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Anatomic study of arcus tendineus fasciae pelvis
B Occelli1, F Narducci, J Hautefeuille
1Department of Gynecologic Surgery, Jeanne de Flandre Hospital, CHU Lille, 59037, Lille, France.
Objective:
To describe the anatomy of the arcus tendineus fasciae pelvis.
Material And Methods:
Two fixed female cadaver pelvises (88 and 66 years old) were dissected.
Results:
The arcus tendineus fasciae pelvis is a 10-cm-long fibrous thickening of the pelvic fascia which is medial to the obturator internus muscle and lateral to the peritoneum. It is inserted on the ischiatic spine and courses downward and anteriorly to the pubovesical ligament. The posterior third of the arcus tendineus fasciae pelvis is fused with the posterior third of the arcus tendineus musculus levatoris ani, forming a curve with upward and anterior concavity. This portion of the arcus tendineus is thick and easy to recognise upon palpation. It is located 1cm slightly above and anterior to the ischiatic spine and 2 cm from of the pudendal vessels, which course around the posterior inferior margin of the ischiatic spine. The superior margin of the median part of the arcus tendineus fasciae pelvis is crossed laterally by vessels for the obturator internus muscle arising from the internal iliac vessels.
Conclusion:
In genital prolapse cure, sutures must be placed through the anterior or median parts of the arcus tendineus fasciae pelvis. In any case, they must remain anterior to the posterior part of the arcus tendineus fasciae pelvis to avoid injury to the pudendal vessels.