Anatomy of the reflected ligament of the inguinal region

Vol. 50 No. 4, 2009


R. Shane Tubbs, Jenny Gober McDaniel, Amanda M. Burns, Anjali Kumbla, Tiffany D. Cossey, Nihal Apaydin, A. Comert, H. I. Acar, I. Tekdemir, M. M. Shoja, M. Loukas

Background: There is a paucity in the literature regarding the reflected ligament. Therefore, the present study was performed in order to further elucidate this anatomy. Material and Methods: Eighteen formalin-fixed adult cadavers (35 sides) underwent dissection of the medial inguinal region. The reflected ligament was observed for and when identified, its dimensions were measured. Results: 83% of sides were found to have a reflected ligament. These were identified in 16 male and 13 female bodies. The size and shape for the reflected ligaments were variable but overall, triangular in nature. In general, the reflected ligament was found to extend from the lacunar and medial inguinal ligaments and extended obliquely toward the midline at an approximate 450 angle to insert near the linea alba. Two ligaments (6.9 %) were identified that interdigitated with the contralateral reflected ligament. The medial and lateral lengths of the ligament had a mean measurement of 2.28 and 2.58 cm. The base of the reflected ligament had a mean of 2.52 cm and the height of this ligament was found to have a mean of 2.56 cm. The mean area of the reflected ligament was calculated as 2.93 square-cm. There was no statistically significant difference between right or left sides or between genders. Conclusions: The reflected ligament was identified in the majority of our specimens and this structure usually contributed to the formation of the posteromedial wall of the external inguinal ring. Therefore, this fact should be included in future descriptions of this ligament.

Corresponding author: Richard Shane Tubbs, MD, PhD, e-mail:

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