Compartment Syndrome of the Gluteal Region: A Rare Condition Requiring a High Index of Suspicion.

Introduction: Compartment syndrome, an exceptionally rare condition, is a surgical emergency that can quickly escalate to limb ischemia and necrosis without treatment. Most cases occur post-trauma, typically affecting the anterior compartment of the leg. Patients present with pain out of proportion to their physical examination findings and often have an early hallmark discovery of pain with passive extension. Compartment syndrome of the buttock requires an even higher index of suspicion, as the condition is even more uncommon, and the diagnosis is complicated by it being difficult to palpate the affected area and passively extend the leg when the patient is supine. Case Report: This case report presents an 83-year-old female with compartment syndrome of the left gluteal region, status post-fall 1 day earlier. She was admitted to the medical team for observation and failed to respond to narcotic pain medication. The physical examination revealed firm, tense, left gluteal compartments with buttock hematoma and surrounding muscle induration, significant pain, and extremity weakness in the sciatic nerve distribution. An emergent fasciotomy was performed to decompress the affected compartments. Conclusion: All physicians must be mindful of gluteal compartment syndrome in patients complaining of buttock pain, especially after pelvic trauma, who present with buttock swelling, tense gluteal compartments, and severe gluteal pain. A delay in diagnosis or treatment can lead to severe consequences, including disability, irreversible gluteal muscle damage, sciatic nerve dysfunction, kidney failure, or death.

A Giant Epidermal Cyst in the Gluteal Region: A Case Report.

Epidermal cysts are the most commonly occurring cysts in the subcutaneous plane and are usually asymptomatic, small, and slow growing. When the size of an epidermal cyst is greater than 5 cm, it is considered a giant epidermal cyst. Common etiologies include sun-damaged skin and acne vulgaris, and they can appear anywhere in the body, but preferably over the face, neck, and trunk. Unusual sites include the breast, penis, spleen, bones, subungual region, palms, soles, and buttocks. In this report, we presented the case of a 31-year-old female having a large, painless, gradually progressing swelling for two years in the left gluteal region, which was insidious in onset and slow-growing. The patient eventually described a discomfort that made it impossible for her to sit for long hours or sleep in a supine position. Clinical examination revealed circumscribed mass over the left gluteal region from which diagnosis of giant lipoma was confirmed, but due to its large size and involvement of the whole left buttock, we considered it important to perform an ultrasound examination to reinforce our diagnosis, which revealed a large cystic mass in the left gluteal subcutaneous plane that was excised. As a definitive management, surgery was performed with excision of the swelling, which was extracted in toto and was identified as a cyst, and on histopathological examination, the cyst wall was lined by stratified squamous epithelium. Hence, this case report highlights a rare case of a giant epidermal cyst in the gluteal region.

Outcomes analysis of anterior and lateral approach for open repair of hip abductor tendons.

BACKGROUND: Gluteal tendons tears are increasingly being recognised as a cause of recalcitrant trochanteric pain, but there is a paucity of robust studies analysing the type of tears, results and predictors of outcome. METHODS: Patients with gluteal tendon tears resistant to conservative treatment who underwent isolated open repair (IR) or total hip arthroplasty and concomitant repair (THA+repair) with a minimum 1-year follow-up were retrospectively assessed separately. Type of tear, surgical approach, and fixation methods were registered. Complications and postoperative outcomes were analysed: visual analogue scale (VAS) of pain, VAS satisfaction, and activity level. Univariate regressions and multivariable models were developed. RESULTS: 90 cases were included: 62 cases underwent IR and 28 cases THA+repair, with an average follow-up of 3.9 years and 2.6 years, respectively. 13 complications were found (n = 5 IR, n = 8 THA+repair), including 9 re-operations (n = 4 IR, n = 5 THA+repair). Mean VAS pain score was 3.02 (SD 2.74) for the IR and 2.32 (SD 2.43) for THA+repair group. Mean VAS satisfaction was 7.09 (SD 3.07) and 7.68 (SD 2.71) for the IR and THA+repair group, respectively. In the IR group 61.4% returned to all pre-injury activities, whereas in the THA+repair group 79% did. Full-thickness tears had higher VAS pain scores (p = 0.0175), and there was trend (p > 0.05) towards higher complications, re-tears and lower VAS satisfaction in this type of tears in both groups. No statistically significant differences were found in outcomes when comparing THA+repair through direct anterior (DAA) with lateral approach (LA). CONCLUSIONS: Isolated gluteal tendon repair or THA+repairs seem to be safe procedures with high levels of satisfaction at short- to mid-term follow-up. The presence of a full-thickness tear is a predictor of inferior outcomes.

