Anatomic study of arcus tendineus fasciae pelvis

Objective: To describe the anatomy of the arcus tendineus fasciae pelvis. M aterial and methods: Two fixed female cadaver pelvises (88 and 66 years old ) were dissected. Results: The arcus tendineus fasciae pelvis is a 10-cm-lo ng fibrous thickening of the pelvic fascia which is medial to the obturator internus muscle and lateral to the peritoneum. It is inserted on the ischi atic spine and courses downward and anteriorly to the pubovesical ligament. The posterior third of the arcus tendineus fasciae pelvis is fused with th e posterior third of the arcus tendineus musculus levatoris ani, forming a curve with upward and anterior concavity. This portion of the arcus tendine us is thick and easy to recognise upon palpation. It is located 1 cm slight ly above and anterior to the ischiatic spine and 2 cm from of the pudendal vessels, which course around the posterior inferior margin of the ischiatic spine. The superior margin of the median part of the arcus tendineus fasci ae pelvis is crossed laterally by vessels for the obturator internus muscle arising from the internal iliac vessels. Conclusion: In genital prolapse c ure, sutures must be placed through the anterior or median parts of the arc us tendineus fasciae pelvis. In any case, they must remain anterior to the posterior part of the arcus tendineus fasciae pelvis to avoid injury to the pudendal vessels. (C) 2001 Elsevier Science Ireland Ltd. All rights reserv ed.