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Download MBBS Anatomy PPT 87 Femoral Triangle Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Human Anatomy ppt lectures Topic 87 Femoral Triangle Notes. - anatomy ppt free download human anatomy ppt lectures, medicine notes ppt, anatomy handwritten notes pdf, mbbs 1st year anatomy notes pdf download, best anatomy notes pdf, human anatomy notes pdf, anatomy easy notes pdf, anatomy notes online, anatomy short notes, Anatomy ppt, Powerpoint Presentations and lecture notes.

This post was last modified on 05 April 2022






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OBJECTIVES

Describe the anatomy of femoral triangle &

adductor canal regarding:

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site, boundaries and contents.
Femoral sheath
Femoral canal
Femoral hernia -applied

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SARTORIUS

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ORIGIN

Anterior superior iliac
spine

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INSERTION

S

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Upper part of medial

S

surface of tibia

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ACTION

(TAILOR'S POSITION)

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Flexion, abduction &
lateral rotation of hip joint
Flexion of knee joint


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PECTINEUS

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ORIGIN:
Superior pubic
ramus
INSERTION:

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P

P

Back of femur

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(below lesser
trochanter)
ACTION:
Flexion &
adduction of hip

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joint


ILIOPSOAS: ILIACUS & PSOAS MAJOR

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I P

M

I P

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M

INSERTION:

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ACTION:

Lesser trochanter of femur

Flexion of hip joint

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Femoral triangle

Contents

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? Femoral n.
? Femoral sheath
? Femoral a. and its branches
? Femoral vein and its tributaries.
? Femoral canal

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? Deep inguinal lymph nodes
? Fatty tissue



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Femoral triangle

Femoral sheath
? A funnel- shaped sheath

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? Derived from transversalis

fascia anteriorly and iliac fascia
posteriorly

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? It surrounds the femoral vessels

and lymphatic about 2.5cm
below the inguinal ligament.

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Femoral sheath

Femoral sheath

Divided into three

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compartments by two
fibrous septa

? Lateral compartment:

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femoral a.

? Middle compartment:

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femoral v.

? Medial compartment:

femoral canal

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The femoral canal

? About 1.3cm long , and its upper

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opening is called the femoral ring

? Content: a little loose fatty tissue, a

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small lymph node of CLOQUET and
some lymph vessels.

? The boundaries of the femoral ring

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? Anteriorly: the inguinal ligament
? Medially: the lacunar ligament
? Posteriorly: the pecten of pubis
? Laterally: the femoral vein
? Superior: covered by femoral

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septum

Femoral hernia

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? If a loop of intestine is forced into the

femoral ring, it expands to form a
swelling in the upper part of the thigh.
Such a condition is known as a femoral

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hernia .

? A femoral hernia is more common in

women than in men (possibly because

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their wider pelvis and femoral canal ).


Femoral Triangle

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Arrangement of Nerve, Artery,

Vein

From medial to lateral

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Femoral Vein

V

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Femoral Ar

A tery

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Femoral Ner

N ve

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VAN




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Profunda femoris

? Arises from the posterolateral surface of

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the femoral artery about 5 cm below the
inguinal ligament.

? Branches:

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? Lateral circumflex artery.
? Medial circumflex artery.
? Perforating arteries


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Profunda femoris A

Medial circumflex a.

Lateral circumflex a.

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perforating arteries


Femoral vein

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? Begins at the adductor



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tendinous opening

? Continues as external iliac

vein deep to inguinal ligament

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? Contains several valves



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Femoral nerve

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? Arises from the lumbar plexus in the

abdomen, and enters the thigh posterior to
the inguinal ligament and lateral to the

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femoral artery.

? It ends by dividing into a number of

branches 2 cm below the inguinal ligament.

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? Muscular branches to: pectineus, sartorius,

quadriceps femoris

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Femoral nerve

? Cutaneous branches:

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? Anterior cutaneous nerves of

the thigh

? Saphenous nerve is the

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longest branch of the femoral
nerve. It accompanies the
femoral vessels in the adductor
canal, then accompanies the

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great saphenous vein to the
medial side of the leg and food.

Femoral n.

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Femoral a.

Femoral v.

Saphenous nerve

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The deep inguinal lymph nodes


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? Lie medial to the femoral v.

