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Anatomy
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Ernest F. Talarico, Jalid Sehouli, Giuseppe Del Priore, Werner Lichtenegger
The internal iliac artery divides into anterior and posterior divisions (Figure 4.8). The branches that arise from the posterior division are the iliolumbar, sacral arteries, and the superior gluteal artery. The first branch to arise from the anterior division may be the iliolumbar artery. This aside, the umbilical artery (obliterated hypogastric vessel) is the first major branch, and it runs along the lateral pelvic wall then ascends toward the umbilicus giving rise to superior vesicular arteries and terminating as the medial umbilical ligament. This ligament raises a fold of peritoneum (medial umbilical fold), and identification of the umbilical ligament is very helpful in the preparation of the parametrium during radical hysterectomy.
Neuroanatomy overview
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
The sciatic nerve is the largest nerve in the body and arises from L4, L5, and S1–S3. It passes out of the pelvis through the greater sciatic foramen below the pyriformis muscle resting on the posterior surface of the ischium. It lies deep to the gluteus maximus muscle but superficial to the gemelli (superior and inferior), obturator internus, and quadratus femoris. The superior gluteal artery passes above the pyriformis; the inferior gluteal artery passes below the pyriformis, medial to the sciatic nerve. The sciatic nerve lies halfway between the greater trochanter and the ischial tuberosity. In the posterior thigh, the nerve travels on top of the adductor magnus and deep to the long head of the biceps femoris. The nerve then reaches the popliteal fossa (see common peroneal nerve and popliteal fossa) as the tibial nerve.
Local advancement flaps
Published in P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams, Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
The superior and inferior gluteal arteries are branches of the internal iliac artery. As they leave the pelvis, they are separated by the piriformis muscle (Figure 7.3.6). The superior gluteal artery divides into deep, superior and inferior branches which supply the glutei and give arterial muscular perforators to the overlying skin. The inferior gluteal artery in a similar fashion supplies the glutei and the lower buttock skin becoming the infragluteal artery at the lower border of the gluteus maximus. This artery anastomises with branches of the medial femoral circumflex artery to form a subfascial plexus along the posterior thigh. This plexus is the basis of the posterior thigh fasciocutaneous flap which is described below.
Treatment approaches of stage III and IV pressure injury in people with spinal cord injury: A scoping review
Published in The Journal of Spinal Cord Medicine, 2023
Carina Fähndrich, Armin Gemperli, Michael Baumberger, Marco Bechtiger, Bianca Roth, Dirk J. Schaefer, Reto Wettstein, Anke Scheel-Sailer
The following surgical procedures were described to treat ischial PI: a bilateral muscle advancement flap,31 VY-hamstrings, myo- or fasciocutaneous and myocutaneous gluteus maximus inferior flap,15 gluteus maximus rotation, gracilis, VY hamstring advancement, inferior gluteal perforator, medial thigh fasciocutaneous flap,32 posterior thigh fasciocutaneous flaps,5,11,32 flaps based on the hamstrings9 or gluteal myocutaneous rotation flap.7 For the closure of sacral PIs a uni- or bilateral fasciocutaneous gluteus maximus rotation or VY-flap,15 gluteus maximus or superior gluteal artery perforator flap,32 gluteal rotation flap,5,11 gluteal myocutaneous advancement flap7 or a gluteus maximus myocutaneous flap9 were described. PIs over trochanter are closed with a tensor fascia latae flap,5,7,9,11,15,32 VY flap or an anterior lateral thigh flap32 (Appendix Table 6).
The evolution of breast reconstructions with free flaps: a historical overview
Published in Acta Chirurgica Belgica, 2023
Filip E. F. Thiessen, Nicolas Vermeersch, Thierry Tondu, Veronique Verhoeven, Lawek Bersenji, Yves Sinove, Guy Hubens, Gunther Steenackers, Wiebren A. A. Tjalma
In 1976, Fujino published the first case report of a free tissue transfer to reconstruct a breast after radical mastectomy. A skin-fat-muscle flap from the upper portion of the greater gluteal muscle was harvested including the superior gluteal artery and vein. A successful microvascular anastomosis was performed connecting the superior gluteal vessels to the thoracoacromial artery and lateral thoracic vein. The same authors reported the use of a gluteal free flap for the reconstruction of a congenital aplastic breast [10,11]. In 1978, Serafin et al. were the first to describe a series of free flaps to reconstruct the breast after radical mastectomy. Ten groin flaps and two contralateral LD-flaps were used in combination with an implant in twelve patients [12]. Holmström was the first to use the abdominal pannus as donor site to reconstruct the breast. This flap was called the free abdominoplasty flap, which was based on the inferior epigastric vessels and a superficial vein [13]. Basically Holmstöm was the first to describe and perform a free TRAM flap.
Hypovolemic shock caused by delayed-onset superior gluteal artery rupture, successfully treated with arteriographic embolization
Published in Acta Chirurgica Belgica, 2018
Rupture of the superior gluteal artery (SGA) is usually associated with pelvic bone fractures and acetabular fractures secondary to blunt trauma [1]. However, despite recent advances in technologies and tools, rupture of the SGA remains a challenging problem because it is difficult to manage and is frequently associated with significantly high mortality and morbidity [2]. Rupture of the SGA causes early hemodynamic changes, which may be effectively treated through embolization. Its early detection and embolization not only prevent further complications, such as compartment syndrome and hypovolemic shock, but also eliminate the need for any surgical interventions [3]. Even though the SGA rupture and consequent bleeding is a very rare disease entity and induces potentially catastrophic outcomes, but it takes a relatively long time to make an appropriate diagnosis because most clinicians have not sufficient experience on SGA injury. We present a case of blunt buttock trauma without pelvic bone or acetabular fracture which resulted in delayed massive bleeding from the SGA. Delayed SGA bleeding should be considered in late-onset shock associated with blunt buttock trauma. It is thought that if active SGA bleeding is suspected, urgent arteriography with embolization is the treatment of choice.