Superior gluteal

The uterine blood supply is primarily from the uterine arteries. The uterine arteries arise as branches of the internal iliac (hypogastric) arteries. In most cases, the internal iliac artery divides into a posterior division that gives off the iliolumbar, the lateral sacral and the superior gluteal arteries and an anterior division that gives rise to parietal branches (the obturator, inferior gluteal and internal puden-... 

Embolization, by definition, reduces blood flow distally. Therefore, it is no surprise that distal necrosis is a recognized complication of trauma embolization. However, unintentional reflux of embolization material from the internal iliac into the femoral artery can cause inadvertent ischemia in the leg. Sciatic palsy with associated foot drop and sacral plexus palsy has been reported [57]. Embolization of the superior gluteal artery in a patient vdio will be subjected to prolonged bedrest may cause sacral and buttock ischemia leading to skin break down [58]. Sexual dysfunction seems not to he a complication of bilateral internal iliac artery embolization, but is more likely a result of nerve injury secondary to the fracture or pelvic trauma [59]. 

FIGURE 7.3. Adipose tissue thickness in people in the general population (solid bars) and in obese persons (dashed bars). Adipose tissue thickness was measured by ultrasound measurements (not by the usual technique of skinfold measurements) at the gluteal site (G), femoral site (F), hypogastric site (H), and epigastric site (E). The epigastric site that was used was one-third the distance down from the tip of the sternum to the umbilicus. This site was somewhat thicker in men than in women. The femoral site was one-third the distance down from the anterior superior Uiac spine (wide part of the pelvis) to the patella (knee). This site was much thicker in women than in men. Biopsies were also taken at the indicated sites and examined imder the microscope to acquire fat cell size. (Redrawn with permission from Krotkiewski et ah, 1983.)... 

Fig. 12.24. Sites of pelvic avulsion injuries. A, iliac crest (abdominal muscle insertion). B, anterior superior iliac spine (sartorious muscle origin). C, anterior inferior iliac spine (rectus femoris origin). D, greater trochanter (gluteal insertions). Ey Lesser trochanter (illiopsoas). F, ischial tuberosity (hamstring muscle). G, body of pubis and inferior pubic ramus (adductors and gracillis)...

Anatomic Considerations The bladder is supplied by the superior and inferior vesical arteries derived from the anterior trunk of the internal iliac artery. With anatomic variation, the vesical arteries may originate from the obturator and inferior gluteal arteries, and in the female, additional branches are derived from the uterine and vaginal arteries. When... 

For example, in a patient with a hypervascular carcinoma of the uterine cervix as defined by angiography through catheters placed in the main trunk of the internal iliac arteries, the radionuclide flow study can be utilized to demonstrate the flow distribution almost exclusively to the true pelvis. Therefore, the position of the catheters would be adequate and more selective catheterization would not be necessary. On the other hand, in a patient with a hypovascular tumor (most squamous cell carcinomas of the cervix are relatively hypovascular), catheter placement into the internal iliac artery may not only infuse the true pelvis, but may also infuse the buttocks. Embolization of the superior and inferior gluteal arteries with coils or segments of Gelfoam or both can be used to prevent the infusion of the buttocks and redistribute the chemotherapy to the true pelvis. This may result in increased pudendal flow and potentially increase local toxicity. 

The L3 to L5 vertebrae also have tender points in the lateral buttock muscles (gluteals). The lower pole L5 tender point is superior and slightly medial to the posterior inferior iliac spines. L3 and L4 tender points are treated in a manner similar... 

Sacral sulcus Posterior superior iliac spirsc Greater trocKanter Gluteal crevice Gluteal folds... 

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