Local advancement flaps
P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams in Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
Manchot in 1889 provided the first description of genital blood supply and appreciated that the cutaneous supply could be divided into anterior and posterior. The anterior supply consists of the superficial and deep external pudendal arteries which are branches of the femoral artery. These form a rich anastomosis with the anterior branch of the obturator artery. The posterior supply is mainly from the internal pudendal artery, a branch of the internal iliac artery. This gives rise to lateral and medial branches, the latter anastomosing with branches of the inferior gluteal artery, before the internal pudendal artery divides into its two terminal branches, the penile or clitoral branch and the perineal artery. The terminal branches of the perineal artery form the transverse perineal artery and the posterior labial (scrotal) arteries which anastomose with branches of the deep external pudendal, obturator, and medial circumflex femoral arteries (Figure 7.3.2).
Lower Limb
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno in Understanding Human Anatomy and Pathology, 2018
The skin of the gluteal region is innervated by the cluneal nerves: The inferior cluneal nerves are branches of the posterior femoral cutaneous nerve, while the superior cluneal nerves and middle cluneal nerves are branches of the dorsal rami (Plate 5.1b). Apart from these cutaneous nerves, there are two major nerves in the gluteal region that provide motor innervation to muscles: The superior gluteal nerve runs superior to the piriformis muscle and the inferior gluteal nerve runs inferior to this muscle (Plate 5.7). Also inferior to the piriformis runs—together with the sciatic nerve and the posterior femoral cutaneous nerve—the pudendal nerve. The pudendal nerve is peculiar because it emerges from the greater sciatic foramen, wraps around the sacrospinous ligament, and then turns medially again to pass through the lesser sciatic foramen to enter the perineum together with the internal pudendal artery. As an aside, the name “pudendal” derives from the Latin word “puta,” which refers to the “shameful” supply/drainage of the anal and genital tissues by these vessels and nerves. These classical human anatomists either had a major hang-up about their sexuality or a great sense of humor.
Fistula repair
J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan in An Atlas of Gynecologic Oncology, 2018
Martius graft—a vertical incision is made over the labium majus and a graft of labial fat and bulbocavernosus muscle fashioned by anterosuperior separation from the deep fascia (Colles fascia) over the urogenital diaphragm. Vascular supply is from the posterior labial branches of the internal pudendal artery. Good results are also seen when inferior separation is undertaken and the external pudendal vessels are preserved. The graft is passed subcutaneously to cover a vaginal repair; this is particularly appropriate to provide additional bulk in a colpocleisis, and in urethral and bladder neck fistulas may help to maintain competence of closure mechanisms by reducing scarring (see Figure 31.17).
Pelvic floor muscle training: mechanisms of action for the improvement of genitourinary syndrome of menopause
Published in Climacteric, 2020
J. Mercier, M. Morin, A. Tang, B. Reichetzer, M.-C. Lemieux, K. Samir, D. Zaki, F. Gougeon, C. Dumoulin
As hypothesized, blood flow in the internal pudendal artery and the dorsal clitoral artery improved at rest. This implies that more blood goes through the internal pudendal artery and its terminal branches at each cardiac cycle. Training other skeletal muscles has been previously shown to increase blood flow in both the main artery and their terminal branches in postmenopausal women. Nyberg et al. observed increased blood flow velocity at rest in the femoral artery of postmenopausal women after leg muscle training24. Gavin et al. found an increased capillary density in the trained muscle (the quadriceps) in the same population25. Blood flow of the internal pudendal artery and the dorsal clitoral artery also improved after the maximal PFM contraction task. This implies that those vessels enhanced their capacity of adaptation to meet the muscle’s needs after PFM activation. The internal pudendal artery provides blood to the PFM, the vagina, the vulva, the clitoris, and the perineum. Therefore, an increase in blood flow at rest and after PFM activation in this artery should provide more blood to these structures and impact them. This hypothesis is supported by the significant increase in vaginal secretions and improved color of the vaginal epithelium after a PFMT program5, as well as increased thickness of vaginal mucosa using the Vaginal Atrophy Index. These changes may be related to a reduction in GSM symptoms, such as vaginal dryness and vaginal pruritus.
Lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction: from physiology to clinical aspects
Published in The Aging Male, 2018
Aldo E. Calogero, Giovanni Burgio, Rosita A. Condorelli, Rossella Cannarella, Sandro La Vignera
The penile arterial supply displays slight variation in its anatomy. The penis is usually supplied by branches of the internal pudendal artery, which continue as the penile artery. The bulbar artery supplies the proximal shaft and is the first branch of the penile artery, which then divides into the dorsal and cavernosal arteries. The cavernosal artery enters and supplies the corpora cavernosa via several helicine arteries, which in turn flow into the sinusoids via multiple arterioles. The intercavernous septum is perforated, allowing for communication of blood (and injected pharmacological agents) across the midline. Emissary veins pierce the tunica albuginea to drain into the deep dorsal vein, via the spongiosal, circumflex and cavernosal veins [4] (Figure 1).
Pelvic floor muscle rehabilitation for genitourinary syndrome of menopause: why, how and when?
Published in Climacteric, 2023
J. Mercier, C. Dumoulin, G. Carrier-Noreau
Postmenopausal women experience atrophy of blood vessels located in the lamina propria of the vaginal epithelium, which leads to a reduction of blood flow [46]. In our study, vulvovaginal blood flow was assessed before and after PFMT using a color Doppler ultrasound of the main vessel irrigating both the vulvovaginal tissues and PFM, the internal pudendal artery and one of its terminal branches, the dorsal clitoral artery. After PFMT, an improvement in blood flow in both arteries was found at rest [45]. This implies that more blood goes through the internal pudendal artery and its terminal branches at each cardiac cycle. Training of other skeletal muscles, such as the quadriceps, has been previously shown to increase blood flow in both the main artery and their terminal branches in postmenopausal women [47] as well as increase capillary density in the trained muscle [48]. After the intervention, results also showed an improved blood flow adaptation after a PFM contraction task in both arteries. This implies that these blood vessels enhanced their adaptive capacity after PFMT to meet the muscle’s needs after their activation. The internal pudendal artery provides blood to the PFM, vagina, vulva, clitoris and perineum. Therefore, an increase in blood flow in this artery at rest and after PFM activation should provide more blood to these structures and impact their function. This hypothesis is supported by the significant increase in vaginal secretions, improved color of the vaginal epithelium and increased thickness of the vaginal mucosa found after the PFMT program in our study [22]. These changes may reduce GSM symptoms, such as vaginal dryness and vaginal pruritus.
Related Knowledge Centers
- Greater Sciatic Foramen
- Internal Iliac Artery
- Piriformis Muscle
- Pelvic Cavity
- Perineum
- Artery
- Pudendal Arteries
- Sex Organ
- Gluteal Muscles
- Sacrospinous Ligament