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Medial Thigh Anatomy in Female Cadavers

Clinical Applications to the Transobturator Midurethral Sling

Shah, Nemi M. MD*; Jackson, Lindsey A. MD*; Phelan, John N. PhD; Corton, Marlene M. MD, MSCS*

Female Pelvic Medicine & Reconstructive Surgery: July 24, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000610
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Background Mesh resection for refractory pain after transobturator midurethral sling may require exploration of structures different than those involved in insertion. Our objective was to describe the muscular and neurovascular anatomy of the medial thigh compartment.

Methods Dissections were performed in unembalmed female cadavers. Relationships of medial thigh structures were evaluated relative to the midpubic arch and obturator nerve. An out-to-in transobturator tape was passed in a subset of cadavers, and its relationships to the obturator nerve and adductor muscles were examined. Descriptive statistics were used for analyses.

Results Sixteen cadavers were examined. The adductor longus muscle was a median of 37 mm (26–50) from the midpubic arch with tendon length of 26 mm (12–53) and width of 16 mm (14–29). The gracilis was 21 mm (17–26) from the midpubic arch with tendon length of 28 mm (15–56) and width of 45 mm (31–68). The obturator nerve was 58 mm (51–63) from the midpubic arch with width of 5 mm (4–7). No differences between measurements in the supine and lithotomy positions were noted. The transobturator tape was 42 mm (30–47) from the midpubic arch, 36 mm (30–44) from the obturator nerve, and 20 mm (5–31) from the closest obturator nerve branch. The transobturator sling passed through the gracilis muscle in all specimens with variable passage through the adductors longus (75%) and brevis (25%).

Conclusions Familiarity with the medial thigh is essential for surgeons utilizing transobturator midurethral slings. Risks of mesh excision should be weighed against benefits before extensive thigh dissection for pain-related indications.

From the Departments of *Obstetrics and Gynecology, and

Cell Biology, University of Texas Southwestern Medical Center, Dallas, TX.

Correspondence: Nemi M. Shah, MD, University of Texas Southwestern Medical Center, Ob/Gyn Residency Office, 5323 Harry Hines Blvd, Dallas, TX 75390. E-mail: nemi.m.shah@gmail.com.

The authors report no conflicts of interest. No financial donors contributed to this study.

Findings were presented as an oral presentation at the Society of Gynecologic Surgeons, 44th Annual Scientific Meeting in Orlando, FL, on March 14, 2018.

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