibrils that are themselves made up of smaller fibrils. These fibrils are wavelike in appearance when they are not under tension. This is further evidence of the fractal nature of the fibrillar architecture. chaos. I came to recognize that this seemingly chaotic fibrillar disorder, together with tissue continuity, ensures the efficiency of the living organism. The concept of order and proportionality suddenly seemed to lose ground to nonlinearity and apparent disorder, which in fact permit creative adaptability and the tendency for life to auto- organize in the most efficient way. After 20 years studying fascia, I say with certainty that the importance of the role of the extracellular matrix must be reconsidered. This will provide new, more coherent theories, particularly in the fields of embryology, morphogenesis, and phylogenetics. I believe that surgical exploration must be a cornerstone of this modern research, and an essential point of reference, because it is the only way to provide a clear and precise description of the anatomy of human living matter as it really is. Nature is certainly a symphony of fragility and complexity, but it is gradually becoming more comprehensible. Jean-Claude Guimberteau, MD, is co- founder and former scientific director of the Institut Aquitain de la Main, and past president of the French Society for Plastic and Reconstructive Surgery. He has developed the profession's knowledge of the structure and function of tendon physiology, and pioneered techniques for secondary flexor tendon repair. His innovative use of videoendoscopy to investigate fascia in vivo resulted in his text Architecture of Human Living Fascia (Handspring Publishing, 2015), from which this article is adapted. For more information about Guimberteau, visit his website at

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