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Surgical and Radiologic Anatomy

, Volume 39, Issue 9, pp 953–959 | Cite as

The blood supply to the sacrotuberous ligament

  • Jonathan Lai
  • Maira du Plessis
  • Candace Wooten
  • Jerzy Gielecki
  • R. Shane Tubbs
  • Rod J. Oskouian
  • Marios Loukas
Original Article
  • 179 Downloads

Abstract

Knowledge of the vascular supply associated with the sacrotuberous ligament is incomplete, and at most attributed to a single coccygeal branch. Our aim was to investigate the sacrotuberous ligament vasculature with a focus on its origin and distribution. We dissected 21 hemipelvises (10 male and 11 female). The gluteus maximus was reflected medially, and a special emphasis was placed on the dissection of the vascular and neuronal structures. All specimens exhibited several (1–4) coccygeal arteries branching from the inferior gluteal artery penetrating the sacrotuberous ligament along its length. Seven specimens demonstrated the superior gluteal artery supplying sacral branches to the proximal superior border of the sacrotuberous ligament. Our study highlights several branches from a variety of origins as the supply to sacrotuberous ligament unlike previous reports stating only one vessel. Our results implicate surgical procedures in and around the area of the gluteal region such as decompressive procedures of the pudendal nerve, as it travels between the sacrotuberous and sacrospinous ligaments.

Keywords

Sacrotuberous ligament Inferior gluteal artery Superior gluteal artery Pudendal nerve entrapment Pelvic variations 

Notes

Acknowledgements

The authors wish to thank Jessica Holland, MS, CMI, Medical Illustrator for the illustrations used in this publication. We also wish to acknowledge the individuals who donated their bodies without whom this project would not have been possible.

Compliance with ethical standards

Conflict of interest

The authors declare that there are no conflicts of interest of any kind.

All specimens were handled in accordance to the laws and regulations of the country in which the study was performed. The specimens used for this research are protected under IRB approval number (06014) as issued by the Institutional review board.

