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Neurovascular bundle structure
- Two types: superficial and deep bundles
- Superficial bundles do not include arteries
- Deep bundles often include arteries
- Superficial bundles consist primarily of capillaries and nerves
- Deep bundles have smooth muscle and connective tissue structures outside the endothelium
Function of neurovascular bundles
- Ensure continuous supply of oxygenated blood to important nerves
- Useful for axons
- Crucial role in maintaining nerve health and function
- Provide oxygen and nutrients to nerves
- Help remove waste products from nerves
Clinical significance of neurovascular bundles
- Both superficial and deep bundles are at risk during surgical incisions
- Protecting bundles during surgery is essential to prevent neurological damage
- Great saphenous vein and superficial peroneal nerve are at risk in leg surgery
- Posterior tibial artery is the main deep bundle at risk
- Preservation of neurovascular bundles during prostate surgery improves urinary continence and erectile function
Neurovascular bundles in leg surgery
- Great saphenous vein and accompanying nerve at risk
- Superficial peroneal nerve also at risk
- Superficial peroneal nerve originates from common peroneal nerve
- Posterior tibial artery is the main deep bundle at risk
- Posterior tibial artery gives rise to medial and lateral plantar arteries
Neurovascular bundles in prostate surgery
- Preservation of bundles during nerve-sparing radical prostatectomy improves urinary continence and erectile function
- Recommended in elderly men and those with pre-existing erectile dysfunction
- Surgeries with preserved bundles have lower frequency of positive margins
- Positive margins occur in only 5.8 percent of surgeries with preserved bundles
- Preserving neurovascular bundles is important for post-surgery quality of life