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I am here with the amazing Dr. Jean Claude Guimberteau. He is a plastic and reconstructive surgeon who specialises in microsurgery and hand surgery. He has been working in the industry for over 50 years now. So he really knows what he’s talking about.
He was trained in hand and plastic department of Bordeaux University. During his surgical training, he was one of the pioneers in microsurgery and transplantations. He introduced innovative concepts in hand anatomy, physiology, and secondary flexor tendon repair.
He’s a pioneer to – I can never say this word well – endoscopic exploration of the tissular organisation of the human body. Director and producer of many videos on living matter. He has developed a new concept of living tissue and proposed a new ontology for human interior architecture.
I am so excited to be here in this conversation today because after watching several presentations by Dr. Guimberteau, the images that he’s managed to capture offer a tangible look inside the body and a doorway into what your fascia looks like whilst you’re still living, and it becomes very, very obvious why hydration and movement, just as simple things, are so important when it comes to your fascia when you see these images.
And the visuals when I first saw them felt almost miraculous, to be able to look at such a tiny detailed level of what is happening in the human body.
So usually when we talk about fascia or look at it, the images that we’re looking at are from cadavers, and the unique thing with your images is that the fascia and the subjects are still alive. So how do you go about getting these images?
Well, at the beginning, frankly speaking, I was not at all interested in fascia. Not at all.
I am a surgeon and I had at that time a technical problem. It was to repair tendon. Okay. To repair tendon it’s very difficult and at that time we had one technical procedure and it was in two times.
So when you had a patient, it was at least six or nine months out of work and it’s a lot. And the result was not so good.
So I decide one day to change my way of doing and to try to do it in one operating time. And so I decide to use vascularised tendon and of course to understand how is working the gliding system.
Mhm.
And then for the first time I use a microscope at the beginning and then years later I use an endoscope.
Okay.
And I discovered, frankly speaking, discovered a new world for me. A new world explaining how is working the gliding system. It’s based on fibrils. Fibres and fibrils only. Nothing else.
And these fibres and these fibrils have a behaviour, a mechanical behaviour able to give the suppleness, flexibility with, how can I say, a come back to the resting position without any rupture.
And for me it has been really a discovery because at the university you are never informed of this way of doing.
At the university, we are taught that the sliding system is either thanks to the connective tissue but without explaining physiology, or is it thanks to virtual space? Virtual space which is in fact difficult to describe. What is a virtual space?
So little by little I realise a new way of thinking, not only the mobility but also the continuity of things because when a tendon or a muscle is in flexion or extension it’s not alone. It’s around a lot of other tendon, arteries, nerves and so on.
And when you move a tendon, you don’t move the nerve. You don’t move the artery. When you move a muscle, you move only one muscle, not the others.
So thanks to this fibrillar network and this concept I was able to explain how one tendon can move completely without any influence on the other tendon which are very close but are completely independent on the functional point of view.
And little by little, I decide to explore tendon at the beginning, then muscle, then nerve, then artery, vein, then skin.
And I observe that all these elements are totally linked. Totally linked.
And at the university, we are taught about a body made of separate organs. You have, for example, you have the bladder, you have the bone, you have the stomach, you have the kidneys. Okay, that’s of course it’s right.
But how all these elements are linked together? How are they able to move during a constraint? It’s never explained, never.
And so little by little I create a sort of concept in my mind that in fact we are globally, globally framed by a fibrillar network.
Yes, we are. And I love how you’ve captured it. I mean that’s what I find absolutely fascinating. And I love that your understanding of it has come from – you’ve come from such a different angle with it because of course you have the medical background and training but you’ve seen it. You’ve seen it in practice. You’ve seen how it’s put together and that is what I think is particularly interesting with how you’ve put your work together. It’s absolutely fascinating.
It’s a privilege. I have to add something. It’s a privilege of a surgeon.
Mhm.
Because we see the things.
Mhm.
And it’s difficult when you are not in front of living matter to imagine this way of thinking.
Mhm.
Because you are formatted by the university teaching and it’s difficult to change your mind if you are not confronted to the reality of things.
