Structures that pass behind the medial malleolus beneath the flexor
retinaculum (medial to lateral) [Tom Does Very Nice Hat]
. 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).
With the thigh flexed, abducted & laterally rotated:
It corresponds to the upper T" of a line drawn from the mid-inguinal point to
It is the main artery of the LL & also supplies
Superficial external pudendal artery.
S uperficial epigastric a rtery.
Superficial circumflex iliac 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
li1fii*-li[H'n#;i,,. " ad d u c,. r
o Qqscending genicular aftery (anastomtica magna):
{S - rnf,l into the collateral circulation around the knee.
o Common Femoral arterv: (above origin of profunda femoris artery)
[ii:i:,[: i#:t;'il :;", -;; nerve a n d
. 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
- 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.
. 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
, The contents of the inguinal canal are protected by upward retraction.
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
-7[-t tf'," lower border of popliteus muscle by dividing into 2 terminal branches:
anterior & posterior tibial arteries.
a) Popliteal artery is the commonest site of peripheral arterial aneurysm
. 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.
BeClruS: At the tower border of poptiteus muscte
as the larger of 2 terminal branches of
COUnSg: lt descends in the posterior
compartment of leg, accompanied by posterior
Tibial nerve, between superficial & deep calf
EttOS: Deep to flexor retinaculum midway between
medial malleolus & calcaneus by dividing into
lateral & medial plantar arteries.
1. Muscular branches &nutrient artery of tibia.
2. Circumflex fibular & peroneal arteries.
3. Calcanean &medial malleolar arteries.
At the lower border of popliteus muscle as the smaller
of the 2 terminal branches of popliteal artery.
ln front of the ankle joint midway between the 2
malleoli by becoming the dorsalis pedis artery.
1. Posterior and anterior tibial recurrent arteries.
3. Anterior medial malleolar artery.
4. Anterior lateral malleolar artery.
BeOtruS: As a direct continuation
E tt OS : tn the sote by compteting
Medial & lateral tarsal arteries.
Arcuate artery (gives the 2nd,
3rd & 4th metatarsal arteries).
ol anterior tibialartery in front of ankle
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.
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
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
!ts- Anastomosis around the Knee Joint
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.
1- Venae comittant with the anterior & posterior tibial arteries.
) which together form the popliteal vein ) then the femoral vein.
Accompanies femoral artery through opening in adductor magnus.
ln the adductor canal: saphenous nerve passes from lateral to
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.
saphenous opening 4 cm below &
It accompanies the saphenous nerve
in the leg (might be injured during
stripping operation ) anesthesia or
hyperesthesia in medial side of the
From lateral part of the venous arch.
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
It accompanies the sural nerve.
3 superficial veins drain into the long saphenous:
- Superficial circumflex iliac.
- Superficial external pudendal.
- 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
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