Lecture 2 Femoral Triangle Flashcards
What are the boundaries of the femoral triangle?
- Base: Inguinal ligament
- Lateral wall: Sartorius m.
- Medial wall: Adductor longus m.
SAIL
(Sartorius, Adductor Longus, Inguinal Ligament)
What are the contents of the femoral triangle?
N.A.V.e.L under your naval (from lateral–> medial)
- Femoral nerve
- Femoral artery
- Femoral vein
- Femoral canal (empty space) with deep inguinal lymph nodes
What makes up the floor of the femoral triangle?
- Pectineus m.
2. Iliopsoas m.
What makes up the roof of the femoral triangle?
Fascia lata
What is the femoral triangle?
A subfacial place/triangular depression that is located on the superomedial 1/3 of the thigh.
What is the femoral sheath?
The femoral sheath is a funnel shaped prolongation of the transversalis fascia that will surround the femoral vessels, allowing them to glide smoothly when the hips are moving.
Femoral sheath is a prolongation of what?
It is an inferior prolongation of the transversalis fascia.
What does the femoral sheath allow?
helps vessels glide smoothly deep when hip joints are moving.
When does the femoral sheath end?
4-10 cm below the inguinal ligament. It is continuous with the connective tissue that covers the femoral vessels.
How is the femoral sheath organized?
The femoral sheath surrounds the femoral artery, vein and lymph. Not the femoral nerve.
Two vertical walls divide it into 3 components (lateral, intermediate and medial compartments).
- Lateral portion holds the femoral artery.
- Intermediate holds the femoral vein.
- Medial portion holds the femoral canal.
What exactly is the femoral canal?
The femoral canal is the medial compartment of the femoral sheath. It contains
- [lymph vessels],
- [loose connective tissue] and
- [fat].
This opening will allow the femoral vein to increase during venous return.
:)
:)
Describe the opening of the femoral canal.
The opening is about 1 cm wide and is called the femoral ring. It is covered by parietal peritoneum.
What is best: a complete or partial cut to the femoral artery?
Complete cut. Partial cuts will result in more loss of blood.
Femoral hernias
Femoral hernias are most common in women
Femoral hernias are protrusions of the small intestine through the anterior abdomen–> femoral ring–> femoral canal.
They can get bigger by leaving the canal and entering the subcuteneous tissue.
Thus, they will appear as a mass in the femoral triangle.
Where do direct inguinal hernias happen?
Hasselbach’s triangle. Borders are made up of the
- Rectus abdominas m. (medial border)
- Inguinal ligament (base)
- Inferior epigastric vessels. (lateral border)
It passes through the superficial inguinal ring.
Thus, direct hernias occur medial to the inferior epigastric rings
Where do indirect inguinal hernias occur
Passes through the deep and superficial inguinal ring.
Where do you feel to look for inguinal hernias?
Superficial inguinal ring. Both indirect and direct hernias pass through. To test for indirect, look at the deep inguinal ring and to look for direct, look at Hasselbach’s triangle.
Where do inguinal lymph nodes drain lymph from?
- Lower limbs (including the butt region)
- Perineum and parts of the anal canal.
- Anterior abdominal wall, up to the umbilicis
What are the two groups of inguinal lymph nodes?
- Superficial inguinal lymph nodes
- Proximal (horizontal) group
- Distal (vertical) group
- Deep inguinal lymph nodes
Where are the superficial inguinal lymph nodes located?
They lie in the superficial fascia.
The proximal (horizontal) group is located 1cm inferior to the inguinal ligament.
The distal (vertical) group is located on each side of the great saphenous vein.
Both the proximal and distal superficial inguinal ligaments do what?
- Pass deep to the inguinal ligament
2. Drain into external iliac lymph nodes
Where do superficial inguinal lymph nodes drain into?
External iliac lymph nodes.
Where are the deep inguinal lymph nodes located?
inside of the femoral canal/femoral sheath.
Where do the deep inguinal lymph nodes drain into?
External iliac lymph nodes.
What is the femoral nerve?
The femoral nerve comes off of L2-L4 and forms in the abdomen, within the psoas minor muscle.
It is the largest branch of the lumbar plexus!
What does the femoral nerve innervate?
Anterior thigh muscles, hip and knee joint.
- Iliacus m.
- Sartorius m.
- Quadriceps femoris
- Pectineus m.
What seperates the femoral nerve into anterior and posterior divisions?
Lateral circumflex femoral artery.
What are the branches of the femoral nerve?
- Anterior intermediate cutaneous branch of the femoral nerve
- Anterior medial cutaneous branch of the femoral nerve
- Saphenous nerve.
Saphenous nerve
Last branch of the femoral nerve that innervates the
- Anterior and medial knee and leg
- Medial foot
Lateral femoral cutaneous nerve
Nerve that comes off L2-L3 of the lumbar spine.
It is only cutaneous.