I suppose it’s a little bit like – this is a very basic analogy – but it’s a little bit like looking at a cadaver and trying to imagine what its voice sounded like. It’s something that you can only imagine rather than something that you would ever fully experience. Whereas as a surgeon you get that opportunity to be in the living tissue with people.
Yes, you are right and sometimes I use another analogy. It’s when you are in front of a furniture it’s difficult to imagine that this wood had leaves.
Yes. Was a tree once.
Yes. So it’s almost the same.
Yeah. Yeah. It’s another way of thinking living matter. Yeah. It’s such a fascinating subject, fascia. I’ve been obsessed for 30 years and I think I will always be obsessed because it is such a curious substance in the body and it’s why I got so excited and I feel privileged to be here in this conversation with you to talk to you about this.
And if I can add something, and I feel responsible also, is that we have been taught about human anatomy. I have taught human anatomy from cadaver information.
So can you imagine that we are talking about living thanks to dead information?
And this is accepted. This is surprising. Nobody has say, hey stop, we are talking about living and you are talking about dead. We can’t say the same thing.
Until now nobody has say that and I am surprised to be the first one to say that. Really I am surprised because it’s an evidence for a surgeon.
Yeah, absolutely. So when we see some of the images, when you look inside somebody, a lot of it obviously is separate. You can see the tendons, the nerves and the muscles.
But what happens? Are there areas, let’s say, in living humans that show adhesions from scar tissue that you’ve documented as well? Because a lot of the things that I speak about with my audience is about speaking about things that get stuck as well with the fascia.
Well, first, if you are talking about the fascia, you have to define what is fascia.
Sometimes you can have different proposition but I think that we can have a consensus.
Fascia is a fibrillar network, ubiquitous. That’s mean globally in your body you are made of fascia, you are made of fibrillar network.
This fibrillar network is made of collagen fibre or elastin fibres and this fibrillar network is mobile and fractalised.
That’s mean that a big fibre can be divide in a smaller one and the smaller one can be divide in a smaller one again and so on and so on and so on.
And then with this iterative division you are at the level of the cell and all the cells are embedded in this fibrillar network.
So the cohesion, in fact it’s not a cohesion, it’s a total fusion between cells and fibrillar network and all this structure, this mobile structure, is able to move, to adapt for any kind of constraint because the cells are embedded in this fibrillar network able to move without rupture.
This is important.
Seeing that is like mind-blowing to me. I remember the first time I saw you present some of this.
Exactly.
And I just literally sat there with my mouth open seeing it in action. It’s very, very special.
You have to know that for me it has been also surprising because I was not prepared for that.
Yeah.
Because my teaching at the university was very academic and during years and years and years I have respect this kind of teaching. It’s around 40, 45 years old.
But I understood that in fact what I have been taught at the university was not wrong.
No.
Very often it was not wrong. It’s just one aspect.
Yes.
It’s not completely right. We have to work on this aspect of things.
Absolutely. Can I ask out of interest, just because obviously you are filming living tissue, but I’m saying tissue but they’re humans. So what’s the process of like, how do you speak with your subjects that they know that that’s going to happen? Is it like an agreement?
Each time you have to inform the patient. Each time you have to need an agreement and that’s all.
But we don’t need more because I think in Europe it’s the same. When you are not able to recognise the patient, the images are not belonging to the patient. So you are free to use them. The only condition is don’t recognise the patient.
Okay.
That’s all. And so if you are looking at the fibrillar network, you can’t recognise.
Yes. And it’s so fascinating. You’re not interested in knowing anything other than what you’re looking at because it’s so interesting.
Yes. But what we are talking now, I think in one century or more, it will be wrong.
Yeah.
Probably because I think the technology will be able to say, hey, this fibre is belonging to this kind of genetic identification and so on and so on.
I think it’ll be more detailed.
Yeah. Interesting.
Each of us has a particular fibrillar framework because the fibrillar framework is responsible of your form, your body. And we are different. Everybody is unique.
It’s so unique.
