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General Surgery
Perineum
Built from Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
What’s inside
11 sections · 129 slides
Overview
- Scope of this topic
Embryogenesis
- Cloaca and allantois
- Urorectal septum and cloacal division
- Partition of the cloaca
- Mesonephric duct and ureteric absorption
Definition, boundaries and subdivisions
- Definition of the perineum
- Perineum in gynaecologic usage and the perineal body
- Orientation and relations of the perineum
- Meaning of superficial and deep in the perineum
- Boundaries and angles of the perineal diamond
- Boundaries and subdivisions of the perineum
- The perineal diamond and its two triangles
- Subdivisions of the perineum
- The perineum complex
Layers and fasciae of the urogenital triangle
- Continuity of perineal fascia with the abdominal wall
- Camper's fascia in the perineum
- Colles' fascia
- Variability of the membranous fascial layers
- Nature of the superficial perineal cleft
- Extent of the superficial perineal cleft
- Superficial cleft versus superficial pouch
- Fascial blending at the external genitalia
- Layers of the urogenital triangle, superficial to deep
- Muscles of the superficial perineal pouch
- Erectile bodies of the perineum
- Perineal membrane and deep perineal vessels
- Muscles of the deep perineal pouch
- Pelvic diaphragm and the urogenital hiatus
- Urogenital diaphragm and the perineal spaces in sagittal section
- Unpaired potential spaces of the pelvis in sagittal section
Superficial perineal pouch
- Boundaries of the superficial perineal pouch
- External perineal fascia of Gallaudet
- Colles, Gallaudet and the two spaces
- Suspensory ligament and the deep fascial plane
- Ischiocavernosus
- Bulbospongiosus
- Superficial transverse perineus muscle
- Variability and innervation of the superficial transverse perineus
- Ejaculatory musculature
- Orientation of the penile surfaces
- Corpora cavernosa and their crura
- Tunica albuginea of the corpora cavernosa
- Vascular architecture within the corpora
- Haemodynamics of erection and detumescence
- Mechanism of erection
- Corpus spongiosum and glans penis
- Thickness of the tunica albuginea
- Penile bulb and the course of the urethra
- Vasculature and innervation of the penile shaft
- Female homologues of the penile urethra
- Vestibular bulbs and glans clitoris
- Greater vestibular (Bartholin) glands
Perineal membrane and the deep pouch
- The perineal membrane
- Inferior fascia of the deep pouch
- Support function of the deep pouch
- Pelvic supporting structures
- Classical description of the urogenital diaphragm
- Fascial closure of the perineal compartments
- Transverse perineal ligament
- Oelrich's reexamination of the superior fascia
- Strasser's confirmation of a continuous sphincter
- Two accounts of the urogenital diaphragm
- Sealing of the female urogenital hiatus
- Nomenclature of the deep compartment
- Superior fascia and the periprostatic sheath
- Difficulty demonstrating the superior fascia
- Transverse section of the prostate and urethra at the seminal colliculus
Muscles of the deep compartment
- Muscles of the deep compartment
- Deep transversus perineus muscle
- Sphincter urethrae
- Compressor urethrae
- Sphincter urethrovaginalis
- Transversus vaginalis
- Urethral sphincter complex
- Fibres of Luschka and the vaginolevator attachment
- Membranous urethra
- Segments of the male urethra
- The bare area (pars nuda) of the urethra
- Perineal view of the male urethral sphincter
- Median section of bladder, urethra, prostate and urethral sphincter
- Prostate and urethra with the sphincter removed
- Perineal view of the female urogenital sphincter
- Female urogenital sphincter, bladder and vagina
- Oblique view of the female urogenital sphincter
Internal pudendal vessels and the pudendal nerve
- Internal pudendal artery
- Branches of the internal pudendal artery in the deep pouch
- Course of the pudendal nerve
- Walls of the pudendal canal
- Site of the pudendal canal
- Branches of the pudendal nerve
- Inferior rectal nerve
- Perineal branch of the posterior femoral cutaneous nerve
- Perineal nerve and its branches
- Transverse motor branch of the perineal nerve
- Dorsal nerve of the penis or clitoris
- Nerve distribution to the penis and its component parts
Anal triangle
- Boundaries of the anal triangle
- Ischioanal fossae
- Ischioanal fat and continence
- Posterior continuity of the ischioanal fossae
- Recesses of the ischioanal fossa and horseshoe abscess
- Blood supply and innervation of the anal triangle
- Neurovascular supply of the perineum
Fistula tracts of the anal region
- Fistula tracts and the perineal compartments
- Intersphincteric fistula
- Intersphincteric fistula opening into the rectum
- Transsphincteric fistula
- Suprasphincteric fistula
- Extrasphincteric fistula
- Rectal fistula tracts illustrating Goodsall-Salmon's rule
Surgical considerations and summary
- Anatomic complications of the perineum
- Key numbers from this topic
- Compartments and their contents
- Takeaways
- References
- References (continued)
- References (continued)
- Skandalakis' Surgical Anatomy: The Embryologic and Anatomic Basis of Modern Surgery
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