Gluteal lymphoedema associated with lower extremity lymphoedema: A preliminary study with indocyanine green lymphography and magnetic resonance imaging.

INTRODUCTION: Indocyanine green (ICG) lymphography studies have identified that one in three to five patients with cancer-related lower extremity lymphoedema (LEL) demonstrated dermal backflow extending to the gluteal region. This study aimed to further characterize gluteal lymphoedema using contemporaneous magnetic resonance imaging (MRI). PATIENTS AND METHODS: Twenty-eight patients with unilateral advanced LEL who underwent both ICG lymphography and MRI prior to any surgical procedure were included in this study. The patients were divided into two groups with/without gluteal lymphoedema by the presence of dermal backflow on ICG lymphography. MRI was used to evaluate tissue changes. RESULTS: Ten patients demonstrated gluteal lymphoedema on ICG lymphography and had a higher incidence of skin hypertrophy in the gluteal region. However, no difference in excess leg volume was found between the two groups. A trend of increasing gluteal subcutaneous tissue in the affected side was identified in patients with gluteal lymphoedema with a median increase of 20% compared with an 11% increase in the non-gluteal lymphoedema group. The excess gluteal subcutaneous tissue was positively correlated to ipsilateral excess leg volume. CONCLUSION: The gluteal lymphoedema group on ICG lymphography had skin thickening in the gluteal region and was likely identified in the secondary cancer-related group. Surgical and conservative management options for gluteal lymphoedema need to be considered in advanced LEL.

FABREX: A NEW CLINICAL TEST FOR DIAGNOSIS GLUTEAL TENDINOPATHY.

Objective: This study aims to describe a simple and accurate semiological method executing a specific maneuver with the lower limb to direct the semiological investigation towards the tendinopathies in the gluteus medius and minimus. Methods: Fifty patients participated in the study, with a mean age of 44.1 ± 13 years, with persistent pain on the side of the hip for more than three months. To compare the FABREX (proposed test) and Lequesne semiological tests, in the diagnosis of tendinopathies in the gluteus medius and minimus, Magnetic Resonance Imaging (MRI) was adopted as the gold standard. Results: FABREX presented high sensitivity and moderate specificity for tendinopathy in the gluteus medius and high sensitivity and specificity for tendinopathy in the gluteus minimus. Conclusion: The proposed test, when positive, can be used to determine the diagnosis of gluteal tendinopathies (high specificity). Moreover, it has high sensitivity, excluding the diagnosis when negative. This study represents the initial step for validating the FABREX test, and can therefore be considered a simple and accurate procedure to identify patients with or without gluteal tendinopathies. Level of Evidence III, Case Control Study.