Yes. It’s why everybody has its own fibrillar network.
Yeah. I love that you’re saying this. It’s one of the things I speak a lot about with my audience. There are basic principles but really you need to learn your own body because your body is so unique to you and its needs will also be unique.
Absolutely. Outside and inside.
Absolutely.
And so your background is in plastic surgery with a focus on hands. Can I ask what drew you specifically to plastic surgery and then why did you choose to specialise in hands?
Well, first when I was at the university, I’ve been taught for general surgery, general.
And then I had a senior surgeon who was practising plastic surgery, reconstructive surgery.
Well, it’s a long time ago. It’s around 50 years ago and at that time it was just the beginning of microsurgery. Transplantation of organs, re-implantation of limbs, of hands.
Wow.
And it was a new world for reconstructive surgery and I choose this specialty.
So I did a lot of microtransfers and so on, but for me the most interesting was hand surgery because hand surgery is difficult because in a small volume, a finger for example, you have bone, you have two tendon, you have two arteries, you have two nerves in a small volume and it’s difficult to repair.
Mhm.
It’s really a challenge.
And so I decide to do more for hand surgery and to learn more.
And then I create a trauma centre in Bordeaux which is now a very big unit.
And so we developed this kind of specialty in Bordeaux area and all the southwest of France.
And so I was split between plastic surgery and hand surgery.
And even of that I was doing a little bit of aesthetic surgery, plastic reconstructive and aesthetic surgery, like abdominoplasty, like mammoplasty for example and so on.
And at what stage did you begin to become so fascinated with fascia? Like at which point did it become more of an obsession for you?
Well, it’s not really a passion because I am a very rationalist and materialist surgeon.
But at the beginning I never use the word of fascia because fascia for a surgeon is a muscle or a tendon. It’s very evident, obvious, that you have a fascia lata, you have fascia from plantaris and so it’s very well and clearly defined.
And so for me at the beginning around the tendon it was a fibrillar network which was called connective tissue.
At the university we are never taught about fascia except for anatomical identification but never concerning a fibrillar network.
We are taught about connective tissue and all the doctors in the world know connective tissue.
And when I made my first movie, Strolling Under The Skin, I never use the word of fascia.
And for the first Fascia Research Congress in 2007, I was invited to present this movie and I discovered that what I was describing was called by osteopath, was called fascia.
Mhm.
And little by little the way of thinking of osteopath, that’s mean a global aspect, the global aspect of the body, was not so far from my way of thinking.
Mhm.
And so I remember at that time, and he died now, but Tom Findley was the first to organise the Fascia Research Congress and I remember to talk with him and in fact he was a doctor and we were very close in the way of thinking.
And so, well, I decide to use the word of fascia.
Yeah.
But it needs a precise anatomical definition.
Sure.
There is no magic in fascia. It’s an anatomical, how can I say, it’s an element of anatomy.
Yes.
There is no magic.
Absolutely. Can I ask at which point, you say you’ve been looking at this obviously for many decades now, but at which point did the photography actually come into play? Like when did you start making images of what you were observing in people?
Well, in fact I began with photography.
Okay.
And then I use a microscope, but it was not very easy to use.
And then I use a microscope with a camera and then an endoscope with a camera and then a high definition camera with a high technology for an endoscope.
And little by little, depending of the level of technology, the images got better and better and better.
Understood. Understood. Very, very fascinating.
Obviously you’ve been working at looking at this tissue at a close level for a long time. Is there anything that is being uncovered or that you’re seeing at the moment that you’re particularly interested in or excited about around it?
Oh yes. Yes.
After years I have understood the mobility of the fibres. I have understood how the cells are inside this fibrous network.
The problem is how information is spread in this kind of tissue.
And in all the body this is a problem of information because all these elements are under tension. All these elements are able to, how can I say, to move. All these elements are able to retract to the resting position.
And the problem is that they are retracting to the resting position at the best level with a complete tissue memory.
How is working this tissue memory? From where is coming the information to get back always at the good place, same place?
Yes.
