Chapter 3 LOWER LIMB

Fig. 3.1. Vessels and nerves of the gluteal region: 1 - erector spine muscle; 2 - gluteus medius muscle; 3 - sacrum; 4 - superior gluteal artery and vein (superficial branches); 5 - piriformis muscle; 6 - medial clunial nerve; 7 - sacrotuberal ligament; 8 - inferior gluteal artery and veins; 9 - superior gemellus muscle; 10 - tendon of the internal obturator muscle; 11 - inferior gemellus muscle; 12 - greater trochanter of femur; 13 - quadratus femoris muscle; 14 - trochanteric bursa; 15 - sciatic nerve; 16 - artery accompanying a sciatic nerve; 17, 22 - gluteus maximus muscle; 18 - pudendal nerve and fat body of ischioanal fossa; 19 - posterior cutaneous nerve of thigh; 20 - semitendinous muscle; 21 - ischial tuberosity; 23 - inferior gluteal nerve; 24 - thoracolumbar fascia

3.1. TOPOGRAPHICAL ANATOMY OF REGIONS

3.1.1. GLUTEAL REGION

Borders. Superior border is the iliac crest, inferior border is the gluteal fold. The intergluteal fold is the medial border, lateral border is the conditional line connecting the anterior superior iliac spine with the greater trochanter of a thigh.

External relief. The region has the view of eminence which is formed by two muscles: gluteus maximus and gluteus medius. Layers

Skin. The skin of this region is thick, inactive, not elastic. It is innervated by the superior, medial, and inferior clunial nerves.

Subcutaneous fat layer has a cellular (lobular) structure. Superficial fascia. It is divided in the apex of this area and limits the lumbar and gluteal fat.

Proper fascia. It is thick and consists of two layers. Superficial layer forms a fascial compartment separated for the gluteus maximus muscle. The deep layer covers the deep layer of muscles.

Muscles. The superficial layer includes the gluteus maximus muscle, the deep layer contains the gluteus medius and gluteus minimus muscles, the piriformis muscle, the gemellus superior muscle, the gemellus inferior muscle, the obturator internus muscle, the quadratus femoris muscle.