? Receive deep lymphatics of

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lower limb, perineal region,
and efferent lymphatics from
the superficial inguinal ln.

? Drain into the external iliac

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ln.
Applied/Clinical Anatomy


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? -stab wound at the apex of the femoral triangle may

cut all the large vessels of the lower limb , injury to
femoral vessels results in fatal hemorrhage.

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? -femoral artery is quite superficial in the femoral

triangle thus can be easily exposed for ligation.
catheters are passed upwards till the heart for certain

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minor operations.

? -femoral vein is commonly used fir intravenous

infusions in infants.

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Clinical Relevance of the Femoral

Triangle


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? Femoral Pulse

? Just inferior to where the femoral artery crosses the

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inguinal ligament, it can be palpated to measure the
femoral pulse.



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? The femoral artery crosses exactly midway between

the pubis symphysis and anterior superior iliac spine.
The presence of a femoral pulse means that blood is
reaching the lower extremity.

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Access to the Femoral Artery

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? Within the femoral triangle, the femoral artery

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is located superficially, and thus easy to
access. This makes it suitable for a range of
clinical procedures.

? One such procedure is coronary angiography.

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? Here, the femoral artery is catheterized with a

long, thin tube. This tube is navigated up the
external iliac artery, common iliac artery,

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aorta, and into the coronary vessels.

Cardiac catheterization

? (also called heart catheterization) is a diagnostic and occasionally

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therapeutic procedure that allows a comprehensive examination of
the heart and surrounding blood vessels.

? It enables the physician to take angiograms

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? record blood flow,

? calculate cardiac output and vascular resistance

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? perform an endomyocardial biopsy, and evaluate the heart's

electrical activity.

? Cardiac catheterization is performed by inserting one or more

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catheters (thin flexible tubes) through a peripheral blood vessel in
the arm (antecubital artery or vein) or leg (femoral artery or vein)
under x-ray guidance.

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Coronary artery balloon angioplasty



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? A radioactive dye is then

ejected into the coronary
vessels,

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and

any

wall

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thickening or blockages can
be

visualized

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via

x-ray

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imaging.

? The femoral artery can also

be catheterised to draw

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blood for arterial blood
gases.



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FEMORAL VENOUS CATHETERIZATION

? Indications
? Emergency

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venous

access

during cardiopulmonary resuscitation

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(CPR), in that it provides a rapid and
reliable route for the administration of
drugs to the central circulation of the
patient in cardiac arrest

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? In hypotensive trauma patients
? Urgent or emergency hemodialysis

access

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? Hemoperfusion access in patients with

severe drug overdose

? Central venous pressure monitoring

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EMBALMING


FEMORAL SHEATH

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? The femoral artery, vein

and canal are contained
within a fascial

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compartment ? known
as the femoral sheath.



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THE FEMORAL CANAL

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? The femoral canal is an anatomical

compartment, located in the anterior thigh. It
is the smallest and most medial part of

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the femoral sheath.

? It is approximately 1.3cm long.

FEMORAL CANAL - BOUNDARIES

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? The femoral canal is located in the anterior

thigh, within the femoral triangle. It can be
thought of as a rectangular shaped

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compartment.

? It has four borders and an opening:

? Medial border ? Lacunar ligament.

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? Lateral border ? Femoral vein.

? Anterior border ? Inguinal ligament.

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? Posterior border ? Pectineal ligament,

superior rami of the pubi and the pectineus
muscle

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Borders of the femoral canal

? The opening to the femoral canal is located at its

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superior border, known as the femoral ring. The
femoral ring is closed by a connective tissue layer ?
the femoral septum.

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? This septum is pierced by the lymphatic vessels

exiting the canal.

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CONTENTS


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? The femoral canal contains:

? Lymphatic vessels ? draining the deep

inguinal lymph nodes.

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? Deep lymph node ? the lacunar node.

? Empty space.

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? Loose connective tissue.

? The empty space allows distension of the

adjacent femoral vein, so it can cope with

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increased venous return, or increased intra-
abdominal pressure..


Clinical Relevance: Femoral Hernia

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? The femoral canal is of particular clinical importance,

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as it a common site of bowel herniation.

? A hernia is defined as `where an internal part of the

body pushes through a weakness in the muscle or

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surrounding tissue wall`.

