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ABSTRACT:Dissection of the pudendal nerve and its branches in 71 cadavers revealed anatomic variations not previously described. Knowledge of this variation is necessary to prevent nerve injury resulting in sexual of sensory dysfunction. Because descriptions vary, this study re-evaluated the anatomy of the PN as implicated in perineal procedures in South Africans. The course of the PN from the gluteal region into the perineum was dissected in an adult sample of both sexes and of African and Predictions should be verified clinically.

Purpose: Several surgical and clinical procedures are performed in the area of the medial compartment of the thigh. This places the obturator nerve and its branches in potential danger of injury. This study aimed to provide a clear description of the anatomy and course of the obturator nerve and its branches to assist surgeons and clinicians in the safe performance of various pelvic procedures. Methods: One hundred and one (101) formalin-fixed were dissected. Dissections were performed just lateral to the lumbar vertebra to describe the origin of the obturator nerve. The course of the nerve, with its relations, was observed and recorded until it terminated in the medial thigh. The location of the obturator nerve within the obturator foramen was quantified by measuring the distance from three bony landmarks of the obturator foramen to the nerve. Findings: Variations were observed in the root origins of the obturator nerve, its course in the abdomen, bifurcation patterns and the innervation patterns of its terminal branches. Conclusion: The results of this study may be used in the pre-operative preparation of surgeons that are to perform surgery in the area of the obturator foramen. The study serves to assist in expanding the knowledge on the anatomy of the obturator nerve and its branches in a South African context. These results should be verified in a clinical setting.

Objective: Variations in the branching pattern of the pudendal nerve (PN) have been described in the literature. This study investigated these variations in order to comment on a safe area for the placement of a Richter's stitch. Methods: Richter's procedure was performed on nine unembalmed female cadavers and followed by dissection. PN dissections were done on another 20 embalmed female cadavers. Variations in the branching pattern of the PN were noted and the distance between the Richter's stitch placed and the PN/or the inferior rectal nerve (IRN) measured. Results: The IRN entered the gluteal region as a separate structure in 6/29 cases. The separate IRN was found to pass between 4.1 and 14.45 mm medial to the ischial spine in 18/29 cases. In one case, the Richter's stitch was found to pierce the IRN. The distance between the stitch and the PN and/or the IRN ranged from 0 to 17.8 mm. Conclusions: To minimize the risk of nerve damage or entrapment, the Richter's stitch should be placed >20 mm from the ischial spine. This recommended area should be revised for different population groups, as variations might exist between groups.