Objetivo: Esse estudo propõe descrever um método semiológico simples e acurado, por meio de uma manobra específica com o membro inferior, a fim de direcionar a investigação semiológica para as tendinopatias dos glúteos médio e mínimo. Métodos: Participaram do estudo 50 pacientes, com média de idade de 44,1 ± 13,0 anos, apresentando dor persistente na face lateral do quadril há mais de 3 meses. A RM foi adotada como padrão ouro, para fins de comparação entre as duas manobras semiológicas (FABREX (teste proposto) e teste de Lequesne) no diagnóstico das tendinopatias do glúteo médio e mínimo. Resultados: O FABREX apresentou alta sensibilidade e moderada especificidade para tendinopatia de glúteo médio e alta sensibilidade e especificidade para tendinopatia do glúteo mínimo. Conclusão: A manobra proposta, quando positiva, pode ser utilizada para determinar o diagnóstico de tendinopatias glútea (alta especificidade). Além disso, possui alta sensibilidade, descartando o diagnóstico quando negativa. O presente trabalho constitui o passo inicial para validação do teste de FABREX, podendo assim, ser considerado um procedimento simples e acurado para identificar pacientes com ou sem tendinopatias glúteas. Nível de Evidência III, Estudo de Caso Controle.

Sciatica and femoral head osteonecrosis complicating a gluteal hydatid cyst: A case report.

INTRODUCTION AND IMPORTANCE: Hydatid disease is an endemic echinococcal infestation in Tunisia. Only 4% of hydatid cysts are located in the muscle. The gluteal localization is a very rare entity. The present case illustrates a gluteal hydatid cyst resulting in sciatica and osteonecrosis of the femoral head, an exceptional entity. CASE PRESENTATION: A 49-year-old man of urban origin, with free medical history, presented to our outpatient clinic with left sciatica and mechanical hip pain, that have been ongoing for 2 years. Pelvic radiograph showed femoral head osteonecrosis and lytic lesions of the ischium. MRI scan identified an extra-articular vesicular cyst in the left gluteal region involving the gluteus maximus. It suggested the diagnosis of musculo-skeletal echinococcosis. The patient underwent surgery and intraoperative findings showed a gluteal vesicular cyst with direct compression of the sciatic nerve, it also revealed femoral head necrosis. The cyst was drained and the pericyst excised. Total hip arthroplasty was postponed and the patient received a course of anthelmintic chemotherapy. CLINICAL DISCUSSION: Muscular involvement of hydatid cysts is rare and seen only in 4% of cases. Neurological complications from sciatic nerve compression can present as sciatica, with a principal differential diagnosis of nerve root compression. Aseptic femoral head osteonecrosis, an exceptional complication of an extra-articular gluteal hydatid cyst, can result from three mechanisms: a direct mechanical compression, an ischemic process due to vessel obstruction or a cellular process mediated by osteoclasts. Treatment is based on surgical excision combined with anthelmintic chemotherapy, the latter reduces the number of live cysts and the risk of recurrence. CONCLUSION: Although gluteal cysts are extremely rare with different clinical symptoms, surgery associated with anthelmintic treatment has a good functional outcome.

Application of Point-of-Care Ultrasound Scanning for the Diagnosis of Perianal Abscess.

A sixty-year-old man with ulcerative colitis and polymyalgia rheumatica, for which he was receiving prednisolone, visited the emergency department complaining of a gradual worsening of pain in the right buttock. Physical examination revealed mild redness and tenderness at the right side of the anus. Ultrasound revealed an approximately 38-mm long, avascular subcutaneous collection with heterogeneous echogenicity in the tender region. A perianal abscess was diagnosed, the lesion was punctured, and pus was drained, after which the pain improved. Point-of-care ultrasonography was effective in the prompt diagnosis and subsequent treatment of this patient's perianal abscess.