Pinching of this nerve as it passes the inguinal ligament can cause meralgia paresthestica along the lateral thigh.
[Q:] Bob got anterior hip dislocation. What can occur?
The femoral nerve and lateral femoral cutaenous nerve can be affected.
Perhaps meralgia paresthetica.
Names for the adductor canal
- Subsartorial canal
2. Hunter’s canal
What is the adductor canal?
The adductor canal is a intermuscular passage for the femoral vessels to reach the popliteal fossa.
It begins at the apex of the femoral triangle and ends at the adductor hiatus.
What is the adductor hiatus?
An opening in the tendon of the the adductor magnus m. where femoral vessels can reach the popliteal fossa (posterior knee and leg).
What is the chief arterial supply to the lower limb?
Femoral artery.
How does the femoral artery enter the femoral triangle?
Midpoint of the inguinal ligament.
In the inferior thigh, near the knee, it branches into what?
Descending genicular artery, which branches into both a
- Articular branch
- Saphanous branch
What does the articular branch innervate?
knee joint
What does the saphenous branch innervate?
Tibia.
How can we cannulate the femoral vessels?
1st, we have to locate the femoral artery.
The femoral artery is located 2-3 cm below the midpoint of the inguinal ligament, located between the ASIS and pubic tubercle.
Where can we compress the femoral artery?
Head of the femur is posterior to the femoral artery.
Profunda Femoris A.
The Profunda Femoris (Deep branch of the femoral A) is the largest branch of the femoral artery.
It descends behind adductor longus.
The perforating arteries go behind the thigh.
Profunda femoris A gives rise to what in the femoral triangle?
- Medial Circumflex Femoral A.
2. Lateral Circumflex Femoral A.
What is the chief artery to the thigh?
Deep Femoral A.
Medial Circumflex Femoral Artery is the MAIN supply of what?
Main supply to the femoral head and neck.
Lateral Circumflex Femoral Artery supplies what?
Lateral thigh muscles
and
Head of the femur
The lateral circumflex femoral a has 3 branches
What are the 3 branches of the lateral circumflex femoral a
- Ascending
- Transverse
- Decending
What do the perforating branches of the deep femoral a supply?
Adductor Magnus M
Vastus Lateralis M.
Hamstring muscles
What can the Great Saphenous Vein be used for?
It is fairly superficial.
It can be used to administer blood, electrolytes and drugs in babies.
How can we access the venous system of the great saphenous vein?
We can access it via saphenous cutdown: an incision can be made anterior to the medial malleolus.
What can be a result of saphenous cutdown?
Pain along the medial border of the foot because we nick the saphenous nerve
Where can we palpate the femoral A?
The initial part of the Femoral Artery is more superficial in position, making it useful and palpable. You can feel it just distal to the midline of the Inguinal Ligament
Where can we compress the femoral a?
Initial part. just distal to the midline of the inguinal ligament
Where is the femoral artery cannulated?
Inferior to the inguinal ligament. it is used this way in
- left cardiac angiography
- Coronary arteriography
What can be used in blood gas analysis?
Femoral artery
Lacteration of the femoral artery and nerve
the superficial portion of the femoral artery is often lacerated, along with the femoral vein, because they are so close together.
This can lead to a arteriovenous shunt
What is saphenous varix?
Saphenous varix is the dilation of the terminal part of the great saphenous vein., causing edema in the femoral triangle. When patients with varicose veins come in with groin swelling, this is the first thing that should be looked at.
Where can the saphenous nerve be seen superficially?
- with the [sartorius m and the gracilis m]
What does the saphenous nerve innervate?
Anteromedial part of the leg
medial part of foot
Adductor cannal transports what?
femoral vessels around the leg, allowing them to go through the adductor hiatus and into the popliteal fossa.
Where does the adductor canal begin?
apex of the femoral triangle
What goes through the adductor canal?
Femoral vessels.
The [saphenous n] and the [saphenous branch of the descending genicular a] will exit through the medial side of the canal (wont go through the adductor hiatus).
What is the CHIEF arterial supply of the entire lower limb?
- Femoral A.
What can we use for radiographic imaging of the left heart and coronary vessels?
femoral a
How can we slow/ stop arterial bleed in the lower extremely?
Apply pressure to the upper leg and trap the femoral a between our hands and head of the femur.
Primary artery of the thigh
deep femoral A
What does the great saphenous vein drain?
- dorsum of the foot
- medial leg
- medial thigh
where it joins with the femoral vein.
What can we harvest for coronary bypass surgey?
great saphenous vein (GSV)
Venous cutdown
an emergency procedure done so tthat we can access the venous system. OFten times, the great saphenous vein undergoes venous cutdown when a cut is made at the MEDIAL MALLEOLUS.
this can damage the saphenous n.
Side effect of saphenous cutdown
pain on medial border of foot because of damage to the saphenous nerve
