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is evidence that the underlying tissues are permanently hydrated. This phenomenon can be seen when you cut through any structure containing liquid, for example when you cut through the skin of an orange with a knife. Such structures quickly dry up when exposed to atmospheric pressure or to the heat emitted by the lights in the operating theater. The tissue structures, no longer hydrated, adhere slightly to surgical instruments and need to be moistened regularly during any surgical procedure. No Empty Spaces Unlike what we've seen in anatomy texts, all available space within the body is occupied by structures. There are no empty spaces. You can distinguish muscles, arteries, and veins, but moist, transparent veils of connective tissue surround them. This connective tissue fills the areas between the anatomical structures. You cannot distinguish areas of "virtual space" between anatomical structures, nor can you see surgical planes as described in traditional anatomy textbooks. Even though living matter contains distinct anatomical structures, which can be separated by WHAT THE PICTURES SHOW US It's All Connected The first observation of intratissular endoscopy is that everything seems to be linked and interconnected. It is important to emphasize that it is not the cell that provides the link but a profusion of fibers, fibrils, and microfibrils. One gradually realizes that the body is shaped by a fibrillar network at every level, from macroscopic to microscopic, and from superficial to deep (Images 3A–3D). This fibrillary network plays a major role in shaping the substance of the body. It is not the cells alone that determine the form of the body; rather, they themselves are shaped and molded by the extracellular system in which they are embedded. Tissue Hydration Another striking feature is the moistening of the tissues as soon as a surgical incision is made. Without a tourniquet, bleeding occurs immediately and hinders observation of the tissues. But even when a pneumatic tourniquet is applied so as to obtain a clear, bloodless field, fluid exudes from the wound and trickles along the sides of the incision. This procedure to surgically reconstruct the flexor tendons of the fingers. At the time, my intellectual curiosity stopped there. I was aware of the existence of connective tissue that somehow enabled sliding of the tendon within the tendon sheath. I had learned about paratenons, peritenons, and virtual spaces with visceral and membranous sheaths. The description of these structures in classic anatomy books provided a reassuring and logical theory of the movement of tendons within their sheaths, but I found this to be completely inaccurate and hopelessly inadequate when I started observing living tissue through an endoscope. I, therefore, began to pay close attention to the study of this connective tissue, which has long been neglected by surgeons and anatomists. I was surprised to discover that it is composed of a network of collagen fibers, which are arranged in a completely disorderly fashion with no apparent logic. I could have abandoned the task of trying to understand the complex organization of this tissue, but I was intrigued by the fact that it seemed to ensure the efficient, independent movement of adjacent structures with great precision and finesse. Could apparent chaos and efficiency coexist? I soon realized that this sliding system, which I named the Micro- Vacuolar Collagenic Absorbing System (MVCAS), is found everywhere in the body and could be considered to constitute the primary framework of the body. I had noticed this during my early dissections. At the time, however, I did not understand what I was seeing. My logical, pragmatic, Cartesian mind was unprepared for this discovery. Dissection of the anterior aspect of the forearm at the macroscopic level with no magnification ( Image 3A), at the mesoscopic level ( Image 3B, 2x), and at the microscopic level ( Image 3C, 10x; Image 3D, 40x). 3A 3C 3B 3D C h e c k o u t A B M P 's l a t e s t n e w s a n d b l o g p o s t s . Av a i l a b l e a t w w w. a b m p . c o m . 57