An Interview

with
Dr. Jean
Jean--Claude
Guimberteau
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 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 in bodywork when his film 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. 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
Pictures taken from Strolling under the Skin, courtesy of Endovivo.

Terra Rosa e-magazine, No. 7 (March 2011)

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Interview with Dr. Guimberteau

Pictures taken from Muscle Attitudes, courtesy of Endovivo.

All the tissues observed were developed within the

framework of multifibrillar architectures and resulting
from the intertwining of fibrils : there are the miminutes so that the surgical team were not disturbed
during their work. Surgeries were performed either with crovacuoles which in fact are intra fibrillar micro vola garrot (a stick used for tightening a bandage, in order ume, and which are the basic elements combining a
to compress the arteries of a limb), which allows rather polyhedral fibrillar frame enclosing multiple micro
vacuolar spaces of varying sizes between 10 m and 100
dull observation in terms of colour, or without a garrot
which gives more lively images but is disturbed by blood m, with a gel inside.
extravasation (leakage). Then after, we extend to skin
* Note: 1 m or micro meter is a millionth of a meter.
flaps and abdominal surgeries.
I dont 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.

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
What is the scale (magnification) we are looking structures are formed in the same manner and are continuous.
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?

Terra Rosa e-magazine, No. 7 (March 2011)

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

25

Interview with Dr. Guimberteau

Pictures taken from Muscle Attitudes, courtesy of Endovivo.

linked to each other. This is a global tissue concept.

covery and new technology will be the key point for this
development.

Which part of your work would you suggest that

could be the most important relevance for man- What are your current projects?
ual therapists?
We continue to explore using HD (high definition)
I think that our last movie Muscle Attitudes is the most technology and we will soon make a new movie on tenappropriate for manual therapists, however Skin Excur- dons anatomy and physiology.
sion gives more detail on the intracutaneous connecBut for now, we want to show these films and images to
tions.
all people because we have to share the beauty of human
living matter thanks to a book and new videos.
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 dis-

Available from www.terrarosa.com.au

Terra Rosa e-magazine, No. 7 (March 2011)

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