Femoral Triangle and Adductor Canal, Study notes of Anatomy

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Femoral Triangle and Adductor Canal Dr. Heba Kalbouneh Associate Professor of Anatomy and Histology Inguinal ligament Pubic symphysis Femoral triangle Pectineus muscle Adductor longus muscle Gracilis muscle Adductor magnus muscle Sartorius muscle Adductor hiatus Femoral triangle Adductor canal Femoral Triangle and Adductor Canal Roof: Formed by 1-Skin 2-Superficial fascia and its contents 3-Deep fascia containing the saphenous opening Genitofemoral nerve (femoral branch) Ilioinguinal nerve Great saphenous vein Superficial inguinal lymph nodes Genitofemoral nerve (femoral branch) Contents of the femoral triangle 1-Femoral nerve and its branches 2-Femoral artery and its branches 3-Femoral vein and its tributaries 4-Deep inguinal lymph nodes 5- Femoral sheath!!! 6-Femoral branch of genitofemoral nerve 7-Lateral cutaneous nerve of the thigh Lateral cutaneous nerve of the thigh Femoral nerve Femoral artery Femoral vein Deep inguinal lymph nodes Nerve Artery Vein Inguinal lymph nodes NAVI gate The femoral triangle from lateral to medial The femoral sheath is formed by a downwards extension of the abdominal fascia Anterior wall: is a downward prolongation of the fascia transversalis of the anterior abdominal wall Posterior wall: is a downward prolongation of the fascia iliaca of the posterior abdominal wall Two Anterio-posterior septa divide the sheath into 3 compartments: 1-Lateral compartment (arterial) occupied by the femoral artery and femoral branch of the genitofemoral nerve 2-Intermediate compartment (venous) occupied by the femoral vein 3-Medial compartment (lymphatic) occupied by the lymph vessels and one of the deep inguinal lymph nodes (femoral canal) Femoral canal Is the small medial compartment of the femoral sheath. 0.5 inch in length (just admits the tip of the little finger) Base: directed upwards, towards the abdominal cavity called the femoral ring The femoral ring is closed by a condensation of extraperitoneal tissue called femoral septum Apex: directed downwards, its closed by fusion of its wall Inguinal ligament Ilium Pectineal ligament Lacunar ligament Anteriorly: Inguinal ligament Medially: Lacunar ligament (the sharp free edge that connects the inguinal ligament to the pectineal ligament) Laterally: Femoral vein Posteriorly: Pectineal ligament (the thickened periosteum along the pectineal line of the superior pubic ramus and continues medially with the lacunar ligament) The boundaries of the femoral ring are: Inguinal ligament Ilium Pectineal ligament Lacunar ligament Because of these anatomic structures, the neck of the sac is unable to expand. Once an abdominal viscus has passed through the neck into the body of the sac, it may be difficult to push it up and return it to the abdominal cavity (irreducible hernia). Furthermore, after the patient strains or coughs, a piece of bowel may be forced through the neck, and its blood vessels may be compressed by the femoral ring, seriously impairing its blood supply (strangulated hernia). A femoral hernia is a dangerous condition and should always be treated surgically Pectineal ligament Inguinal ligament Lacunar ligament PRIMAE PICTURES [3 ne Differential diagnosis of a femoral hernia Consider diseases that may involve other anatomic structures close to the inguinal ligament. Inguinal hernia: The swelling lies above and medial to the pubic tubercle. Superficial inguinal lymph nodes: Usually, more than one lymph node is enlarged. In patients with inflammation of the nodes (lymphadenitis), carefully examine the entire area of the body that drains its lymph into these nodes. Great saphenous vein: A localized dilatation of the terminal part of the great saphenous vein (saphenous varix) Psoas sheath: Tuberculous infection of a lumbar vertebra can result in the extravasation of pus down the psoas sheath into the thigh. Femoral artery: Aneurysm of the femoral artery Anterior superior iliac spine Inguinal ligament Femoral nerve Femoral artery Femoral vein Lymphatics passing through femoral canal Pubic tubercle Medial margin of sartorius muscle Pubic symphysis Medial margin of adductor longus muscle Femoral triangle Surface anatomy Adductor canal (Subsartorial) or Hunter’s canal John Hunter described the exposure and ligation of the femoral artery in this canal for aneurysm of the popliteal artery; this method has the advantage that the artery at this site is healthy and will not tear when tied, as may happen if ligation is attempted immediately above the aneurysm Transverse section through the middle of the left thigh as seen from above The Anteriomedial wall is formed by: Sartorius and fascia The posterior wall (floor) is formed by: Adductor longus and magnus The Anterolateral wall is formed by: Vastus medialis The posterior wall is formed by: Adductor longus and magnus Adductor longus Adductor magnus The adductor canal contains 1- Femoral artery 2- Femoral vein 3- Saphenous nerve 4- Nerve of vastus medialis 5- Obturator nerve 6- Subsartorial plexus of nerves Subsartorial plexus of nerves: Located on the fascia under the sartorius and is formed by branches from 1- Medial cutaneous nerve of the thigh 2- Saphenous nerve 3- Obturator nerve In the upper part of its course, femoral artery lies in the femoral triangle (superficial) covered by skin and fascia 1-Exposed to injuries 2-Good approach for taking femoral pulse 3- Femoral Artery Catheterization Branches of the femoral artery THREE superficial branches TWO deep branches They supply cutaneous regions of the upper thigh, lower abdomen, and perineum. Superficial branches 1-Superficial circumflex iliac artery 2-Superficial epigastric artery 3-Superficial external pudendal artery Deep branches 1-Deep external pudendal artery 2-Profunda femoris artery Branches of the femoral artery in the adductor canal Descending genicular artery The profunda femoris artery (Deep artery of thigh) arises from the posterolateral side of the femoral artery about (4 cm) below the inguinal ligament it gives off A) Medial femoral circumflex artery B) Lateral femoral circumflex artery C) Perforating arteries Internal iliac artery External iliac artery Common iliac artery Obturator Artery Obturator Artery  The obturator artery is a branch of the internal iliac artery  It passes forward on the lateral wall of the pelvis and accompanies the obturator nerve  It gives off muscular branches and an articular branch to the hip joint Femoral Vein  Enters the thigh by passing through the adductor hiatus as a continuation of the popliteal vein  Ascends through the thigh, lying at first on the lateral side of the artery, then posterior to it, and finally on its medial side  Leaves the thigh in the intermediate compartment of the femoral sheath and passes behind the inguinal ligament to become the external iliac vein. Tributaries The tributaries of the femoral vein are the great saphenous vein and veins that correspond to the branches of the femoral artery drain into the great saphenous vein 1- Superficial circumflex iliac vein 2- Superficial epigastric vein 3- Superficial external pudendal vein Femoral vein Great saphenous vein Profunda femoris artery