? In a femoral hernia, part of the small intestine

protrudes through the femoral ring.

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FEMORAL HERNIA

? It presents as a lump

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situated inferolaterally to
the pubic tubercle.

? more common in women

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due to

? their wider bony pelvis
? Narrower blood vessels

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FEMORAL HERNIA

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? The borders of the femoral canal

are tough, and not particularly
extendible.

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? This can compress the hernia,

interfering with its blood supply.

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A hernia with a compromised
blood supply is known as
a strangulated hernia


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Femoral Canal


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? During open femoral hernia repair lacunar ligament may

have to be incised ? this puts an accessory obturator artery
at risk

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? 50% of people have an accessory or abnormal obturator

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artery



? Accessary Obturator Artery:

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? Deep inferior epigastric gives a pubic branch to the

periosteum of superior pubic ramus ? this anastamoses
with the pubic braches of obturator artery

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? If obturator artery absent ? then this anastamosis is

patent

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Cross-section of the thigh, showing

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the borders of the adductor canal.

Note: the adductor magnus is not visible in this
illustration

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CONTENTS



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? The adductor canal serves as a passageway from

structures moving between the anterior thigh and
posterior leg.

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? It contains the femoral artery, femoral vein, nerve to

the vastus medialis and the saphenous nerve (the

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largest cutaneous branch of the femoral nerve).



? As the femoral artery and vein exit the canal, they

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become the popliteal artery and vein respectively.


Clinical Relevance ? Adductor Canal

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Block



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? In the adductor canal block, local anaesthetic is

administered in the adductor canal to block
the saphenous nerve in isolation, or together
with the nerve to the vastus medialis.

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? The block can be used to provide sensory

anaesthesia for procedures involving the distal
thigh and femur, knee and lower leg on the

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medial side.

? The sartorius and femoral artery are used as

anatomical landmarks to locate the saphenous

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nerve.


Adductor Canal Compression

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Syndrome



? Adductor

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canal

compression

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syndrome

describes entrapment of the neurovascular
bundle within the adductor canal.

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? caused by hypertrophy of adjacent muscles such

as vastus medialis.

? It is most common in young males, who may

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present with claudication symptoms due to
femoral artery occlusion (more common) or
neurological symptoms due to entrapment of the
saphenous nerve.

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Adductor canal

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? An intermuscular cleft situated on the medial aspect of

the middle third of the thigh beneath the sartorius.

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? Extends from apex of femoral triangle to adductor

tendinous opening

? Boundies

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? Anterior wall: adductor lamina and sartorius
? Lateral wall : vastus medialis
? Posteomedial wall: adductors longus and magmus

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? Contents

? Saphenous n.
? Femoral a. and femoral v.
? lymphatic vessels and loose connective tissue

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Femoral triangle / RELATIONS

Deep contents

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?Femoral a. & v.
surrounded by
femoral sheath


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?Profunda
femoris a. ?
principal artery
of thigh

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?Lat and med.
femoral

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circumflex aa.



?Deep external

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pudendal a.



?Femoral n.

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?A few deeper
lymph nodes --

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Anterior view


Femoral triangle / RELATIONS

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Anterior view

Blood vessels and nerve of medial side of thigh

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? Obturator a.

? Arises from internal iliac artery in the

lesser pelvis

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? passes through the obturator canal where

it divides into anterior and posterior
branches.

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? Obturator n.

? Arises from the lumbar plexus in the

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abdomen.

? Enters the thigh through the obturator

canal where it divides into anterior and

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posterior branches.

? Supplies medial group of muscles of thigh,

obturator externus, and skin of medial

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side of thigh


Test

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Question

Answer

? What is the midinguinal

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? ? way between PS and ASIS

point?

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? Name the structure for

? Femoral artery

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which the midinguinal point



is a landmark?

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Test

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Question

Answer

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? What is the Midpoint of

? ? way between PT and ASIS

Inguinal Ligament?

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? Name the structure for

? Deep inguinal ring

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which the midinguinal point



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is a landmark?




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Test

Question

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Answer

? What are the

? Anterior ? medial part of inguinal

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borders of the

ligament

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Femoral Ring?

? Lateral ? femoral vein
? Posterior ? pectineal ligament and

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pectaneus

? Medial ? crescentic edge of

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lacunar ligament