Unidentified Branches of the Posterior Femoral Cutaneous Nerve and Persistent Neuropathy

The posterior femoral cutaneous nerve (PFCN) is an extensive nerve with numerous collateral branches which provide cutaneous innervation to 2/3(rds) of the posterior thigh, the infragluteal fold, as well as the lateral anal region, scrotum, and labia majora through its inferior cluneal and pudendal nerve branches. It has been noted in multiple studies that patients can experience persistent PFCN neuropathy after surgery for decompression of known collateral branches. In this study, we used 17 formaldehyde (7 male and 10 female) perfused cadavers obtained from Hershey Medical Center’s donor program to study the branching patterns of the PFCN. As a result, we found that 41% of individuals have an unidentified proximal branch of PFCN that recurs over the inferolateral border of the gluteus maximus, suggesting other areas of potential compression or nerve entrapment that could lead to persistent PFCN neuropathy that’s not improved after treatment for sciatic, pudendal, or inferior cluneal neuralgia. We hope these findings allow clinicians to modify current surgical techniques and improve patients’ post-operative quality of life.