This is for me, it’s really a question. It’s a very good question and we can have beginning of answer by the study of nonlinear chaotic and complex system which have been studied by physicist.
And these studies are not concerning for living matter, human living matter, but for the movement of waves, the movement of clouds, the movement of leaves on a tree, the movement of the stream of the river.
That mean all these ecosystem around us which are not respecting the Euclidean mathematics and physics.
Because all of them are nonlinear and inside our body it’s the same. It’s the same.
Mhm.
So it’s a large field of investigation for the next generation and certainly with an incidence on therapy.
On therapy.
Interesting. I love this thought process. I think it’s a very powerful image that you’ve just painted in terms of where we need to explore and what areas we need to pay attention to. Thank you for sharing that.
Talking from a very practical perspective, so going to a very different area with this, if somebody is considering surgery, in your opinion what are the key considerations for their recovery with their tissues?
I attended the Fascia Research Congress last year in New Orleans and I know that one of the things that they spoke about in a couple of the talks there was stitching different layers together individually.
No layers. No layer.
No layers?
No layers.
Okay. So this is what would be interesting. So what would be your suggestion?
No layers. No layers. Please no layers.
Fifty years ago after surgery you had to stay in the bed for 15 days.
Yeah.
Now you can walk the day after.
Yep.
This is a great improvement.
So we have to move living tissue because all these mechanical behaviour of the fibrillar network, if you immobilise it, after it’s difficult to recover the mobility.
Mhm.
And so you have to train the mobility all the time.
Of course after, for example, a hip replacement you have not to run the day after but you can walk slowly, of course, but you can walk.
So you are training all your tissue, all your fibres, all your muscles and so on.
So I think it’s a great improvement in the way of making surgery.
For example, for tendon, 50 years ago we use splint.
Mhm.
I mobilise the finger. Never, never move the fingers the day after.
Yeah. I love that you’ve said that and I agree with that. That’s definitely been my experience as someone who’s worked with thousands of people, well, tens of thousands of people over the last 30 years.
It’s definitely movement, but slowly, just to help the tissues remember what they need to be doing and to revert back to what you said, which is, you know, returning to their original place in a comfortable way.
And I remember I saw Keith Baar speak at the International Fascia Congress and he was talking about the necessity of movement almost immediately after an injury or a surgery to maintain that mobility with the tissue.
You’ve obviously just answered this question because I was going to ask if you notice that that would track with your experiences and it sounds like yes.
But have you ever been surprised at what you’ve seen in somebody’s fascia? Perhaps if they’ve already had a surgery in an area that you’ve then gone back into.
Sorry, I don’t understand your question.
Sorry, that was a lot in one piece. I’ll start that bit again.
So if somebody has already had a surgery and they have another issue and a second surgery is needed in that area, is there ever a time where you’ve gone in and looked and been surprised at what you’ve seen with the fascia there or anything that stood out that’s different from when it’s an area that’s never been opened?
Well, when you are making an operation, you are making an incision.
Yeah.
This incision is destroying the harmonious balance of all this fibrillar network and it will never recover as it was before.
But you can train, you can manage all the tissue around the scar and little by little you can have a good result, a functional good result, and sometimes you can have, not a total recovery, but you can forget your scar.
Okay, you can’t forget because the functional aspect is totally recovered and if, for example, we have to make another time an incision at the same level, we will see that a scarring tissue is, how can I say, is not at all a renaissance, a complete recover of all the fibrillar network.
No, not at all.
It was scarring, it’s tough tissue without any mobility, with any splitting or lengthening of the fibre.
No, it’s disappear forever. But around you can have good result.
Interesting. That is fascinating.
And have you noticed a difference in the quality of the tissues between somebody who is younger versus somebody who’s perhaps in their 40s, 50s, 60s?
Yes. Of course. Of course. Yes. Yes. Yes.
But it’s like in life, it’s better to be young than to be old. It’s the same everywhere.
And yes, young people, they heal very quickly.
Old people may need time because sometimes they have some artery problems, diabetes, different disease and so on. So it’s more challenging.
