Clinical Anatomy of venous ulceration Flashcards
What makes up the upper limb?
Axilla Arm (brachium) Elbow/cubital fossa Forearm (ante-brachium) Wrist Hand
What makes up the lower limb?
Inguinal region Thigh Knee/popliteal fossa Leg Ankle Foot
Where does the subclavian pass through?
Passes above the 1st rib
What is the arterial supply to the limbs?
Subclavian artery Axillary artery Brachial artery Deep brachial artery Radial artery Ulnar artery Metacarpal and digital arteries
How many digital arteries are there per digit?
4
What is the arterial supply to the lower limbs?
External iliac artery Deep femoral artery Femoral artery - perforating arteries Popliteal artery Anterior tibial artery Posterior tibial artery Dosalis pedis artery Medial and lateral plantar artery Arcuate artery Metatarsa and digital arteries
What does the brachial artery give off?
Radial and ulnar arteries
What does the popliteal artery give off?
Anterior tibial artery
Posterior tibial artery
What does the anterior tibial artery give off?
Dorsalis pedis artery
What does the posterior tibial artery give off?
Medial and lateral plantar arteries
What artery between the radial and ulnar is medial?
Ulnar is medial
Radial is lateral
Where does the brachial artery lie?
Medial biceps tendon in the cubital fossa
Where does the radial artery lie?
Lateral to the tendon of flexor carpi radialis
Where does the femoral artery lie?
Inferior to the midpoint of inguinal ligament
Where does the popliteal artery lie?
In popliteal fossa
Where does the posterior tibial artery lie?
Between the posterior border of the medial malleolus and the achilles tendon
Where does the dorsalis pedis artery lie?
Medial to tendon of extensor hallucis longus distal to the ankle joint
What are the characteristics of superficial veins?
Small and thin
Run in superficial fascia
Highly variable
Drain into deep vein
What are the characteristics of deep veins?
Large and thick
Run deep to deep fascia
More predictable
Occur in neurovascular bundles
What makes up the superficial fascia?
Loose connective tissue and fat
Varies in depth
Superficial blood vessels, cutaneous nerves, lymphatics and sweat glands
What makes up the deep fascia?
Tough and sheet like Dense connective tissue Usually white, glistening in appearance Covers most of body deep to skin and superficial fascia Divides limbs into compartments
What is the function of the IT (Iliotibial Tract) band?
Keeps the lateral aspect of hip connected to the lateral aspect of the crurus
What is the origin of the cephalic vein?
Arises from the posterolateral aspect of the dorsal venous network
What is the origin of the basilic vein?
Arises from the anterolateral aspect of the dorsal venous network
Where does the cephalic vein drain?
Into the axillary vein which drains into the subclavian vein at the lateral border of rib 1
Where does the basilic vein drain into?
The brachial vein
What joins the cephalic vein to the basilic vein?
Medial cubital vein
What is the origin of the great saphenous vein?
Arises from the anteriomedial aspect of the dorsal venous arch
What is the origin of the small saphenous vein?
Arises from the posterolateral aspect of the dorsal venous arch
Where does the great saphenous vein drain?
Into the femoral vein in the femoral triangle
Where does the small saphenous vein drain?
Into the popliteal vein in the popliteal fossa
What is the venous drainage of the upper limb?
Deep palmar venous arch Radial and Ulnar veins Brachial vein Axillary vein Subclavian vein Internal jugular vein and brachiocephalic vein
What is the venous drainage of the lower limb?
Planter arch Posterior and anterior tibial vein Fibular vein Popliteal vein Deep and non-deep femoral vein External iliac Common iliac IVC SVC
What is a vena comitantes?
When 3 veins surround an artery wrapped in a vascular sheath helping venous drainage
What is the purpose of venous valves?
To ensure unidirectional blood flow
What happens when there is an incompetent venous valve?
Results in revese flow into superficial veins leading to varicose veins
What do varicose veins predispose to?
DVT and venous ulceration
What does deep vein stasis lead to?
Thrombosis/ embolism
What does superficial microcirculatory deficiencies lead to?
Skin ulceration
What is the commenest site of venous ulceration?
Gaiter area - medial aspect of distal leg drained by the great saphenous vein
What is a saddle embolus?
Blockage of the pulmonary trunk
What is the pathway of superficial lymphatics in the upper limb?
Arise from plexuses in fingers and hand
Follow cephalic and baisilic veins
Where do basilic lymphatics drain to?
Cubital lymph nodes which drain to lateral pectoral lymph nodes
Where do cephalic lymphatics drain to?
Apical pectoral nodes
Where do the deep lymphatics of the upper limb drain to?
Deep veins of upper limb and then drain to the lateral pectoral lymph nodes
Where do pectoral lymph nodes drain to?
Subclavian lymph nodes
Where do the superficial lymph nodes of the lower limb drain to?
Follow saphenous veins
Great saphenous drains to superficial inguinal nodes which drain to external iliac nodes
Small saphenous drains to popliteal nodes which drain to deep inguinal nodes which drain to external iliac nodes
Where do the deep lymphatics of the lower limb drain to?
The popliteal lymph nodes which drain to the deep inguinal which drain to the external iliac
Where do the external iliac nodes drain to?
Common iliac nodes which drain into the lumbar lymphatics
What palmar arch does the radial artery form?
Deep palmar arch
What palmar arch does the ulnar artery form?
Superficial palmar arch
Ulnar sUperficial
What are the borders of the popliteal fossa?
Superomedially: semitendinosus/ semimembranosus
Superolaterally: biceps femoris
Inferiorly: gastrocnemius
What are the contents of the popliteal fossa?
Tibial nerve
Popliteal vein
Popliteal artery
Popliteal lymph nodes
What are the ligaments of the joint capsule of the hip?
Iliofemoral
Pubofemoral
Ischiofemoral
What joint in the foot allows for inversion and eversion?
Midtarsal joints
What are the borders of the femoral triangle?
Superior: inguinal ligament
Laterally: sartorius
Medially: adductor longus
Floor: iliopsoas laterally and pectineus medially
What action does the radiocapitellar joint do?
Supination and pronation
What action does the humeroulnar joint do?
Flexion and extension
