Dr Ahmed Fathalla Ibrahim FEMORAL TRIANGLE Dr Ahmed

Dr. Ahmed Fathalla Ibrahim

FEMORAL TRIANGLE Dr. Ahmed Fathalla Ibrahim

FEMORAL TRIANGLE • • 1. 2. 3. SITE: upper third of front of thigh BOUNDARIES: Superior (Base): inguinal ligament Lateral: medial border of sartorius Medial: medial border of adductor longus 4. Apex: sartorius overlaps adductor magnus Dr. Ahmed Fathalla Ibrahim

FEMORAL TRIANGLE • ROOF: 1. Skin 2. Superficial fascia containing: structures in superficial fascia (see front of thigh I) EXCEPT lateral cutaneous nerve of thigh 3. Deep fascia • FLOOR: from medial to lateral: 1. Adductor longus 2. Pectineus 3. Psoas major 4. Iliacus Dr. Ahmed Fathalla Ibrahim

FEMORAL TRIANGLE • 1. 2. 3. 4. 5. CONTENTS: Femoral sheath Femoral artery Femoral vein Femoral nerve Deep inguinal lymph nodes Dr. Ahmed Fathalla Ibrahim

FEMORAL SHEATH Dr. Ahmed Fathalla Ibrahim

FEMORAL SHEATH • Definition: a funnel-shaped fascial envelope enclosing upper part of femoral vessels • Dimensions: about one & half inches laterally & half an inch medially • Formation: 1. Its anterior wall is a downward continuation of fascia transversalis 2. Its posterior wall is a downward continuation. Dr. of fascia iliaca Ahmed Fathalla Ibrahim

FEMORAL SHEATH • 1. 2. 3. • • • Compartments: Lateral: femoral artery Intermediate: femoral vein Medial: femoral canal that contains: Loose connective tissue, Efferent lymph vessels from deep inguinal lymph nodes, One of deep inguinal lymph nodes Dr. Ahmed Fathalla Ibrahim

FEMORAL CANAL • • 1. 2. 3. 4. Its abdominal opening (femoral ring) is closed by extraperitoneal fatty tissue (femoral septum) Boundaries of femoral ring: Anterior: inguinal ligament Posterior pectineal line Lateral: femoral vein Medial: lacunar ligament Dr. Ahmed Fathalla Ibrahim

FEMORAL CANAL • Importance: accomodates distension of • Applied anatomy: “Femoral hernia” femoral vein during increased venous return in lower limb (e. g. exercise) 1. Definition: protrusion of peritoneum with or without a loop of small intestine through femoral canal 2. Prevalence: more common in female (wider femoral ring) 3. Line of descent: downward, forward then upward 4. Coverings: from inside outward: femoral septum, anterior wall of femoral sheath, Dr. Ahmed Fathalla Ibrahim cribriform fascia, superficial fascia & skin

FEMORAL ARTERY Dr. Ahmed Fathalla Ibrahim

Dr. Ahmed Fathalla Ibrahim

FEMORAL ARTERY • Origin: continuation of external iliac artery at midinguinal point • Course & termination: 1. It crosses femoral triangle 2. It crosses adductor (subsartorial) canal 3. It passes through opening of adductor magnus & continues as popliteal artery Dr. Ahmed Fathalla Ibrahim

FEMORAL ARTERY • Relations in femoral triangle: 1. Anterior: skin & fasciae 2. Posterior: psoas major, pectineus & adductor longus 3. Medial: femoral vein 4. Lateral: femoral nerve • Relations in adductor canal: 1. Anterior: sartorius 2. Posterior: femoral vein, adductor longus & magnus Dr. Ahmed Fathalla Ibrahim

FEMORAL ARTERY • 1. 2. Branches in femoral triangle: Superficial inguinal arteries Deep external pudendal: supplies external genitalia 3. Profunda femoris: largest branch, arises from posterolateral aspect of femoral artery & descends medially anterior to pectineus & between adductor longus & magnus. Branches: medial & lateral circumflex femoral, 4 perforating arteries, ends as the 4 th perforating artery • Branches in adductor canal: Dr. Ahmed Fathalla Ibrahim • Descending genicular: supplies knee joint

FEMORAL VEIN • Origin: continuation of popliteal vein at opening of adductor magnus • Course & termination: 1. Ascends through adductor canal 2. Ascends through femoral triangle 3. Continues as external iliac vein at midinguinal point Dr. Ahmed Fathalla Ibrahim

FEMORAL VEIN • Relations to femoral artery: 1. In adductor canal: posterolateral to artery 2. At apex of femoral triangle: posterior to artery 3. At base of femoral triangle: medial to artery • Tributaries: 1. Great saphenous vein 2. Deep external pudendal vein 3. Profunda femoris vein 4. Medial & lateral circumflex femoral veins Dr. Ahmed Fathalla Ibrahim 5. Descending genicular vein

FEMORAL NERVE Dr. Ahmed Fathalla Ibrahim

FEMORAL NERVE • Origin: branch of lumbar plexus, L 2, 3, 4 • Course & relations: 1. Descends behind inguinal ligament, in the groove between psoas major & iliacus (inside femoral triangle but outside femoral sheath WHY? ) 2. Divides into anterior & posterior divisions Dr. Ahmed Fathalla Ibrahim

FEMORAL NERVE Branches: • From trunk: (Above inguinal ligament) • Muscular to iliacus • From anterior division: 1. Intermediate cutaneous nerve of thigh 2. Medial cutaneous nerve of thigh 3. Muscular to sartorius & pectineus Dr. Ahmed Fathalla Ibrahim

FEMORAL NERVE • From posterior division: 1. Muscular to quadriceps femoris 2. Saphenous nerve: longest cutaenous nerve of body Dr. Ahmed Fathalla Ibrahim

SAPHENOUS NERVE • Descends lateral to femoral artery (in femoral triangle) • Crosses the artery from lateral to medial (in adductor canal) • Pierces deep fascia & becomes subcutaneous (medial to knee joint) • Descends on medial surface of tibia & in front of medial malleolus (with great saphenous vein) • Runs along medial border of foot to end opposite metatarsophalangeal joint of big toe • Supplies medial side of leg & medial border of foot as far metatarsophalangeal joint of big toe & give an infrapatellar branch sharing in Dr. Ahmed Fathalla Ibrahim patellar plexus

DEEP INGUINAL LYMPH NODES • Site: along upper part of femoral vein • Afferents: from: 1. Superficial inguinal lymph nodes 2. Popliteal lymph nodes 3. Deep lymphatics from lower limb • Efferents: pass through femoral canal to end in external iliac lymph nodes Dr. Ahmed Fathalla Ibrahim