Neurovascular bundle

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A neurovascular bundle is a structure that binds nerves and veins (and in some cases arteries and lymphatics) with connective tissue so that they travel in tandem through the body.

Contents

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 capillaries and nerves. Because capillaries function as the sites for substance exchange between interstitial fluid and blood, they tend to have large surface area and short diffusion path. Normally, capillaries consist of a central lumen lined with an endothelium, a single layer of smooth epithelial cells.

Deep bundles

Deep neurovascular bundles, which often include arteries, have a more complicated structure than superficial neurovascular bundles. Since arteries have high intraluminal blood pressure relative to capillaries and veins, these bundles have smooth muscle and connective tissue structures outside the endothelium. This structure allows arteries to contract, relax and remain flexible and transfer blood when under pressure.

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 great saphenous vein and its accompanying nerve, and, laterally, the superficial peroneal nerve. The superficial peroneal nerve originates from the common peroneal nerve near the neck of the fibula and passes between the peroneus longus and brevis muscles, supplying motor branches to these muscles. The superficial branch then continues onto the dorsum of the foot to supply sensory fibers to the skin there.

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]

Related Research Articles

Human leg Lower extremity or limb of the human body (foot, lower leg, thigh and hip)

The human leg, in the general word sense, is the entire lower limb of the human body, including the foot, thigh and even the hip or gluteal region. However, the definition in human anatomy refers only to the section of the lower limb extending from the knee to the ankle, also known as the crus or, especially in non-technical use, the shank. Legs are used for standing, and all forms of locomotion including recreational such as dancing, and constitute a significant portion of a person's mass. Female legs generally have greater hip anteversion and tibiofemoral angles, but shorter femur and tibial lengths than those in males.

Thigh Area between the pelvis and the knee; upper leg

In human anatomy, the thigh is the area between the hip (pelvis) and the knee. Anatomically, it is part of the lower limb.

Femoral triangle

The femoral triangle is an anatomical region of the upper third of the thigh. It is a subfascial space which appears as a triangular depression below the inguinal ligament when the thigh is flexed, abducted and laterally rotated.

Fibularis longus Superficial muscle in the lateral compartment of the leg

In human anatomy, the fibularis longus is a superficial muscle in the lateral compartment of the leg. It acts to tilt the sole of the foot away from the midline of the body (eversion) and to extend the foot downward away from the body at the ankle.

Popliteal artery Continuation of the femoral artery that supplies the lower leg

The popliteal artery is a deeply placed continuation of the femoral artery opening in the distal portion of the adductor magnus muscle. It courses through the popliteal fossa and ends at the lower border of the popliteus muscle, where it branches into the anterior and posterior tibial arteries.

In human anatomy, the dorsalis pedis artery is a blood vessel of the lower limb. It arises from the anterior tibial artery, and ends at the first intermetatarsal space. It carries oxygenated blood to the dorsal side of the foot. It is useful for taking a pulse. It is also at risk during anaesthesia of the deep peroneal nerve.

Tibial nerve Branch of the sciatic nerve

The tibial nerve is a branch of the sciatic nerve. The tibial nerve passes through the popliteal fossa to pass below the arch of soleus.

Gracilis muscle Most superficial muscle on the medial side of the thigh

The gracilis muscle is the most superficial muscle on the medial side of the thigh. It is thin and flattened, broad above, narrow and tapering below.

Fibularis brevis Shorter and smaller of the fibularis (peroneus) muscles

In human anatomy, the fibularis brevis is a muscle that lies underneath the fibularis longus within the lateral compartment of the leg. It acts to tilt the sole of the foot away from the midline of the body (eversion) and to extend the foot downward away from the body at the ankle.

The common fibular nerve is a nerve in the lower leg that provides sensation over the posterolateral part of the leg and the knee joint. It divides at the knee into two terminal branches: the superficial fibular nerve and deep fibular nerve, which innervate the muscles of the lateral and anterior compartments of the leg respectively. When the common fibular nerve is damaged or compressed, foot drop can ensue.

Superficial fibular nerve Nerve in the human leg and foot

The superficial fibular nerve innervates the fibularis longus and fibularis brevis muscles and the skin over the antero-lateral aspect of the leg along with the greater part of the dorsum of the foot.

Deep fibular nerve

The deep fibular nerve begins at the bifurcation of the common fibular nerve between the fibula and upper part of the fibularis longus, passes infero-medially, deep to the extensor digitorum longus, to the anterior surface of the interosseous membrane, and comes into relation with the anterior tibial artery above the middle of the leg; it then descends with the artery to the front of the ankle-joint, where it divides into a lateral and a medial terminal branch.

Popliteal fossa

The popliteal fossa is a shallow depression located at the back of the knee joint. The bones of the popliteal fossa are the femur and the tibia. Like other flexion surfaces of large joints, it is an area where blood vessels and nerves pass relatively superficially, and with an increased number of lymph nodes.

Sole (foot) Bottom part of foot

The sole is the bottom of the foot.

The saphenous nerve is the largest cutaneous branch of the femoral nerve. It is a strictly sensory nerve, and has no motor function.

Anterior compartment of leg Part of the Fascial compartments of leg

The anterior compartment of the leg is a fascial compartment of the lower [leg]. It contains muscles that produce dorsiflexion and participate in inversion and eversion of the foot, as well as vascular and nervous elements, including the anterior tibial artery and veins and the deep fibular nerve.

Nerve supply of the human leg

Cutaneous innervation refers to the area of the skin which is supplied by a specific nerve.

Outline of human anatomy Overview of and topical guide to human anatomy

The following outline is provided as an overview of and topical guide to human anatomy:

The subsartorial plexus is a plexus of nerves that is located under the sartorius muscle.

Fibular artery

In anatomy, the fibular artery, also known as the peroneal artery, supplies blood to the lateral compartment of the leg. It arises from the tibial-fibular trunk.

References

  1. ↑ "AO Surgery Reference". AO Foundation. Retrieved 16 October 2015.
  2. ↑ Faure Walker, Nicholas; Nair, Rajesh; Anderson, Chris (September 2015). "Re: Gunnar Steineck, Anders Bjartell, Jonas Hugosson, et al. Degree of Preservation of the Neurovascular Bundles During Radical Prostatectomy and Urinary Continence 1 Year after Surgery. Eur Urol 2015;67:559–68". European Urology. 68 (3): e63. doi:10.1016/j.eururo.2015.04.014. PMID   25913067.
  3. ↑ "The Patrick C. Walsh Prostate Cancer Research Fund: The Winning Vision Continues".
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