tendons crossing the ankle. Structures that pass anterior to the extensor retinaculum on the anterior surface of the ankle: (medial to lateral) . Saphenous nerve and great saphenous vein (anterior to medial malleolus).

 

IV.B,'The femoral artery bisects the triangb.{S

Femoral vein & its tributaries.

Femoral sheath: surrounding the upper 4 cm of femoral vessels.

Femoral nerve: outside the sheath, but femoral branch of genito-femoral

nerve is inside the sheath

Deep inguinal LNs. {*

Frmoral nerw

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It is the funnel shaped fascial sleeve which encloses the upper 4 cm of

the femoral vessels.

I LowE LIMB

Furucnoru or rne Fenaonel Sneern:

It allows easy & smooth gliding of the femoral vessels during flexion

and extension of the thigh at the hip joint.

Bounoenres & Exrerur

, Sr'fe: below the middle part of Poupart's triangle.

. Shape.'conical.

. Size:4 cm long laterally & 1 cm medially.

. Anterior Wall: fascia transversalis.

. Posterior Wall: fascia iliaca.

CoTvTpARTMENTS

sepfa divide the sheath into 3 compartmenfs:

. Lateral Compartment: contains the femoral artery & the femoral

branch of genito-femoral nerve.

. Middle Compartment: contains the femoral vein.

. Medial Compartment'the femoral canal.

LOWE LIMB I

furnoral vein

Lymdratics

Fcmoralring

fornpartmenh

of thc fomoral

sheatfr:

lnguir*al

lnhnnediate

$aplenrus

Great mplnno$s vei*

Iruler (remonel nrruc):

- lt is the mouth of the femoral canal in the abdomen.

- lt is closed by a plug of fat called femoral septum.

- Boundaries of femoral ring

. $@g!9I: Poupart's ligament (inguinal ligament).

. E!g1igl: Cooper's ligament (pectineal ligament).

Lateral: Femoral vein.

Medial: Sharp crescentic margin of Gimbernat's ligamen!

(lacunar ligament).

N.B. lnguinal ligament, lacunar ligament & reflected part of inguinal

ligament are attached ta pubic tubercle

OUf lef (SApnENOUS OpeNtUC): covered by cribriform fascia

LenGTH I 1.s cm

S HRPg: Funnet shaped.

COruf grufS: LN of Cloquet, lymphatic vessels & areolar CT fat (fat distribution

in femoral canal is higher in the upper part).

PoTNTS oF SURGTcAL lnnpoRTANcE

Femoral ring is wider in females because they have wider pelvis,

smaller vessels & weaker ligaments ) higher incidence of femoral

hernia in fernales.

Femoral hernia descends first downwards in the femoral canal, then

foruvards through the saphenous opening. Later on, if it becomes larger

it curves upwards & laterally in the direction of the A.S.l.S. (this is

because of the attachment of Scarpa's fascia to fascia lata at a finger's

breadth below the inguinal ligament.

c- Abnormal obturator artery (see vascular anatomy).

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abt

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I LowE LIMB

S tf e : naiool& of the thigh. tt begins at

at the opening in adductor magnus muscle.

the apex

{F

CorureNTS

Femoral vessels: the vein at first is behind

the artery then lateralto it.

Descending genicular artery: from

femoral artery (anastomtica magna).

Nerve to vastus medialis: lateralto the

vessels.

4. Saphenous nerye: crosses the vessels

from lateralto medial side.

SuncICAL IIUpOnTANCE:

To decrease bleeding in above knee

amputation, we ligate the femoral vessels in the

canal by dividing the sartorius & its fascia.

However, if there is arteriosclerosis, there is no

need for ligation.

BouNDARIES:

@bicepsfemoris. ' 2. Upper medial: semitendinosus &

semihembranosus muscles supplemented by

the sartorius, gracilis & adductor magnus.

3. Lower lateral: Iateral head of qastrocnemius

suppiffi"Ey the plantaris riuscle.

4. Lower medial: medial head of gastrocnemius.

of femoral triangle & ends

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2.

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LOWE LrMB I

Roop:

-fTe roof of the fossa is formed by:

. Skin.

. Superficial fascia containing:

- The upper part of short saphenous vein.

- Branches of posterior cutaneous nerve of thigh.

. Popliteal fascia (deep fascia of the roof which is a downward extension

of the fascia lata. lt is pierced by saphenous vein).

FlooR: *

1. Upper part: popliteal surface of femur.

2. Middle part: back of the capsule of the knee joint.

3. Lower paft: fascia covering the popliteus muscle. The lower limit of the

fossa is the distal border of the popliteus muscle.

ConreNrs:*

1. Lateral popliteal nerve (common peroneal nerve).

2. Medial popliteal nerve (tibial nerve).

3. Popliteal artery.

4. Popliteal vein.

5. Termination of the posterior cutaneous nerve of the thigh.

6. Poplitea! lymph nodes.

All these structures are embedded in a variable amount of fat.

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RETINACULA.

There are two retinacula: extensor and flexor. These are formed by

thickened deep fascia and their function is to maintain the position of long

tendons crossing the ankle.

Structures that pass anterior to the extensor retinaculum on the

anterior surface of the ankle: (medial to lateral)

. Saphenous nerve and great saphenous vein (anterior to medial

malleolus).

. Superficial peroneal nerve.

Structures that pass deep to the extensor retinaculum (medial to

lateral) [Tom Has Very Nice Dog & Pig]

. Tibialis anterior tendon.

. Extensor hallucis longus tendon.

. Anterior tibial vessels.

. Deep peroneal nerve.

. Extensor digitorum longus tendon.

. Peroneus tertius.

LOWE LrMB I