Download MBBS Anatomy PPT 87 Femoral Triangle Notes

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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