Lower Limb

1. FEMORAL TRIANGLE
Dr M Idris Siddiqui

2. FEMORAL TRIANGLE
• Femoral Triangle is a triangular
depression on the very front of
the upper one-third of the thigh
below the inguinal ligament.
• Its apex is pointed downward.

4. FEMORAL TRIANGLE
• The femoral triangle is a hollow area in
the anterior thigh.
• Large neurovascular structures pass
through this area, and can be accessed
relatively easily.
• Thus, it is an area of both anatomical and
clinical importance.

5. BOUNDARIES OF THE FEMORAL TRIANGLE
• Base: Inguinal ligament.
• Apex: It’s created by the meeting point of the
medial edges of adductor longs and sartorius.
• Floor: It’s gutter-shaped and muscular.
• From lateral to medial side it’s created by these muscles:
– Iliacus.
– Psoas major (tendon).
– Pectineus.
– Adductor longus.
• Roof: The Roof of a Femoral Triangle is created by
the fascia lata having saphenous opening.

8. FEMORAL TRIANGLE
• Borders
• As this area is a triangle, it has three borders:
• Superior border – Formed by the inguinal ligament,
a ligament that runs from the anterior superior iliac
spine to the pubic tubercle.
• Lateral border – Formed by the medial border of
the sartorius muscle.
• Medial border – Formed by the medial border of
the adductor longus muscle. The rest of this muscle
forms part of the floor of the triangle.

9. FEMORAL TRIANGLE
• The superficial fascia overlying the roof includes:
– Superficial branches of the femoral artery and
accompanying veins,
– Upper part of great saphenous vein,
– Superficial inguinal lymph nodes,
– Femoral branch of the genitofemoral nerve, and
– Branches of ilioinguinal nerve.
• The inguinal ligament acts as a flexor retinaculum,
supporting the contents of the femoral triangle during
flexion at the hip.

10. CONTENTS OF THE FEMORAL TRIANGLE
• The primary contents of the Femoral Triangle
are as follows:
–Femoral artery and its branches.
–Femoral vein and its tributaries. Femoral sheath
–Femoral nerve.
–Deep inguinal lymph nodes.
–Lateral cutaneous nerve of the thigh.
• In addition to above structures, Femoral Triangle also
includes:
– Femoral branch of the genitofemoral nerve.
– Fibrofatty tissue.

11. Contents of THE FEMORAL TRIANGLE
• The femoral triangle contains some of the major
neurovascular structures of the lower limb.
• Its contents (lateral to medial) are:
– Femoral nerve – Innervates the anterior compartment of the
thigh, and provides sensory branches for the leg and foot.
– Femoral artery – Responsible for the majority of the arterial
supply to the lower limb.
– Femoral vein – The great saphenous vein drains into the
femoral vein within the triangle.
– Femoral canal – A structure which contains deep lymph
nodes and vessels.
• The femoral artery, vein and canal are contained within
a fascial compartment – known as the femoral sheath.

12. FEMORAL SHEATH
• It’s a funnel-shaped fascial sheath enclosing the upper
3-4 cm of the femoral vessels.
• The femoral sheath is split into 3 compartments by 2
anteroposterior septa.
– The lateral compartment:
• Includes the femoral artery and the femoral branch of the
genitofemoral nerve.
– The intermediate compartment:
• Includes the femoral vein.
– The medial compartment:
• Is small and called the femoral canal.

14. FEMORAL ARTERY AND ITS BRANCHES
• The femoral artery traverses the Femoral Triangle from
the midpoint of its base to the apex.
• The artery enters downward and medially.
– In the base of triangle, it is located lateral to the femoral
vein but at its apex it is located anterior to the vein.
• The femoral artery gives 3 superficial branches:
– Superficial epigastric,
– Superficial circumflex iliac,
– Superficial external pudendal.
• 2 deep branches:
– Profunda femoris
• The profunda femoris is the largest branch of the femoral artery.
– Deep external pudendal.

18. A good way of
remembering the
contents is using
the acronym
NAVEL:
N: Nerve.
A: Artery.
V: Vein.
E: Empty space.
L: Lymph canal.

19. FEMORAL VEIN AND ITS BRANCHES
• The femoral vein accompanies the femoral
artery.
• The vein is posterior to the femoral artery in
the apex and medial to it at the base of the
Femoral Triangle.
• It gets the great saphenous vein and profunda
femoris vein and veins corresponding to the
superficial branches of femoral artery.

20. FEMORAL NERVE
• The femoral nerve is located lateral to the femoral artery,
outside the femoral sheath, in the groove between
the iliacus and the psoas major.
• About 2.5 cm below the inguinal ligament it divides into
anterior and posterior sections which enclose lateral
circumflex femoral artery between them.
• The anterior section produces 2 cutaneous branches-
intermediate and medial cutaneous nerves of the thigh.
– The medial cutaneous branch accompanies the lateral side of
the artery; at the apex of the triangle it crosses the front of the
artery from lateral to medial side.
• The posterior section gives rise to cutaneous nerve,
the saphenous nerve. It goes downward along the lateral
side of the artery

21. THE FEMORAL CANAL
• The femoral canal is the smallest anatomical
compartment, located in most medial part of
the femoral sheath.
• It is approximately 1.3cm long.
• The opening to the femoral canal is located at its
superior border, known as the femoral ring.
– The femoral ring is closed by a connective tissue layer –
the femoral septum.
– This septum is pierced by the lymphatic vessels exiting
the canal. Cloquet’s node is a lymph node situated in the
femoral canal.

23. LATERAL CUTANEOUS NERVE
• It appears underneath the lateral border of the
psoas major above the iliac crest, runs downward
and laterally across the iliac fossa in front of the
iliacus muscle under cover of the iliac fascia.
• It enters the thigh by passing below the lateral end
of the inguinal ligament. Occasionally it goes
through the inguinal ligament.
• It gives cutaneous innervation to the upper lateral
aspect of the thigh.

24. DEEP INGUINAL LYMPH NODES
• The deep inguinal lymph nodes are generally
3 in number and are located medial to the
upper part of the femoral vein.
• The lowest one is situated below the junction
of great saphenous and femoral veins, the
middle one in the femoral canal (the gland of
Cloquet/Rosenmuller), and the greatest one in
the femoral ring.

25. FEMORAL PULSE
• The femoral artery crosses exactly midway between
the pubisc symphysis and anterior superior iliac
spine.
• Just inferior to where the femoral artery crosses the
inguinal ligament, it can be palpated to measure the
femoral pulse.
• The femoral artery crosses exactly midway between
the pubic symphysis and anterior superior iliac
spine (known as the mid-inguinal point).

26. ACCESS TO THE FEMORAL ARTERY
• The location of Femoral Artery is easy to access
because of its superficial location within the
Femoral Triangle, making it suitable for a range of
clinical operations.
• One example of such a procedure is coronary
angiography. In this, the femoral artery is
catheterised with a long, thin tube. This tube is
navigated up the external iliac artery, common iliac
artery, aorta, and into the coronary vessels.
– To view any wall thickening or blockages via X-ray, a
radio-opaque dye is injected into the coronary vessels.

27. FEMORAL HERNIA
• A hernia is defined as “a condition in which part of
an organ is displaced and protrudes through the
wall of the cavity containing it“.
• In the case of femoral hernia, part of the bowel
pushes into the femoral canal, underneath the
inguinal ligament.
• This creates a lump or bulge in the area of the
Femoral Triangle and requires surgical intervention
to treat.