Now, let’s move on to the gluteal region, and
this is supplied by the gluteal arteries,
the superior and the inferior gluteal arteries.
We can see these on the screen here.
Posterior dissection of the gluteal region, we can
see the superior gluteal artery here, and we can
see the inferior gluteal artery coming out here.
Remember, these are an important relationship
to piriformis muscle; superior to piriformis
and inferior to piriformis. We can see they’re
running over towards the head of the femur.
If you look on this side of the screen, we
can see that there’s the potential for some
anastomosis between the gluteal arteries coming
from the internal iliac, and the circumflex
arteries coming from the profunda femoris,
the deep artery. And we can see here we’ve
got numerous branches. Here, we’ve got the
lateral circumflex artery that’s running
all the way around the proximal aspect of
the femur. And then here, we can see we’ve
got the medial circumflex artery which is
coming around in this direction and going
up towards the medial aspect of the femur.
So we’ll have a look at this anastomosis. But
let’s have a look at the gluteal arteries.
They arise from the internal iliac within
the pelvis. And they enter the gluteal region
by passing through the greater sciatic foramen.
The superior gluteal artery passes through
the suprapiriform foramen. This is above piriformis.
And the inferior gluteal artery passes through
the infrapiriform foramen. This is below piriformis.
This superior gluteal artery is going to supply
gluteus medius, minimus, and tensor fascia
lata. Here, we can see piriformis muscle,
this triangular-shaped muscle here. And coming
from above piriformis, we have the superior
gluteal neurovascular bundle, and this superior
gluteal artery is here. Inferior to piriformis,
we have the inferior gluteal artery coming
out. We can see it here. And that is going
to supply gluteus maximus. It also supplies
obturator internus, quadratus femoris, and
provides blood to the proximal posterior thigh
muscles. And here we have an important connection
between profunda femoris and the inferior gluteal
artery. And this is known as the cruciate
anastomosis. So the cruciate anastomosis is
formed by four blood vessels. And only some
of them we can see here. But cruciate means
cross. So we have the inferior gluteal which
is sending a branch downwards. We have the
inferior gluteal which is sending a branch
downwards here. We also have the medial circumflex,
and we’ve got the medial circumflex which
is sending a branch transversely across. Remember,
medial circumflex is going to be positioned
deep the quadratus femoris. So now quadratus
femoris has been reflected. We can see
that here. We also have, coming from the lateral
aspect another transverse branch. So the medial
and the lateral circumflex arteries running
around the proximal aspect of the femur form
these transverse branches. Feeding down into
descending branch from inferior gluteal and
running upwards is going to be an ascending
branch from the first perforating artery,
and the first perforating artery comes from
the profunda femoris artery. So we have one
coming down, inferior gluteal branch, one
coming up from the first perforating, and
two, running transversely to form this cross
there from the medial and lateral circumflex.
This is known as the cruciate anastomosis.