And do you see a difference in the connective tissue with the fibrous layers as they lift, as you’re opening, in somebody who’s younger versus older?
Yes.
In younger you have the beauty of the harmony of this tissue moving, splitting, lengthening and so on.
And when you are observing older tissue, you have less fibres, fibres are thicker, micro volumes are bigger and fibres, the colour is more opaque.
So you have a total changing in the collagen metabolism.
Wow. Amazing.
Yeah, this has been absolutely fascinating. Thank you so much for your time. Is there anything that you particularly feel like you’d like to share about this area or anything that you’d like my viewers to be aware of with your work?
Well, I have a website. So you can give to your participant the link and on this website you have 1,500 video footage.
And there is also, I record 12 conference on tissue living matter organisation on a platform called Endovivo.
Endovivo.
And I would definitely recommend that everybody take a look at these images and check out your lectures as well because they are riveting and fascinating and just some of the most beautiful things I think I’ve ever seen actually.
So I just want to thank you so much for the work that you do and hope that we can have another conversation.
Yeah. Can I add something please?
Yes.
I am just finishing to write a new book which will be published in October, next October.
Amazing.
And the title is The Fibrillar Human or Homo-Fasciaticus.
Ah wow. Okay. Well, we’ll definitely have to have another conversation about that then.
Why not?
Yeah, absolutely. Amazing. Thank you so much for your time.
Pleasure.
Bye.
Bye. Bye. Bye.
ADDITIONAL FOOTAGE
Okay. So here it’s a normal fibrillar network between two muscles.
We are at the back of the patient and you have on one side, on the left side, the latissimus dorsi muscle and on the right side you have the serratus major muscle.
And you can observe this fibrillar network between these two muscles when you are breathing and you can observe this organisation which seem without any order, normal order as human consider, but this organisation give you the most efficient suppleness between these two muscles.
And this introduce a conclusion which is: disperse pattern organisation can give efficient efficiency.
And so for human, for me, and I think I am not the only one to consider, that a non-order organisation is able to give the most efficient result is confusing a little bit and it’s one of my most important surprise.
One of them is to observe that inside of our body things are not order. Things are in apparent disperse pattern.
And the conclusion is, one of them again, human body is not the product of human activity. Human body is a product of nature.
So the rules of nature are not the same as the rules of human activity and human thinking.
This is one of the most important step if you want to understand what happen inside the body.
The rules are not the same.
Amazing. It’s beautiful to see the tissues so clearly depicted here and photographed. Well, videoed. I’m so blown away by these images, as I’m sure our audience will be.
Yeah. And the second footage, if you pop that up.
Yeah. The second one is – you have here almost the same thing. Can you stop?
I can.
Yeah.
Okay. You have a fibrillar network, disperse pattern.
All these fibres here are able to move. Some are going to move, some not. Why? I don’t know.
But for the next time they will move and the former one are supposed to stay stable.
So it’s changing all the time, depend of the constraint and the functional result.
That mean that – can you start it again? – that mean that when you are giving a gesture, a movement, at one moment, at the next moment it will be different.
Well, we have to wait. Well, because all these footage are really primitive footage.
So there is a muscle here. There is the sliding system, the fibrillar network.
This is called also connective tissue.
And this connective tissue is able to move. These fibres are able to move. They can divide. They can lengthen.
Look.
You see the fibres move in order to obtain a functional result.
But if you want to repeat the same movement, the movement of the fibres will be slightly different and unpredictable.
You can’t predict how the fibres are going to move.
But at the end the functional result will be obtained.
And this is really very surprising to see and to think that in our body things are unpredictable.
Things are decide on the moment. It’s not planned. It’s decide just at the moment.
And there is a very famous phrase: future is not given. Future is in the moment.
It’s a great phrase.
So when you are observing living matter in a living body, you are entering in a world in which the rules that you are taught at the university are not completely adapted.
It’s different.
And very often I say the problem is a big paradox.
Everything, all the things we know concerning living is coming from cadaver observation.
And I think that we have to change this way of working.