Fabrex: a new clinical test for diagnosis gluteal tendinopathy / Fabrex: um novo teste clínico para diagnóstico de tendinopatias glúteas

ABSTRACT Objective: This study aims to describe a simple and accurate semiological method executing a specific maneuver with the lower limb to direct the semiological investigation towards the tendinopathies in the gluteus medius and minimus. Methods: Fifty patients participated in the study, with a mean age of 44.1 ± 13 years, with persistent pain on the side of the hip for more than three months. To compare the FABREX (proposed test) and Lequesne semiological tests, in the diagnosis of tendinopathies in the gluteus medius and minimus, Magnetic Resonance Imaging (MRI) was adopted as the gold standard. Results: FABREX presented high sensitivity and moderate specificity for tendinopathy in the gluteus medius and high sensitivity and specificity for tendinopathy in the gluteus minimus. Conclusion: The proposed test, when positive, can be used to determine the diagnosis of gluteal tendinopathies (high specificity). Moreover, it has high sensitivity, excluding the diagnosis when negative. This study represents the initial step for validating the FABREX test, and can therefore be considered a simple and accurate procedure to identify patients with or without gluteal tendinopathies. Level of Evidence III, Case Control Study.

RESUMO Objetivo: Esse estudo propõe descrever um método semiológico simples e acurado, por meio de uma manobra específica com o membro inferior, a fim de direcionar a investigação semiológica para as tendinopatias dos glúteos médio e mínimo. Métodos: Participaram do estudo 50 pacientes, com média de idade de 44,1 ± 13,0 anos, apresentando dor persistente na face lateral do quadril há mais de 3 meses. A RM foi adotada como padrão ouro, para fins de comparação entre as duas manobras semiológicas (FABREX (teste proposto) e teste de Lequesne) no diagnóstico das tendinopatias do glúteo médio e mínimo. Resultados: O FABREX apresentou alta sensibilidade e moderada especificidade para tendinopatia de glúteo médio e alta sensibilidade e especificidade para tendinopatia do glúteo mínimo. Conclusão: A manobra proposta, quando positiva, pode ser utilizada para determinar o diagnóstico de tendinopatias glútea (alta especificidade). Além disso, possui alta sensibilidade, descartando o diagnóstico quando negativa. O presente trabalho constitui o passo inicial para validação do teste de FABREX, podendo assim, ser considerado um procedimento simples e acurado para identificar pacientes com ou sem tendinopatias glúteas. Nível de Evidência III, Estudo de Caso Controle.

Ajuste sacral en lifting glúteo tras grandes perdidas ponderales / Sacral contouring in gluteal lifts after massive weight loss

Introducción y objetivo: Las alteraciones en la región glútea después de una pérdida significativa de peso o una cirugía bariátrica aparecen como piel fácida, reducción de tejido adiposo y pérdida de masa muscular, provocando diversas quejas entre los pacientes. A diferencia de los autores que predefinen la cantidad de tejido a resecar en la región sacra, empleamos este refinamiento al final de la operación, permitiendo la retirada de más piel, corrigiendo asimetrías y dando forma al surco glúteo, según la anatomia de cada individuo.Material y método.Sometimos a lifting glúteo a 15 pacientes. En 12 usamos un colgajo adiposo para proyectar la mitad superior de la región glútea. En 3, además del colgajo adiposo incluimos una prótesis de silicona a través de la misma incisión.Resultados.Entre los 15 pacientes atendidos recogimos las siguientes complicaciones: 1 caso de hematoma tratado solo con aspiración mediante punción; 2 casos de seroma con drenaje espontáneo a través de la herida quirúrgica; y 2 casos de dehiscencia parcial de suturas, con revisión de la cicatriz solo en 1 de estos casos.Conclusiones.En nuestra experiência, el ajuste cutáneo de la región sacra realizado al final de un lifting de glúteos, proporciona una mejor simetría y un posicionamiento más preciso del nuevo surco glúteo. (AU)

