Neurovascular bundle
A neurovascular bundle is a structure that binds nerves and veins (and in some cases arteries and
Structure
There are two types of neurovascular bundles: superficial bundles and deep bundles. As arteries do not travel within the superficial fascia (loose connective tissue under the skin), superficial neurovascular bundles differ from deep neurovascular bundles in both composition and function.
Superficial bundles
Superficial neurovascular bundles do not include arteries, and consist primarily of
Deep bundles
Deep neurovascular bundles, which often include
Function
Neurovascular bundles are useful for axons, ensuring a continuous supply of oxygenated blood to important nerves.
Clinical significance
Both superficial and deep neurovascular bundles are at risk during surgical incisions.
Leg surgery
In surgeries, the principle superficial neurovascular bundles at risk are, medially, the
The main deep neurovascular bundle at risk is the posterior tibial artery. It lies on the posterior aspect of the tibialis posterior and flexor digitorum longus muscle, and medial to the belly of flexor hallucis longus muscle. It also gives rise to medial plantar artery and lateral plantar artery.[1]
During surgery, these neurovascular bundles, both superficial and deep, should be protected in order to prevent neurological damage. A common anatomically informed, surgical technique to avoid damaging neurovascular bundles is to undermine anteriorly to the posterior tibial margin after reaching the fascia, in order to avoid the saphenous vein and nerve. The deep posterior compartment here is superficial and readily accessible. The fascia of the deep posterior compartment is carefully opened distally and proximally, under the belly of the soleus muscle, paying special attention to the posterior tibial neurovascular bundle. Through the same incision, the fascia of the superficial posterior compartment is opened widely, two centimeters posterior and parallel to the incision in the fascia of the deep compartment.
Prostate surgery
The preservation of both neurovascular bundles during nerve-sparing (NS) radical prostatectomy improves urinary continence and erectile function.[2] Consequently, NS is recommended in elderly men and those with pre-existing erectile dysfunction, whom many surgeons would previously have only offered non-NS surgery. It was also found that during surgeries in which neurovascular bundles are preserved, the frequency of positive margins were only 5.8 percent.[3]
References
- Gray's Anatomy: The Anatomical Basis of Clinical Practice, Expert Consult, 40e. By Susan Standring, PhD, DSc, Emeritus Professor of Anatomy, Head of Anatomy and Human Sciences, King's College London, London, UK. 9780443066849
- ^ "AO Surgery Reference". AO Foundation. Retrieved 16 October 2015.
- PMID 25913067.
- ^ "The Patrick C. Walsh Prostate Cancer Research Fund: The Winning Vision Continues".