I agree. I mean, I think this is one of the reasons it’s so powerful to see these images because I think seeing them versus what you normally see in a cadaver is such a different visual.
You can’t see that in a cadaver.
No, you can’t.
You can’t. You can’t.
And it’s why on the website you can find thousand of footage I made during 15 years.
Wow.
Of cells, fibres, vessels, red cell and so on.
You have 1,500, I think, footage.
Wow. I mean, it’s an incredible website. I’m going to pop the link to the website at the end.
Yeah, if you want.
Yes. Yeah. Absolutely. Because I think it’s very powerful for people to be able to have access to this information.
I am going to just – I have to reload the website though because it has disappeared. Give me just one moment and then we will have a few images to take a look at.
Now these first two images are in healthy fascia. I’m correct in saying that, correct?
Yes. The first one was healthy fascia, healthy network, healthy connective tissue.
In fact everybody has to know that it’s the same thing: connective tissue, fascia, fibrillar network. It’s the same thing with different words.
Very often I say when you are talking about the ocean, you have Indian Ocean, you have Pacific Ocean, you have Atlantic Ocean.
Okay?
But it’s the same water everywhere.
That’s a really good way of describing it. I like that.
Just get these two loaded.
Okay, I have 06 next.
Yeah, the next is 06.
Let me just get that one up.
Okay, great. Here we are.
Yes, here we have seen just before a healthy fibrillar network.
Here you are going to observe a scarring fibrillar network.
That mean that all the movement we have seen between the fibres, all this harmonious system of lengthening, sliding, etc., has totally disappear.
And the result is of course the disappearing of movement and creation of adhesion between skin, tendon, muscle, and of course painful because all the nerve hand have been cut are not repaired.
And there is something to say, is that nature never rebuilt the same.
It’s always a scarring tissue.
Even if you think, oh, it’s almost like before. No, it’s a scarring tissue.
Nature is not able to repair identically.
And all these fibres you can see are not able to move.
So very often the surgeon is obliged to release all this tissue to make able the movement.
Here you have a hair follicle, scarring tissue.
There are none of the fibres that we have seen before.
Hair follicles completely in disperse pattern.
The skin here. The scar here with a sort of invagination here.
And all the surface of the skin has not the same polyhedric organisation.
So everything is destroyed.
Not only the surface of the skin but also epidermis, dermis, hypodermis, nerves, etc.
All the elements are destroyed and the scarring tissue is, how can I say, is a totally chaotic response.
Get the next one up for you.
And the next one, this one can show you fibres in a scarring tissue.
This is a scarring tissue between a tendon and a scar.
And you can observe adhesion here between the tendon and surrounding tissue.
And the tendon is not able to move.
So the surgeon has to make a tenolysis to make free the tendon.
And all these adhesions are not able to move.
This is Collagen III, beginning and they can’t move as it was before.
So this harmonious dancing of fibres, giving suppleness, giving elasticity, has totally disappeared.
It will be back gently for months, sometimes years, but it will be never as it was before.
And here you can see the fibres and how is it different compared to the fibres we have seen before in the previous footage.
So it’s a completely changing of disposition, of framing of the fibres, and sometimes thanks to surgery you can recover function.
So you have two different aspect.
First we have seen the healthy normal network able to move, and here we have seen the scarring and absolutely nonfunctional tissue fibrillar network.
Very different.
Yes.
Thank you so much.
And I just want to – I’m just going to pop up on the screen the website so that if people want to go to the website and want to get a membership and take a look at these images themselves, I would highly recommend it.
Because there is absolutely – I think you did – did you just say 1,500 images in there?
No. Yeah. 1,500.
Well, if I remember, you can find 300 photos, images.
Mhm.
And you have 1,500 footage.
Yeah.
And 300 animations trying to explain what we have seen.
There are so many different things you can go and take a look at and it is such a great website if you’re interested in really seeing the visuals on this. I can’t recommend it enough.
So we will pop that in the link as well.
Thank you so much for your time and for explaining those videos. It’s very greatly appreciated and we look forward to continuing conversations with you.
Bye-bye.
Bye-bye.