Background and objective: Alterations in the gluteal region after significant weight loss or bariatric surgery appear as sagging skin, reduced adipose tissue and loss of muscle mass, causing a variety of complaints from patients. Unlike the authors who pre-define the amount of tissue to be resected in the sacral region, we performed this refinement at the end of the operation, allowing the removal of more skin, correcting asymmetric aspects and shaping the gluteal sulcus, depending on the individual anatomy.Methods.Fifteen patients underwent gluteal lifting. In 12 we used an adipose flap to project the upper half of the gluteal region. In 3 of them, in addition to the adipose flap, we included a silicone prosthesis through the same incision.Results.Among our 15 patients we noticed the following occurrences: 1 case of hematoma treated only with aspiration puncture; 2 cases of seroma with spontaneous drainage through the surgical wound; and 2 cases of partial dehiscence of the sutures, with scar revision required in only 1 of these cases.Conclusions.In our experience, the skin adjustment of the sacral region performed at the end of a gluteal lifting, provides better symmetry and more precise positioning of the new gluteal groove. (AU)

Primary sclerosing epithelioid fibrosarcoma presenting as lombosciatic syndrome: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Sclerosing epithelioid fibrosarcoma (SEF) is a rare variant of low grade fibrosarcoma, with specific histological and immunohistochemical features. SEF is a difficult to diagnose. The prognosis is poor with a 40% mortality rate. CASE PRESENTATION: We report a case of 45-year-old female patient who presented to our department with a history of right sciatalgia evolving for three months. On physical examination, a firmly not well-defined mass was found in the right gluteal region. The histological diagnosis revealed a SEF. CLINICAL DISCUSSION: SEF appears to be a slowly growing tumor often present for several months or years before diagnosis. The 3-month delay of our diagnosis shows the difficulty arising from the inconclusive clinical of this tumor. CONCLUSION: SEF of the gluteal region can induce sciatalgia. The diagnosis should be made as early as possible in order to improve the prognosis.

A rare case of recurrent eccrine poroma underlying gluteal abscess.

INTRODUCTION: Eccrine poroma is a benign adnexal neoplasm originating from epidermal sweat ducts mainly affecting the palmoplantar skin, buttock as a location of origin of poroma has rarely been reported, it is the first reported case of recurrent poroma in this site. PRESENTATION OF CASE: We report an unusual case of eccrine poroma in the gluteal region of a 62 years old female associated with gluteal abscess, surgically excised with histologically clear margins, then recurred after one and half year with a given history of mild trauma. DISCUSSION: Given the uncommonness of these neoplasms, there stays a general lack of data on pathogenesis, atypical presentation, atypical sites, recurrence and risk of malignant transformation into porocarcinoma. CONCLUSION: Gluteal skin is an unusual location for a benign poroma. Early recognition and appropriate treatment at the initial presentation by complete resection with histopathology confirmation and follow-up are crucial to ruling out other diagnoses, such as lesions of malignant transformation.

Primary gluteal subcutaneous hydatid cyst.

Hydatid disease is a parasitic zoonosis caused by Echinococcus granulosus larvae. While it can affect almost any part of the human body, liver and lung are the two organs where the disease is most frequently detected. Subcutaneous hydatid cyst, which mostly develops secondary to iatrogenic spillage of cyst contents into incision area during a visceral hydatid cyst surgery, accounts for only 1.5 % of all cases of hydatid cyst. With only a limited number of reported cases, primary involvement of subcutaneous tissue by hydatid cyst is a much more rare occurrence as compared with the secondary form. Subcutaneous hydatid cysts tend to involve trunk and limb roots, and mostly present as a slowly-growing, painless, mobile mass with a normal overlying skin. To our knowledge, only a few cases of primary subcutaneous hydatid cyst in the gluteal region have been reported to date. Here, we present a 72-year-old farmer who presented with a painless lump in the gluteal region and diagnosed as having primary subcutaneous hydatid cyst.

Case report: absence of the right piriformis muscle in a woman.

We report a very rare case of a unilaterally absent piriformis muscle in a 60 year old woman. Accompanying variations comprised a common gluteal artery (instead of two distinct superior and inferior gluteal arteries), and an absent gemellus inferior muscle. The contralateral left side showed a normally developed piriformis muscle. In hominoids, the piriformis is constant, but is regularly missing in several other vertebrates. The piriformis muscle is an anatomical landmark for ultrasound investigations and ultrasound-guided interventions in the deep gluteal region such as a superior gluteal nerve block or even a sacral plexus block, also for any surgical approach such as total hip arthroplasty. A missing piriformis muscle therefore affects the orientation in the deep gluteal region and therefore the identification of the targeted structures.

