Anterior Thigh Part 2 Flashcards
Saphenous opening (fossa ovalis, saphenous hiatus) location
- Hiatus in fascia lata
- 4cm inferior to medial inguinal ligament
- Inferolateral to pubic tubercle
Falciform margin of fossa ovalis
- Crescent shaped superior, lateral and inferior margin
Cribriform fascia (fills fossa ovalis)
- Membranous connective tissue
- Allows for passage of lymph vessels and saphenous vein
Femoral triangle
- Deep to fascia lata
- Contains neurovascular structures
Femoral triangle borders
- Base of triangle is proximal
- Apex is distal
Apex of femoral triangle
- End of femoral triangle
- Beginning of adductor canal
Femoral triangle boundaries
- Superior: inguinal ligament (Poupart’s ligament)
- Medial: medial border of adductor longus
- Lateral: medial border of Sartorius
- Floor: iliopsoas, pectineus, adductor longus
- Roof: fascia lata/cribriform fascia
Femoral triangle superior boundary
- Inguinal ligament (Poupart’s ligament)
Femoral triangle medial boundary
- Medial border of adductor longus
Femoral triangle lateral boundary
- Medial border of Sartorius
Femoral triangle floor
- Iliopsoas
- Pectineus
- Adductor longus
Femoral triangle roof
- Fascia lata/cribriform fascia
Nerve content of femoral triangle
- Femoral branch of genitofemoral nerve
- Femoral nerve and branches
Artery content of femoral triangle
- Femoral artery (located at the midinguinal point)
- Profunda femoris artery
- Lateral and medial femoral circumflex arteries
Venous content of femoral triangle
- Femoral vein
- Termination of saphenous vein
Lymphatic content of femoral triangle
- Femoral canal (lymphatics)
- Deep inguinal nodes
Femoral triangle content (all)
- Femoral branch of genitofemoral nerve
- Femoral artery (located at the midinguinal point)
- Femoral vein
- Femoral canal (lymphatics)
- Deep inguinal nodes
- Femoral nerve and branches
- Termination of saphenous vein
- Profunda femoris artery
- Lateral and medial femoral circumflex arteries
Femoral sheath
- Fascial sheath formed by prolongation of transversalis and ilipsoas fascia
Femoral nerve is NOT in
- The femoral sheath
3 compartments separated by septae (lateral to medial)
- Lateral: femoral artery
- Intermediate: femoral vein
- Medial: femoral canal (empty space and lymphatics)
Femoral canal (medial compartment of the femoral sheath)
- Allows for venous expansion
- Contains lymphatics
- Proximal opening (abdominal end): femoral ring
Femoral ring
- Proximal opening (abdominal end)
- Weak area/site of femoral hernias
Boundaries of femoral canal
- Lateral: Intermediate compartment (Femoral vein)
- Medial: Lacunar ligament
- Anterior: Inguinal ligament
- Posterior: Superior pubic ramus (pectineal ligament)
Lateral boundary of femoral canal
- Intermediate compartment (Femoral vein)
Medial boundary of femoral canal
- Lacunar ligament
Anterior boundary of femoral canal
- Inguinal ligament
Posterior boundary of femoral canal
- Superior pubic ramus (pectineal ligament)
Femoral artery pathway
- Continuation of external iliac artery
- Passes inferior to inguinal ligament at the mid-inguinal point
Femoral artery palpation site
- Palpable in femoral triangle ~ 3cm below inguinual ligament
- Site of compression
Termination of femoral artery
- Passes through femoral triangle, adductor canal, adductor hiatus
- Becomes popliteal artery
Branches of femoral artery
- Superficial circumflex iliac
- Superficial epigastric
- External pudendal
- Profunda femoris
- Muscular branches
- Descending genicular
Superficial circumflex iliac artery supplies
- Skin over ASIS and lateral inguinal ligament
Superficial epigastric artery supplies
- Skin over inferomedial abdominal wall
External pudendal artery (superficial & deep) supplies
- Skin over the anterior perineum
Profunda femoris (deep artery of the thigh, deep femoral)
- Largest branch
- Arises about 2” below ligament
Muscular branches of femoral artery supply
- Sartorius
- Adductors
- Vastus medialis
