Skip to main content

Advertisement

Log in

Relationship of inferior gluteal nerves and vessels: target for application of stimulation devices for the prevention of pressure ulcers in spinal cord injury

  • Original Article
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

A study was carried out to determine whether the location of the inferior gluteal nerve could be reliably predicted using external anatomy or vascular imaging. This study was motivated by our group’s development of an electrical stimulation system to provide direct gluteal stimulation in paralyzed individuals, in particular those with spinal cord injury (SCI). Pressure ulcers are a common complication for many individuals with reduced mobility. Numerous approaches have been employed to treat and prevent pressure ulcers; however no procedure or nursing care regimen has been successful in eradicating them completely. Our group seeks to prevent skin breakdown in susceptible patients by direct electrical stimulation of the paralyzed gluteal muscle, leading to improved circulation and increased muscle mass (hypertrophy) in the treated area. Currently, percutaneous electrodes are placed through an extensive probing process to select the motor point of the target muscle. We examined 15 cadaver gluteal regions to identify the relationship between the internal anatomy of the inferior gluteal artery and nerve as well as the relationship to external anatomic landmarks. The cadavers displayed variability with regard to the morphology of the branches of both nerve and artery. Furthermore, there did not appear to be any relationship between the relative positions of the nerve and artery. However, the potential target area of the proximal origin of the inferior gluteal nerve could reliably be predicted from the external bony anatomy of the lower pelvis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bogie KM, Triolo RJ (2003) The effects of regular use of neuromuscular electrical stimulation on tissue health. J Rehabil Res Dev 40(6):469–475

    Article  PubMed  Google Scholar 

  2. Bogie KM, Wang X, Triolo RJ (2006) Long term prevention of pressure ulcers in high risk individuals: a case study of the use of gluteal neuromuscular electrical stimulation. Arch Phys Med Rehabil 87(4):585–591

    Article  PubMed  Google Scholar 

  3. Charlifue S, Lammertse DP, Adkins RH (2004) Aging with spinal cord injury: changes in selected health indices and life satisfaction. Arch Phys Med Rehabil 85(11):1848–1853

    Article  PubMed  Google Scholar 

  4. Davis JA Jr, Triolo RJ, Uhlir JP, Bhadra N, Lissy DA, Nandurkar S, Marsolais EB (2001) Surgical technique for installing an eight-channel neuroprosthesis for standing. Clin Orthop Relat Res 385:237–252

    Article  PubMed  Google Scholar 

  5. Gupta S, Baharestani M, Baranoski S, de Leon J, Engel SJ, Mendez-Eastman S, Niezgoda JA, Pompeo MQ (2004) Guidelines for managing pressure ulcers with negative pressure wound therapy. Adv Skin Wound Care 17(Suppl 2):1–16, review

    Article  PubMed  Google Scholar 

  6. 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(1):23–30

    PubMed  CAS  Google Scholar 

  7. Higgins JP, Orlando GS, Blondeel PN (2002) Ischial pressure sore reconstruction using an inferior gluteal artery perforator (IGAP) flap. Br J Plast Surg 55(1):83–85

    Article  PubMed  CAS  Google Scholar 

  8. Hollisaz MT, Khedmat H, Yari F (2004) A randomized clinical trial comparing hydrocolloid, phenytoin, and simple dressings for the treatment of pressure ulcers. BMC Dermatol 15,4(1):18

    Article  Google Scholar 

  9. Hoppenfeld S, deBoer P (2003) Surgical exposures in orthopaedics: the anatomic approach. Lippincott Williams and Wilkins, Philadelphia, pp 365–446

    Google Scholar 

  10. Kaya AZ, Turani N, Akyuz M (2005) The effectiveness of a hydrogel dressing compared with standard management of Pressure ulcers. J Wound Care 14(1):42–44

    PubMed  CAS  Google Scholar 

  11. Kirshblum S (2004) New rehabilitation interventions in spinal cord injury. J Spinal Cord Med 27(4):342–350

    PubMed  Google Scholar 

  12. Krause JS, Broderick L (2004) Patterns of recurrent pressure ulcers after spinal cord injury: identification of risk and protective factors 5 or more years after onset. Arch Phys Med Rehabil 85(8):1257–1264

    Article  PubMed  Google Scholar 

  13. Liem NR, McColl MA, King W, Smith KM (2004) Aging with spinal cord injury: factors with associated with the need for more help with activities of daily living. Arch Phys Med Rehabil 85(10):1567–1577

    Article  PubMed  Google Scholar 

  14. Moore KL, Dalley AF (1999) Clinically oriented anatomy. Lippincott Wiliams and Wilkins, Philadelphia, pp 545–562

    Google Scholar 

  15. Park S (2000) Muscle-splitting approach to superior and inferior gluteal vessels: versatile source of recipient vessels for free-tissue transfer to sacral, gluteal, and ischial regions. Plast Reconstr Surg 106(1):81–86

    Article  PubMed  CAS  Google Scholar 

  16. Sheerin F, Gillick A, Doyle B (2005) Pressure ulcers and spinal-cord injury: incidence among admissions to the Irish national specialist unit. J Wound Care 14(3):112–115

    PubMed  CAS  Google Scholar 

  17. Sorensen JL, Jorgensen B, Gottrup F (2004) Surgical treatment of pressure ulcers. Am J Surg 188(Suppl 1A):42–51, review

    Article  PubMed  Google Scholar 

  18. Taly AB, Sivaraman Nair KP, Murali T, John A (2004) Efficacy of multiwavelength light therapy in the treatment of pressure ulcers in subjects with disorders of the spinal cord: a randomized double blind controlled trial. Arch Phys Med Rehabil 85(10):1657–1661

    Article  PubMed  Google Scholar 

  19. Tillmann B (1979) Variations in the pathway of the inferior gluteal nerve (author’s transl). Anat Anz 145(3):293–302, (Article in German)

    PubMed  CAS  Google Scholar 

  20. Windhofer C, Brenner E, Moriggl B, Papp C (2002) Relationship between the descending branch of the inferior gluteal artery and the posterior femoral cutaneous nerve applicable to flap surgery. Surg Radiol Anat 24(5):253–257

    Article  PubMed  CAS  Google Scholar 

  21. Zhang JL, Lu LG, Wu YJ (2005) Anatomic observation of inferior gluteal artery. Zhonghua Zheng Xing Wai Ke Za Zhi 21(1):44–46, (Article in Chinese)

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

Support for this study was provided by funding from the Rehabilitation Research and Development Service of the Dept of Veterans Affairs.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kath Bogie.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Skalak, A.F., McGee, M.F., Wu, G. et al. Relationship of inferior gluteal nerves and vessels: target for application of stimulation devices for the prevention of pressure ulcers in spinal cord injury. Surg Radiol Anat 30, 41–45 (2008). https://doi.org/10.1007/s00276-007-0282-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-007-0282-5

Keywords

Navigation