Ectopic appendix vermiformis located in the right deep gluteal region due to unilateral piriformis agenesis.

Incidental CT findings of a 67 years old female patient that had right piriformis agenesis and migration of appendix vermiformis to the right deep gluteal region is presented. To our knowledge this is the first case that the appendix has such ectopic location. Consideration of such variation would be beneficial to avoid possible complications, especially for surgeons who deal with gluteal region.

Anatomy of the gluteal region and its implication in liposculpture / 中华整形外科杂志

Objective@#To study the morphological characteristics and important anatomical structures of each soft tissue layer of gluteal region, and discuss the recommended levels and safe areas for liposculpture in this region.@*Methods@#Twenty-eight specimens of unilateral buttocks from 14 adult cadavers, including 16 specimens of unilateral buttocks from 8 fresh cadavers and 12 specimens from 6 formaldehyde fixed cadavers were dissected. Among the cadavers, there were 2 males with an average age of 49 years, and 12 females from 23 to 72 years old, median age 46 years. Through anatomy study of soft tissue layers of gluteal region, the morphological features of each layer were observed and documented, and the characteristics of fascia system and adipose tissue, as well as the relationship between the blood vessels and nerves with corresponding layers.@*Results@#The layers of the gluteal region that range from superficial to deep are skin, subcutaneous fat, superficial fascia system, deep fascia system, muscle and fascia compartments. Subcutaneous fat is distributed in superficial and deep layers; the superficial fascia system is well developed and dense with a layered structure; the deep fascia is thin with the characteristic of epimysium. There is a danger zone for deep fat graft in the gluteal region, with its apex at the first sacral vertebra, and its base goes along the gluteal fold, compromising the thighs′ medial two-thirds. Nearly all important blood vessels and nerves of gluteal region are located in deep layer of this danger zone.@*Conclusions@#Based on the characteristics of buttocks of Chinese people, liposuction is mainly performed in the iliolumbar region and posterolateral thigh, which can significantly increase the relative height and fullness of buttocks. For full buttocks, deep fat can be sucked appropriately, which should be longitudinal and gentle to reduce the damage to the superficial fascial system. There is a high risk for fat graft in the buttock. It is recommended to use a blunt needle with an inner diameter of more than 3 mm parallel to the fiber orientation of gluteus maximus for uniform fan-shaped injection with needle withdrawal. Satisfactory result can be obtained by injecting most fat into the subcutaneous adipose layer. Deep injection of grafts into dangerzoneis forbidden.

[Surgical refixation of gluteal tendon tears by mini-open double-row technique]. / Knotenlose Doppelreihenrefixation bei Glutealsehnenruptur.

OBJECTIVE: Stable refixation of gluteal tendons at the anatomic footprint by large-area contact by the means of knotless double-row anchor fixation (HipBridge technique). INDICATIONS: Symptomatic tear of gluteus medius and/or gluteus minimus tendon with persisting pain after nonsurgical treatment, or primarily reconstructable mass rupture with gluteal insufficiency, revision surgeries. CONTRAINDICATIONS: Primary nonreconstructable mass ruptures, atrophic or fatty degeneration of gluteal muscles grade Goutallier 4, local infections. SURGICAL TECHNIQUE: Lateral position, longitudinal skin incision over greater trochanter, longitudinal incision of iliotibial band, resection of trochanteric subgluteus maximus bursa, longitudinal splitting of gluteal tendons over tear, debridement and mobilisation of tendons for sufficient distalisation to tendon footprint at anterior and lateral trochanteric facet, debridement of sclerotic greater trochanter, punching and tapping of proximal row, placement of two proximal anchors loaded with nonresorbable suture tape, fan-shaped four times gluteal tendon perforation at myotendinous transition zone, double-V-shape crossing of suture tapes, punching and tapping of distal row, fixation of crossed tapes with two distal knotless suture anchors under mild pretensioning of gluteal tendons, side-to-side tendon suture, vastogluteal and iliotibial band closure, wound closure. POSTOPERATIVE MANAGEMENT: Stage-dependent physiotherapy with partial weight-bearing with 20 kg for 6 weeks, no active abduction, no adduction and no external rotation in flexion for 6 weeks after surgery. From week 7 after surgery, free range of motion, active-assisted abduction and increase in weight-bearing by 15 kg/week. No peak load for 4 months. Thromboembolic prophylaxis until full weight-bearing is reached. RESULTS: Success rates of 80-90% can be expected in cases with no or only minor muscle atrophy.

