3 superficial veins drain into the long saphenous: - Superficial circumflex iliac. - Superficial epigastric. - Superficial external pudendal. Other tributaries: - Antero-lateral: from the thigh. - Postero-medial: from the thigh.

 

Structures that pass behind the medial malleolus beneath the flexor

retinaculum (medial to lateral) [Tom Does Very Nice Hat]

. Tibialis posterior tendon.

o Flexor digitorum longus.

. Posterior tibial vessels.

. Tibial nerve.

o Flexor hallucis Iongus.

. Synovial sheaths of all the tendons.

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BgClruS: As the continuation of external iliac artegybehind the mid-inguinal

pffiiaway between A.S.l.S. & symphysis pubis). {f

E ru OS : By becoming the popliteal artery by passing through an opening in the

adductor magnus between its 2 insertions (10 cm above knee joint).

SuRrece Aruerouv:

With the thigh flexed, abducted & laterally rotated:

It corresponds to the upper T" of a line drawn from the mid-inguinal point to

the adductor tubercle.

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It is the main artery of the LL & also supplies

wall.

A) 3 Superficial

Superficial external pudendal artery.

S uperficial epigastric a rtery.

Superficial circumflex iliac artery.

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external pudendal artery.

femoral artery (profunda femoris artery):

It arises from the postero-lateral aspect of the common

femoral artery 2-4 cm distalto the inguinal ligament.

It is the main supply to medial & posterior compartments

of the thigh.

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o Common Femoral arterv: (above origin of profunda femoris artery)

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femoral nerve.

. Posteriorly il lies on psoas major and pectineus muscle.

o Superficial Femoral arterv: (below origin of profunda femoris artery)

o Passes first in the femoral triangle.

- Deep to it are the profunda vessels, pectineus & adductor

longus muscles,

- The femoral vein is first medial then behind the artery.

. Then the artery passes in Hunter's canal.

- lt lies posterior to sartorius.

- The femoral vein is first behind then lateral to the artery.

Exposune

. The femoral vessels are best exposed by a vertical incision 15 cm long

and centered over the mid-femoral point.

. The deep fascia of the leg is incised and the artery is found lying lateral

to the common femoral vein.

, The contents of the inguinal canal are protected by upward retraction.

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B gC lru S : As a continuation of femoral artery at the adductor hiatus.

C O U RS g : lt descends as the deepest structure in the popliteal fossa over

the floor of popliteal fossa.

Ettos:

-7[-t tf'," lower border of popliteus muscle by dividing into 2 terminal branches:

anterior & posterior tibial arteries.

BRencn es:

SuncrcAL IurpoRTANcE:

a) Popliteal artery is the commonest site of peripheral arterial aneurysm

due to:

. Constant pulsation of the artery against the underlying adducter

magnus may cause changes in the arterialwall.

. Popliteal artery is fixed to the capsule of the knee joint by fibrous

band just above the femoral condyles. This may be a source of

continuous traction on the artery.

b) Popliteal pulse is palpated easily when leg is semi-flexed.

LOWE LIMB I

BeClruS: At the tower border of poptiteus muscte

as the larger of 2 terminal branches of

popliteal artery.

COUnSg: lt descends in the posterior

compartment of leg, accompanied by posterior

Tibial nerve, between superficial & deep calf

muscles.

EttOS: Deep to flexor retinaculum midway between

medial malleolus & calcaneus by dividing into

lateral & medial plantar arteries.

Bneucnes:

1. Muscular branches &nutrient artery of tibia.

2. Circumflex fibular & peroneal arteries.

3. Calcanean &medial malleolar arteries.

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BeCINS:

At the lower border of popliteus muscle as the smaller

of the 2 terminal branches of popliteal artery.

ENoS:

ln front of the ankle joint midway between the 2

malleoli by becoming the dorsalis pedis artery.

Bnlucnes:

1. Posterior and anterior tibial recurrent arteries.

2. Muscular branches,

3. Anterior medial malleolar artery.

4. Anterior lateral malleolar artery.

5. Circumflex fibular artery.

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BnnrucHES:

Medial & lateral tarsal arteries.

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The arteries of the sole of the foot are derived

from the posterior tibial artery. It splits into

medial and lateral plantar arteries.

Medial plantar arterv passes along the medial

part of the sole of the foot and terminates by

branching into digital branches.

Lateral plantar arteru becomes the plantar

arterial arch which anastomoses by way of a

perforating artery with dorsalis pedis artery. The

arch gives rise to several metatarsal branches

which split into digital branches.

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LOWE LrMB I

A- Cruciate Anastmosis of the Thigh

This anastomosis is placed on the back of the

thigh a short distance below the greater

trochanter and looks like a cross.

It has 2 limbs: horizontal & vertical

o tJpper descending limb ) Superior & inferior

gluteal arteries.

oLower ascending timb > 1't perforating artery'

oMediat horizontal limb ) transverse branches

of medial circumflex femoral artery'

o Lateral horizontal limh ) transverse branches

of lateral circumflex femoral artery'

Advantages of Cruciate anastomosis:

It connects internal iliac artery with

femoral artery. So, if external iliac is

obstructed, the internal iliac artery can

supply the thigh.

!ts- Anastomosis around the Knee Joint

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Descending genicular branch of femoral artery'

Descending branch of the lateral circumflex femoral artery.

5 genicular branches from popliteal a(ery.

Anterior and posterior tibial recurrent branches from the anterior tibial artery.

Circumflex fibular branch of the posterior tibial artery'

The venous system of the lower limb is formed of superficial & deep systems

according to the relation to the deep fascia & perforators to communicate both.

It starts by:

1- Venae comittant with the anterior & posterior tibial arteries.

2- Peroneal veins.

3- Soleal venous plexus.

) which together form the popliteal vein ) then the femoral vein.

The femoral vein:

Accompanies femoral artery through opening in adductor magnus.

ln the adductor canal: saphenous nerve passes from lateral to

medial superficial to it.

Passes anterior to the upper attachment of the pectineus muscle.

From medial part of the venous arch.

ln front of the medial malleolus.

!n the medial side of the leg.

Postero-medial to the medial condyle.

Joins the femoral vein at the

saphenous opening 4 cm below &

lateralto the pubic tubercle.

It accompanies the saphenous nerve

in the leg (might be injured during

stripping operation ) anesthesia or

hyperesthesia in medial side of the

leg).

From lateral part of the venous arch.

Behind the lateral malleolus.

ln the lateral side of the leg.

Posterior to the popliteal fossa.

Joins the popliteal vein in the middle

of popliteal fossa (sapheno-popliteal

junction is variable, as short

saphenous may open in the femoral

or long saphenous vein).

It accompanies the sural nerve.

LOWE LIMB I

3 superficial veins drain into the long saphenous:

- Superficial circumflex iliac.

- Superficial epigastric.

- Superficial external pudendal.

Other tributaries:

- Antero-lateral: from the thigh.

- Postero-medial: from the thigh.

- Vein of Leonardo da Vinci: from the calf.

Long saphenous is the longest vein in the body.

The commonest site for vene-section of long saphenous vein is anterior to

the medial malleolus.

Long saphenous contains valves ) unidirectional blood flow,

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