Preventing Severe Complications in Labium Minus by Preserving the Neurovascular Bundle: Anatomy and New Surgical Technique.

backgroundSurgical injury to the labium minus neurovascular bundle (NVB) can result in severe iatrogenic, ischemic, and neurological complications, including labium minus posterior nerve neuropathy and pudendal nerve neuralgia.

methodsThe objectives are to identify the anatomical distribution of the neurovascular bundle (NVB) within the labium minus and to develop a new surgical intervention to protect the labia minora from severe complications. Additionally, to answer the study question: "Can preservation of the labia minora NVB reduce severe surgical complications?" Anatomical dissection of the labia minora was performed on ten adult female fresh cadavers (group I) and twenty living women (group II). Pictorial documentation was obtained from both groups.

resultsThe study's findings established the role of the labium minus NVB in ischemic and neurological complications. Anatomical dissection in group I showed that the perineal NVB enters the posterior-inferior labium minus, on average, 1.2 cm from the midline, then courses upwards and bifurcates to create the labial inferior branch, which runs horizontally within the labial base, and the superior branch, which also runs horizontally and below the labial free margin. Multiple anastomoses between the main branches of NVB run vertically. The deep femoral neurovascular bundle connects to the superior labial NVB.

conclusionsThe labium minus NVB pathway is a complex network with multiple anastomoses. A newly developed and clinically tested surgical intervention effectively eliminates ischemic and neurological complications of the labia minora. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .