femoral triangle and adductor canal...the femoral canal contains: 1-a plug of fat 2-a constant lymph...
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Femoral Triangle and Adductor
Canal
Dr. Heba Kalbouneh
Associate Professor of Anatomy and Histology
Femoral Triangle and
Adductor Canal
Is a triangular depressed area located in the upper part of
the medial aspect of the thigh immediately below the
inguinal ligament.
Femoral triangle
Superiorly: Inguinal ligament
(the base of the triangle)
Laterally:
Medial border of sartorius
Medially:
Medial border of adductor
longus
The apex: directed downwards
and is formed by the meeting
point of sartorius and adductor
longus
Floor:
Gutter shaped
from lateral to medial is made
by:
A. Iliacus
B. Psoas
C. Pectineus
D. Adductor longus
C
A B
D
Roof:
Formed by
1-Skin
2-Superficial fascia and
its contents
3-Deep fascia containing
the saphenous opening
Genitofemoral nerve
(femoral branch) Ilioinguinal nerve Great saphenous vein
Superficial inguinal
lymph nodes
Genitofemoral nerve
(femoral branch)
Contents of the femoral
triangle
1-Femoral nerve and its
branches
2-Femoral artery and its
branches
3-Femoral vein and its
tributaries
4-Deep inguinal lymph
nodes
5- Femoral sheath!!!
6-Femoral branch of
genitofemoral nerve
7-Lateral cutaneous nerve
of the thigh
Lateral
cutaneous
nerve of the
thigh
Femoral
nerve Femoral
artery
Femoral vein
Deep inguinal lymph nodes
Nerve Artery
Vein
Inguinal lymph nodes
NAVI gate
The femoral triangle from lateral to medial
Femoral
sheath
The femoral sheath is a funnel
shaped sheath of fascia
surrounding the upper 1.5
inches of femoral vessels
The femoral sheath
The femoral sheath is formed by a
downwards extension of the abdominal
fascia
Anterior wall: is a downward
prolongation of the fascia transversalis
of the anterior abdominal wall
Posterior wall: is a downward
prolongation of the fascia iliaca of the
posterior abdominal wall
Two Anterio-posterior septa divide the
sheath into 3 compartments:
1-Lateral compartment (arterial)
occupied by the femoral artery and
femoral branch of the genitofemoral nerve
2-Intermediate compartment (venous)
occupied by the femoral vein
3-Medial compartment (lymphatic)
occupied by the lymph vessels and one of
the deep inguinal lymph nodes (femoral
canal)
Femoral canal
Is the small medial compartment of
the femoral sheath.
0.5 inch in length (just admits the
tip of the little finger)
Base: directed upwards, towards the
abdominal cavity called the
femoral ring
The femoral ring is closed by a
condensation of extraperitoneal
tissue called femoral septum
Apex: directed downwards, its
closed by fusion of its wall
The Femoral canal contains:
1-a plug of fat
2-a constant lymph node—the node
of the femoral canal or Cloquet’s
gland, and lymph vessels
The canal has two functions: first, as
a dead space for expansion of the
distended femoral vein and, second,
as a lymphatic pathway from the
lower limb to the external iliac nodes
Note: the femoral ring is wider in females
because of their wider pelvis and therefore,
femoral hernia is commoner in females than in
males
The femoral ring is the base of the femoral canal.
Part of the intestine can sometimes pass through the femoral
ring into the femoral canal pushing the femoral septum before
it and causing a femoral hernia
Inguinal ligament
Ilium
Pectineal ligament
Lacunar ligament
Anteriorly: Inguinal ligament
Medially: Lacunar ligament (the
sharp free edge that connects the
inguinal ligament to the pectineal
ligament)
Laterally: Femoral vein
Posteriorly: Pectineal ligament
(the thickened periosteum along
the pectineal line of the superior
pubic ramus and continues
medially with the lacunar
ligament)
The boundaries of the
femoral ring are:
Inguinal ligament
Ilium
Pectineal ligament
Lacunar ligament
Because of these anatomic
structures, the neck of the sac is
unable to expand.
Once an abdominal viscus has
passed through the neck into the
body of the sac, it may be difficult
to push it up and return it to the
abdominal cavity
(irreducible hernia).
Furthermore, after the patient
strains or coughs, a piece of bowel
may be forced through the neck,
and its blood vessels may be
compressed by the femoral ring,
seriously impairing its blood
supply (strangulated hernia).
A femoral hernia is a dangerous
condition and should always be
treated surgically
Inguinal ligament
Pectineal ligament
Lacunar ligament
A protrusion of abdominal parietal peritoneum down through the femoral canal
to form hernial sac
The neck of the hernial sac is located
below and lateral to the pubic tubercle in femoral hernia
While in the inguinal hernia
The neck of the hernial sac is located above and medial to the pubic tubercle
Inguinal canal
Differential diagnosis of a femoral hernia
Consider diseases that may involve other anatomic structures close to the inguinal ligament.
Inguinal hernia: The swelling lies above and medial to the pubic tubercle.
Superficial inguinal lymph nodes: Usually, more than one lymph node is enlarged. In patients
with inflammation of the nodes (lymphadenitis), carefully examine the entire area of the body
that drains its lymph into these nodes.
Great saphenous vein: A localized dilatation of the terminal part of the great saphenous vein
(saphenous varix)
Psoas sheath: Tuberculous infection of a lumbar vertebra can result in the extravasation of pus
down the psoas sheath into the thigh.
Femoral artery: Aneurysm of the femoral artery
Femoral triangle
Surface anatomy
Adductor canal
(Subsartorial)
or
Hunter’s canal
John Hunter described the exposure
and ligation of the femoral artery in this
canal for aneurysm of the popliteal
artery; this method has the advantage
that the artery at this site is healthy and
will not tear when tied, as may happen
if ligation is attempted immediately
above the aneurysm
Is an intermuscular canal in the middle 1/3 of the
medial side of the thigh beneath the sartorius
It begins above at the apex of the femoral triangle
It ends below at adductor hiatus (the opening in the
adductor magnus).
In cross section it is triangular (has 3 walls)
1-Anteromedial wall
2-Anterolateral wall
3-Posterior wall (floor)
Adductor (Subsartorial) Canal
1 2
3
4
Transverse section through the middle of the
left thigh as seen from above
The Anteriomedial wall is formed by:
Sartorius and fascia
The posterior wall (floor) is formed by:
Adductor longus and magnus
The Anterolateral wall is formed by:
Vastus medialis
The posterior wall is
formed by:
Adductor longus and
magnus
Adductor longus
Adductor magnus
The adductor canal contains
1- Femoral artery
2- Femoral vein
3- Saphenous nerve
4- Nerve of vastus medialis
5- Obturator nerve
6- Subsartorial plexus of nerves
Subsartorial plexus of nerves:
Located on the fascia under the sartorius and is
formed by branches from
1- Medial cutaneous nerve of the thigh
2- Saphenous nerve
3- Obturator nerve
1-Enters the thigh from behind the inguinal
ligament as a continuation of the external iliac
artery.
2-Lies midway between the anterior superior
iliac spine and the symphysis pubis
Midinguinal point
The femoral artery
3-Its upper half lies superficial in the femoral
triangle while in the lower half it lies deep in
the subsartorial (adductor) canal
4-Ends at adductor hiatus by entering the
popliteal fossa as THE POPLITEAL ARTERY
(what does this mean?)
See next slides
Inguinal ligament
External iliac artery
Femoral artery
Adductor
hiatus
Popliteal artery
Saphenous nerve
In the upper part of its course, femoral artery
lies in the femoral triangle (superficial) covered
by skin and fascia
1-Exposed to injuries
2-Good approach for taking femoral pulse
3- Femoral Artery Catheterization
Branches of the femoral artery
THREE superficial branches
TWO deep branches
They supply cutaneous
regions of the upper
thigh, lower abdomen,
and perineum.
Superficial branches
1-Superficial circumflex iliac artery
2-Superficial epigastric artery
3-Superficial external pudendal artery
Deep branches
1-Deep external pudendal artery
2-Profunda femoris artery
Branches of the femoral artery in
the adductor canal
Descending genicular artery
Superficial external
pudendal artery
Superficial
circumflex
iliac artery
Superficial epigastric
artery
Deep external
pudendal
artery
Pudendal “to be
ashamed” in latin.
Refers to the
external genitalia
The femoral vein lies
medial to the artery in the
upper part of the femoral
triangle, then it lies
posterior and finally lateral
to the artery at the apex of
the femoral triangle
Saphenous nerve
crosses femoral artery
anteriorly
Saphenous
nerve
Adductor
hiatus
Femoral artery
Popliteal
artery
The profunda femoris artery
(Deep artery of thigh) arises
from the posterolateral side of
the femoral artery about (4 cm)
below the inguinal ligament
it gives off
A) Medial femoral circumflex
artery
B) Lateral femoral circumflex
artery
C) Perforating arteries
Internal iliac artery
External
iliac
artery
Common iliac artery
Obturator Artery
Obturator Artery
The obturator artery is a branch of the
internal iliac artery
It passes forward on the lateral wall of the
pelvis and accompanies the obturator nerve
It gives off muscular branches and an
articular branch to the hip joint
Femoral Vein
Enters the thigh by passing through the
adductor hiatus as a continuation of the
popliteal vein
Ascends through the thigh, lying at first on
the lateral side of the artery, then posterior to it,
and finally on its medial side
Leaves the thigh in the intermediate
compartment of the femoral sheath and passes
behind the inguinal ligament to become the
external iliac vein.
Tributaries
The tributaries of the femoral vein are the great
saphenous vein and veins that correspond to the
branches of the femoral artery drain into the
great saphenous vein
1- Superficial circumflex iliac vein
2- Superficial epigastric vein
3- Superficial external pudendal vein
Femoral vein
Great saphenous
vein
Profunda
femoris
artery
Femoral vein
Superficial
epigastric vein
Great saphenous vein
Superficial external
pudendal vein
Superficial
circumflex
iliac vein
Test Your Knowledge
1-Mention Branches of Femoral artery………………………………………………
2-Boundaries of adductor canal……………………………………………………
3-Branches of femoral nerve ………………………………………………………
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