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Pudendal nerve 3-dimensional illustration gives insight into surgical approaches
Georg J Furtmüller1, Courtney A McKenna, Johannes Ebmer
1From the *Vascularized Composite Allotransplantation Laboratory, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine; †Department of Anatomy and Neurobiology, University of Maryland Baltimore School of Medicine, Baltimore, MD; ‡Multimedia Department of Continuum Health Partners, St Luke's and Roosevelt Hospitals, New York, NY; §Department of Art as Applied to Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; ∥Academic Medical Illustration Department of Mount Sinai Health System, New York, NY; ¶Institut für Anatomie, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Austria; and #Department of Plastic Surgery and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Abstract:
The pudendal nerve is located topographically in areas in which plastic surgeon reconstruct the penis, the vagina, the perineum, and the rectum. This nerve is at risk for either compression or direct injury with neuroma formation from obstetrical, urogynecologic, and rectal surgery as well as pelvic fracture and blunt trauma. The purpose of this study was to create a 3-dimensional representation based on magnetic resonance imaging of the pelvis supplemented with new anatomic dissections in men and women to delineate the location of the pudendal nerve and its branches, providing educational information both for surgical intervention and patient education. The results of this study demonstrated that most often there are at least 2, not 1, "pudendal nerves trunks" as they leave the pelvis to transverse the sacrotuberous ligament, and that there are most often 2, not 1, exit(s) from Alcock canal, one for the dorsal branch and one for the perineal branch of the pudendal nerve.