Unexpected Diagnosis in Gluteal Region -A Primary Intramuscular Hydatid Cyst: A Case Report.

INTRODUCTION: Primary hydatid cyst is rarely seen in musculoskeletal system. This paper presents a case of an intramuscular hydatid cyst in gluteal region. CASE OF REPORT: We present the case of a 36-year-old woman affected by pain and a mass in her right gluteal region. Serological tests and radiographies were inconclusive. Ultrasonography showed a 52 mm × 47 mm diameter hypoechoic intramuscular cyst with septations. Computed tomography showed a cystic lesion located between muscle groups. The mass was excised under spinal anesthesia. It was a well-demarcated cystic lesion with 5 cm diameter. Albendazole chemotherapy was prescribed postoperatively. CONCLUSION: Hydatid cysts must be considered in differential diagnosis in patients with cystic masses in musculoskeletal system, especially in patients living in endemic areas.

Use of infragluteal folds as a full-thickness skin graft donor site for construction of the neovagina in cases of Mullerian agenesis.

AIM: The aims of this study were to present the results of using infragluteal folds as a skin graft donor site in cases of Mullerian agenesis undergoing full-thickness skin graft vaginoplasty and to evaluate the outcomes of the surgical technique. METHODS: Demographics and clinical parameters of 24 consecutive Mullerian agenesis patients refusing any dilatational procedure and undergoing neovaginal construction using infragluteal folds skin grafts from May 2004 to July 2015 were analyzed. RESULTS: The mean age of the patients was 21.5 ± 5.7 years. Five patients had nonfunctional rudimentary uterus, one patient had unilateral ovarian agenesis, one patient had unilateral renal agenesis, and one had undergone a previous vaginoplasty. There were no serious complications needing surgical or medical intervention. The depth of the neovagina in patients with a follow-up period of more than 6 months (n = 17) varied from 7 to 12 cm. Of these patients, the sexually active ones (n = 8) did not complain of dyspareunia or vaginal dryness during sexual intercourse. The resulting scars were satisfactory and acceptable for all patients. CONCLUSION: It has been our practice to use infragluteal folds as a skin graft donor site for full-thickness skin graft vaginoplasty. We believe that the results of this study demonstrate that this area is versatile and an excellent alternative to the groins and lower abdomen. Further clinical and histomorphological investigations are necessary for strong statements and results.

A Variant of the Sciatic Nerve and its Clinical Implications.

Variants of gluteal neural anatomy are important to consider, especially during surgical approaches to the hip. During the routine dissection of the gluteal region, a variant of the sciatic nerve was found where the nerve left the pelvis fully split into its tibial and common fibular components. Intrapelvically and extrapelvically, there was no splitting of the two components by the piriformis muscle. Distally, the two parts of the nerve were draped over the medial and lateral edges of the ischial tuberosity. To avoid iatrogenic injury to the sciatic nerve during invasive or surgical approaches to this region, all possible anatomical variations, such as the one presented herein, should be appreciated by the clinician.