Blood Supply of the Scrotum
The scrotum receives its arterial blood supply from two main vascular systems: the external pudendal arteries (branches of the femoral artery) and the internal pudendal arteries (branches of the internal iliac artery), which give rise to multiple scrotal branches that extensively anastomose across three distinct cutaneous territories 1.
Primary Arterial Sources
External Pudendal System
- Inferior external pudendal arteries are the dominant supply to the lateral scrotal territories
- These vessels access the scrotum at the midpoint of the scrotal root and fan out to cover each entire hemiscrotum
- Each lateral territory receives its own inferior external pudendal artery 1
Internal Pudendal System
- Internal pudendal arteries give rise to perineal arteries, which continue as the main scrotal arteries
- These vessels supply the central cutaneous territory by accessing via the posterior scrotal face
- They run deeply on both sides of the scrotal septum 1
- In canine anatomy (which parallels human), the ventral perineal arteries course ventrally and cranially toward the caudal scrotum before terminating as the dorsal scrotal arteries 2
Anatomical Distribution Pattern
The scrotal skin is organized into three interconnected cutaneous territories:
- Two lateral territories: Each supplied by an inferior external pudendal artery
- One central territory: Vascularized by branches of the two main scrotal arteries (continuations of perineal arteries)
- These territories demonstrate extensive inter-anastomosis, providing robust collateral circulation 1
Clinical Relevance
This dual vascular supply with rich anastomotic networks explains why:
- Scrotal flaps based on either vascular system can be reliably designed for urethral reconstruction
- The caudal/posterior blood supply (from perineal arteries) can support longitudinal median island scrotal flaps with profuse axial vascularization 1
- Color Doppler and spectral Doppler ultrasound can effectively evaluate scrotal perfusion in acute pathology 3
The dorsal scrotal arteries appear to supply a larger area than the ventral scrotal arteries, making the caudal perineal skin particularly valuable as a cutaneous pedicle for reconstructive procedures 2.