Descending genicular (highest genicular)
- Last branch before adductor hiatus
- Branches off in adductor canal
Descending genicular (highest genicular) supplies
- Vastus med
- Add mag
- Knee joint
Branches of Descending genicular (highest genicular)
- Saphenous branch
- Articular branch
The femoral artery is often called
- Common femoral
- After profunda femoris it may be called superficial femoral
Profunda femoris artery (deep femoral artery, deep artery of the thigh)
- Typically branches off the femoral artery posterolaterally (~ 1 – 2” below inguinal ligament)
Profunda femoris artery pathway
- Passes between pectineus and adductor longus
- Then between adductor longus and brevis
- Descends thigh posterior to adductor longus (anterior to brevis and magnus)
Branches of profunda femoris
- Lateral femoral circumflex
- Medial femoral circumflex
Lateral femoral circumflex artery
- Lateral side of PFA
- Passes lateral posterior (deep) to Sartorius and rectus femoris
3 branches of lateral femoral circumflex artery
- Ascending
- Transverse
- Descending
Ascending branch of lateral femoral circumflex artery pathway
- Ascends along intertrochanteric line, under TFL
Ascending branch of lateral femoral circumflex artery supplies
- Greater trochanter, head and neck of femur (Trochanteric anastomosis)
- Muscular branches
Transverse branch of lateral femoral circumflex artery pathway
- Passes anterior to vastus intermedius
Transverse branch of lateral femoral circumflex artery
- Joins cruciate anastomosis
- Muscular branches
Descending branch of lateral femoral circumflex artery pathway
- Descends along vastus lateralis
Descending branch of lateral femoral circumflex artery
- Anastomoses with lateral superior genicular artery at the knee
- Muscular branches
Medial femoral circumflex artery pathway
- Medial side of PFA
- Passes between iliopsoas and pectineus
- Curves medially around femur between obturator externus and add brevis
Medial femoral circumflex artery is located between
- Quadratus femoris and adductor longus posteriorly
3 branches of medial femoral circumflex artery
- Ascending
- Transverse
- Descending
Ascending branch of medial femoral circumflex artery
- Greater trochanter, head and neck of femur (Trochanteric anastomosis)
- Muscular branches
Transverse branch of medial femoral circumflex artery
- Joins cruciate anastomosis
- Muscular branches
Descending branch of medial femoral circumflex artery supplies
- Muscular branches
Perforating arteries (4) pathway
- Pierce adductor magnus near femoral shaft attachment
Perforating arteries supply
- Major supplier to medial and posterior compartments of the thigh
1st perforating artery
- Above the superior border of adductor brevis (can pierce it)
2nd perforating artery
- Pierces adductor brevis
- Usually gives off femoral nutrient artery
3rd perforating artery
- Below inferior border of adductor brevis
4th perforating artery
- Terminal end of PFA
- Proximal to adductor hiatus (at short head biceps femoris)
Trochanteric anastomosis are major suppliers to
- Head
- Neck
- Femur (after age 3)
- Especially the MFC
Arterial ring anastomosis located
- Around femoral neck
- Near trochanteric fossa
Trochanteric anastomosis
- Ascending branches of lateral/medial femoral circumflex arteries
- Descending branches of superior/inferior gluteal arteries
- Primarily from LFC and MFC
Retinacular arteries
- Pierce capsule
- Travel along femur neck to the head of femur
- Contribute to trochanteric anastomosis
Cruciate anastomosis located
- Near lesser trochanter
- Provide for collateral circulation
Cruciate anastomosis
- Descending branch of Inferior gluteal a.
- Transverse branches of medial/lateral circumflex a.
- Ascending branch of 1st perforating branch of deep femoral
If external iliac or proximal femoral artery is blocked, blood can still reach lower extremity via
- Internal iliac > inferior gluteal > trochanteric/cruciate anastomosis
