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Contents of Lower (Frontal)
- 3. Superficial fascia of thigh Deep fascia of thigh Femoral Triangle Femoral sheath
- 5. 7 cutaneous nerve 3 small cutaneous arteries Great saphenous vein with its tributaries Superficial inguinal (lower lateral region of abs) lymph nodes with lymphatics Prepatellar and subcutaneous infrapatellar bursae in front of knee joint Superficial Fascia
- 7. 1. Seven Cutaneous Nerve Ilionguinal nerve Femoral branch of genitofemoral nerve Lateral cutaneous nerve Intermediate cutaneous nerve of thigh Medial cutaneous nerve Saphenous nerve give infrapatellar branch Occasional cutaneous branch of anterior division of obturator nerve. Superficial Fascia
- 9. 2. Three Cutaneous Arteries (Derived from Femoral Artery) Superficial epigastric artery Superficial circumflex iliac artery Superficial external pudendal artery Even though this artery is branch of femoral artery but it ends in great saphenous vein. Superficial Fascia
- 11. • Begins in the dorsum of foot from medial end of dorsal venous arch. • Runs upward in front of medial malleolus, along medial side of leg and behind knee. • In thigh it incline forwards to reach saphenous opening. • It pierces cribriform fascia and opens into femoral vein. • The arteries receive tributaries from the 3 cutaneous arteries. 3.GreatSaphenousVein Superficial Fascia
- 12. SpecialtyofTheGreat SaphenousVein Connected to the deep vein through perforating vein. Blood flow only from superficial to deep due to valve in perforating vein. The failure of the valve make veins dilated & tortuous (varicose veins). Superficial Fascia
- 13. Arrangement is in T-shape • Lower vertical group that place along the upper part of the great saphenous vein • Upper horizontal group place just below the inguinal ligament Receive afferent lymphatics from • Skin and fascia of lower limb (except the short saphenous territory) • Gluteal region • anterior abdominal wall below the umbilicus • Perineum including the lower par t of anal canal • Female genitalia including vagina below the hymen however it excludes testis • Uterine lymphatics from fundus and body of the uterus The lymph is sent to the deep inguinal lymph nodes 4. Superficial Inguinal Lymph Node Superficial Fascia
- 15. 5. Subcutaneous bursa Superficial Fascia Bursa is a closed sac line with synovial membrane containing synovial fluid Acts as lubricator Structure content is: 1. Prepatellar bursa 2. Subcutaneous infrapatellar bursa
- 17. Deep Fascia
- 19. 1) Fascia Lata Fascia lata sends the intermuscular septa to the linea aspera There are medial, posterior and lateral intermuscular septa - Medial septum is thinner and form cribriform fascia over the saphenous opening - Lateral septum is thicker forming iliotibial tract
- 22. 2) SAPHENOUS OPENING a. An oval gap or aperture in fascia lata. b. Situated 4 cm below and lateral to the pubic tubercle c. The size is 3x1⅟2 d. Between superficial and deep layers of fascia lata
- 23. Superficial layer • By its upper, lower and lateral margin form a sharp edge called falciform margin of saphenous opening. • This margin is adherent to anterior layer of femoral sheath and attached by the cribriform fascia Deep layer • Medially continuous with superficial layer at its lower margin • It pass posterolaterally and disappear behind the femoral sheath • Attached at the pecten pubis
- 24. Cribriform fascia A modified part of deep fascia that cover the saphenous opening This fascia is pierce by: Great saphenous vein Two superficial artery Lymphatics
- 26. • A 2 inches wide - thickened band of deep fascia located at the lateral part of the thigh. • Superiorly attached to the tubercle of iliac crest • Inferiorly attached to the smooth facet on anterior surface of lateral tibial condyle • Superiorly tract split at the greater trochanter of the femur The split will receive an insertion from the • Superficial ¾ of gluteus maximus posteriorly • Tensor fasciae latae anteriorly • When these two muscle contract iliotibial tract tightens and act as splint for knee • Functioning in stabilizing the pelvis on high • Maintain the extension of knee when standing
- 28. Femoral Triangle ( A triangle depression in front of 1/3 of the thigh below the inguinal ligament )
- 30. Boundaries of Femoral Triangle • Lateral boundaries is the medial border of sartorious • Medial boundary is the medial border of adductor longus • Base is the inguinal ligament • Apex is the meeting point of medial and lateral border • Directed inferiorly • Continuous below with the adductor canal
- 31. Roof is made up of: • Skin • Superficial fascia • Deep fascia Base is made up of: Medial; • Adductor longus • Pectinus Lateral; • Iliacus • Tendon of psoas major
- 32. Content of The Femoral Triangle 1 . Femoral artery and its branches (3 deep and 3 superficial branches) 2. Femoral vein and its tributaries : Great saphenous vein Lateral and medial circumflex veins Those corresponding to deep branches of femoral artery 3. Femoral sheath enclosing upper 1 ½ inches of femoral vessel 4. Deep inguinal lymph node 5. Nerves : Femoral nerve Nerve to pectinus Femoral branch of genitofemoral nerve Lateral cutaneous nerve of thigh
- 35. Explain the femoral sheath. Is a downward prolongation. Located behind inguinal ligament . Part of fascial lining of abdominal cavity. Surround upper 4cm of femoral vessel. Funnel shaped, its lateral is vertical and its medial wall is oblique
- 36. Compartment and Contents of Femoral Sheath Two vertical anteroposterior septa divided the sheath into three compartments. a. Lateral (arterial) compartments contains femoral artery and femoral branch of genitofemoral nerve b. Intermediate (venous) compartment contain femoral vein c. Medial (lymphatic) is smallest of all known as femoral canal
- 39. Femoral Canal (medial compartment of femoral sheath) 1. Conical in shape being wide above and narrow below. 2. ½ inches wide and ½ inches long at the base 3. Femoral ring is base and upper end of femoral canal. a. Oval in shape b. Boundaries: Anteriorly is inguinal ligament Posteriorly is pecten of pubis Laterally is septum separating it from femoral vein Medially is concave margin of lacunar ligament
- 40. Femoral canal larger in women because: Greater breadth for female pelvis Relative smaller size of femoral vessel in females Weakening of muscle in abdominal walls in female (femoral hernia)
- 41. FunctionofCanal To accommodate the distension of femoral vein when venous return is increase during muscular activity (advantage) Through which femoral hernia will develop (disadvantage
- 42. Femoral Hernia Femoral hernia is a potential weakness in abdominal wall Course of enlarging hernial sac is typical. Omentum or intestinal loops may protrude down through the femoral ring : 1) First, it passes downwards through femoral canal. 2) Then, forwards through saphenous opening. 3) Finally, upwards along superficial circumflex iliac vessels. During manual reduction of such a hernia, same course must be followed in a reverse direction.