Study On The Fine Architecture Of Fascial Planes Around The Lateral Femoral Cutaneous Nerve At Its Pelvic Exit And Clinical Application Of Ultrasound Detection

Objective: Meralgia paresthetica is commonly caused by mechanical entrapment of the lateral femoral cutaneous nerve(LFCN).The entrapment often occurs at the site where the nerve exits the pelvis.Its optimal surgical management remains to be established,partly because the fine architecture of the fascial planes around the LFCN has not been elucidated.The aim of this study was to define the fascial configuration around the LFCN at its pelvic exit.Methods: Thirty-six cadavers(18 female,18 male;age range 38–97 years)were used for dissection(57 sides of 30 cadavers)and sheet plastination and confocal microscopy(2 transverse and 4 sagittal sets of slices from 6 cadavers).Thirty-four healthy volunteers(19 female,15 male;age range 20–62 years)were examined with ultrasonography.Results: The LFCN exited the pelvis via a tendinous canal within the internal oblique–iliac fascia septum and then ran in an adipose compartment between the sartorius and iliolata ligaments inferior to the anterior superior iliac spine(ASIS).The iliolata ligaments newly defined and termed in this study were 2–3 curtain strip–like structures which attached to the ASIS superiorly,were interwoven with the fascia lata inferomedially,and continued laterally as skin ligaments anchoring to the skin.Between the sartorius and tensor fasciae latae,the LFCN ran in a longit udinal ligamental canal bordered by the iliolata ligaments.Conclusions:(1)The plastination sheets can provide macro and microscopic images support for anatomical research,which can also be used to reconstruct 3D models to more clearly observing stereoscopic nerves and their fascial structures with surrounding planes.(2)These two segments of lateral femoral cutaneous nerve can be localized by ultrasound scans.These results indicate that the internal oblique–iliac fascia septum and iliolata ligaments may make the LFCN susceptible to mechanical entrapment near the ASIS.To surgically decompress the LFCN,it may be necessary to incise the oblique aponeurosis and iliac fascia medial to the LFCN tendinous canal and to free the iliolata ligaments from the ASIS.(3)the iliolata ligaments form the part of the fascia lata over the LFCN and upper sartorius.