References

  1. 1.
    Arora J, Mehta V, Suri RK, Rath G (2009) Unilateral partial ossification of sacrotuberous ligament: anatomico-radiological evaluation and clinical implications. Rom J Morphol Embryol 50:505–508PubMedGoogle Scholar
  2. 2.
    Benson JT, Griffis K (2005) Pudendal neuralgia, a severe pain syndrome. Am J Obstet Gynecol 192:1663–1668CrossRefPubMedGoogle Scholar
  3. 3.
    Colborn GL, Rogers Jr RM, Skandalakis JE, Badalament RA, Parrott TS, Weidman TA (2004) Chapter 28. Pelvis and perineum. In: Skandalakis JE, Colburn GL, Weidman TA, Foster RS Jr, Kingsworth AN, Skandalakis LJ, Skandalakis PN, Mirilas PS (Eds). PMP, Greece, pp 1567Google Scholar
  4. 4.
    Hammer N, Steinke H, Slowik V, Josten C, Stadler J, Böhme J, Spanel-Borowski K (2009) The sacrotuberous and the sacrospinous ligament—a virtual reconstruction. Ann Anat 191:417–425CrossRefPubMedGoogle Scholar
  5. 5.
    Hashimoto I, Murakami G, Nakanishi H, Sakata-Haga H, Seike T, Sato TJ, Fukui Y (2001) First cutaneous branch of the internal pudendal artery: an anatomical basis for the so-called gluteal fold flap. Okajimas Folia Anat Jpn 78:23–30CrossRefPubMedGoogle Scholar
  6. 6.
    Konschake M, Brenner E, Moriggl B, Hörmann R, Bauer S, Foditsch E, Janetschek G, Künzel K, Sievert K, Zimmermann R (2016) New laparoscopic approach to the pudendal nerve for neuromodulation based on an anatomic study. Neurourol Urodynam 9999:1–7Google Scholar
  7. 7.
    Loukas M, Louis RG Jr, Hallner B, Gupta AA, White D (2006) Anatomical and surgical considerations of the sacrotuberous ligament and its relevance in pudendal nerve entrapment syndrome. Surg Radiol Anat 28:163–169CrossRefPubMedGoogle Scholar
  8. 8.
    Loukas M, Louis RG Jr, Tubbs RS, Wartmann C, Colborn GL (2008) Intra-abdominal laparoscopic pudendal canal decompression—a feasibility study. Surg Endosc 22:1525–1532CrossRefPubMedGoogle Scholar
  9. 9.
    Loukas M, Benninger B, Tubbs RS (2012) Gray’s clinical photographic dissector of the human body. Elsevier Saunders, Philadelphia, pp 241–252Google Scholar
  10. 10.
    Lo T, Horng S, Huang H, Lee S, Liang C (2005) Repair of recurrent vaginal vault prolapse using sacrospinous ligament fixation with mesh interposition and reinforcement. Act Obstet Gynecol Scand 84:994–995CrossRefGoogle Scholar
  11. 11.
    Moore KL, Dalley 2nd AF, Agur AMR (2014) Chapter 3: pelvis and perineum. In Moore KL, Dalley 2nd AF, Agur AMR (eds) Clinically oriented anatomy, 7th edn. Lippincott Williams & Wilkin: Philadelphia.Google Scholar
  12. 12.
    Nyyssonen V, Talvensaari-Mattila A, Santala M (2013) Posterior intravaginal slingplasty versus unilateral sacrospinous ligament fixation in treatment of vaginal vault prolapse. ISRN Obstet Gynecol 2013. doi: 10.1155/2013/958670 CrossRefGoogle Scholar
  13. 13.
    Possover M (2014) A new technique of laparoscopic implantation of stimulation electrode to the pudendal nerve for treatment of refractory fecal incontinence and/or overactive bladder with urinary incontinence. J Minim Invasive Gynaecol 21:729CrossRefGoogle Scholar
  14. 14.
    Possover M, Foreman A (2015) Pelvic neuralgias by neuro-vascular entrapment: anatomical findings in a series of 97 consecutive patients treated by laparoscopic nerve decompression. Pain Phys 18:E1139–E1143Google Scholar
  15. 15.
    Robert R, Prat-Pradal D, Labat JJ, Bensignor M, Raoul S, Rebai R, Leborgne J (1998) Anatomic basis of chronic perineal pain: role of the pudendal nerve. Surg Radiol Anat 20:93–98CrossRefPubMedGoogle Scholar
  16. 16.
    Robinson A (ed) (1917) Cunningham’s manual of practical anatomy, 6th edn. William Wood and Co, New YorkGoogle Scholar
  17. 17.
    Sandri A, Regis D, Toso M, Bartolozzi P (2013) Surgical removal of a partial ossified sacrotuberous ligament for refractory pudendal nerve entrapment syndrome. J Orthop Sci 18:671–674CrossRefPubMedGoogle Scholar
  18. 18.
    Solomon MJ, Tan K, Bromilow RG, Al-mozany N, Lee PJ (2014) Sacreotomy via the abdominal approach during pelvic exenteration. Dis Colon Rectum 57(2):272–277CrossRefPubMedGoogle Scholar
  19. 19.
    Standring S, Borley NR, Collins P, Crossman AR, Gatzoulis MA, Healy JC, Johnson D, Mahadevan V, Newell RLM, Wigley CB. (eds.) (2008) Gray’s anatomy: the anatomical basis of clinical practice, 40th edn. London: Churchill Livingstone Elsevier. pp 1349–1385Google Scholar
  20. 20.
    Thompson JR, Gibb JS, Genadry R, Burrows L, Lambrou N, Buller JL (1999) Anatomy of pelvic arteries adjacent to the sacrospinous ligament: importance of the coccygeal branch of the inferior gluteal artery. Obstet Gynecol 94:973–977PubMedGoogle Scholar
  21. 21.
    Woodley SJ, Kennedy E, Mercer SR (2005) Anatomy in practice: the sacrotuberous ligament. N Z J Physiother 33:91–94Google Scholar

Copyright information

© Springer-Verlag France 2017

Authors and Affiliations

  • Jonathan Lai
    • 1
  • Maira du Plessis
    • 1
  • Candace Wooten
    • 2
  • Jerzy Gielecki
    • 3
  • R. Shane Tubbs
    • 4
  • Rod J. Oskouian
    • 4
  • Marios Loukas
    • 1
  1. 1.Department of Anatomical SciencesSt. George’s UniversitySt George’sGrenada
  2. 2.Department of Family MedicineUniversity of LouisvilleLouisvilleUSA
  3. 3.Department of AnatomyUniversity of Warmia and Mazury in OlsztynOlsztynPoland
  4. 4.Seattle Science FoundationSeattleUSA

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