Superficial Fascia of the Thigh It is differentiated into a superficial fatty layer & deep membranous layer. Fatty layer of superficial fascia : it is downward continuation of that on anterior abdominal wall Deep membranous layer becomes adherent to the deep fascia of the thigh (Fascia Lata) along a horizontal line ½ inch below the inguinal ligament.

Deep Fascia of the Thigh (Fascia Lata) T.S of middle of right thigh Superiorly : it is attached to the pelvis + inguinal ligament. Laterally : it is thickened to form the iliotibial tract which is attached above to iliac tubercle /and below to lateral condyle of tibia. -Iliotibial tract receives insertion of : tensor fascia latae + gluteus maximus muscle. Inferioly : it is attached to capsule of knee joint + patella + upper end of tibia & fibula. Posteriorly ( in Gluteal region) : it forms sheaths, which enclose the tensor fasciae latae & gluteus maximus muscles. Its deep surface is attached to back of femur by 3 intermuscular septa…. Lateral/ medial /& posterior.

Deep Fascia of the Thigh (Saphenous Opening) It is an oval opening in the deep fascia of the thigh. opening – It lies in front of thigh just below inguinal ligament. It transmits : great saphenous vein + branches of femoral artery (superficial epigastric, superficial circumflex iliac & superficiial external pudendal) + lymph vessels. It is located 1,5 in. below and lateral to pubic tubercle. It has margin called Falciform margin which is sharp superiorly, laterally and inferiorly. It is filled with loose C.T called cribriform fascia.

Fascial Septae and Compartments of Thigh 3 fascial septa pass from inner aspect of deep fascial sheath of thigh to linea aspera of femur, dividing the thigh into 3 compartments : anterior, medial and posterior. Contents of Anterior compartment : 1-Muscles : sartorius, iliacus, psoas, pectineus, and Quadriceps femoris Ms. 2-Blood supply : femoral vessels. 3-Femoral nerve.

Muscles of Anterior Compartment of Thigh

Quadriceps Femoris Insertion

Femoral Sheath It is funnel-shaped tube of fascia that surround the upper 1 in. of femoral vessels & lymphatics, below inguinal ligament. The upper end of sheath opens into abdomen, while lower end fuses with the walls of femoral vessels (tunica adventitia). Its anterior wall is formed of downward continuation of fascia transversalis of anterior abdominal wall. Its posterior wall is formed of downward continuation of the fascia iliaca of posterior abdominal wall. it is divided by 2 fibrous septa into 3 compartments : 1-lateral compartment : contains femoral artery. 2-intermediate comp. : contains femoral vein. 3-medial comp. : femoral canal transmitting lymph vessels.

Femoral Canal It is the medial compartment of femoral sheath. It is about ½ in. long. It contains lymph vessels + fatty C.T Its upper end opens into abdomen and is called femoral ring, which is closed by femoral septum (condensation of extraperitoneal tissue of fatty tissue & lymph). Boundaries of Femoral Ring : -Anteriorly : inguinal ligament. -Posteriorly : superior ramus of pubis. -laterally : femoral vein. -Medially : lacunar ligament. Its lower end is closed by fusion of its walls. Applied anatomy : femoral hernia.

Femoral hernia Femoral hernia is more common in female because of wider pelvis and femoral canal, it should always be treated surgically. The neck of the herniated sac lies below and lateral to pubic tubercle, while In Inguinal hernia, the neck of swelling lies above and medial to pubic tubercle. It may be difficult to push it up to return to abdomin. –irreducible hernia.. After coughing or straining, a piece of bowel may be forced through the neck, and its blood vessels may be compressed by femoral ring performing strangulated hernia.

Femoral Triangle It lies in the upper part of medial side of the thigh. Boundaries : -superiorly (base) : inguinal ligament. -laterally : sartorius. -medially : medial border of adductor longus. Floor : from lateral to medial : -iliopsoas, pectineus & adductor longus. Roof : skin & fascia of the thigh. Contents : femoral nerve & its branches, femoral sheath, femoral artery & its branches, femoral vein & its tributaries, and deep inguinal lymph nodes.

Femoral Artery It begins behind the midinguinal point, (between ant.sup.iliac spine & pubic tubercle of symphysis pubis), as a continuation of external iliac artery. It descends through the femoral triangle, then vertically toward the adductor tubercle of femur. ends at opening in adductor magnus muscle to enter the popliteal fossa as popliteal artery.

Relation of Femoral Artery Anteriorly : its upper part is covered by skin & fascia. Its lower part is covered by sartorius muscle. Posteriorly : iliopsoas, pectineus, and adductor longus. Femoral vein is behind femoral artery in the lower part of femoral triangle. Medially : femoral vein (in upper part of femoral triangle) Laterally : femoral nerve & its branches.

Branches of Femoral Artery Superficial circumflex iliac artery : to the region of anterior superior iliac spine. Superficial epigastric artery : to region of umbilicus. Superficial external pudendal artery : to supply skin of scrotum (or labium majus). Deep external pudendal artery : to supply skin of scrotum (or labium majus). Profunda femoris artery : is a large and important branch arising from lateral side of femoral artery, about 1,5 in. below inguinal ligament. It passes medially behind femoral vessels to enter medial side of thigh.

Branches of Femoral Artery Profunda femoris artery : -it ends by becoming 4th perforating artery. -at its origin it gives off medial and lateral femoral circumflex arteries. -during its coarse it gives off three perforating arteries. Descending genicular artery : near its termination to supply knee joint.

Femoral vein It enters thigh by passing through opening in adductor magnus as a continuation of popliteal vein. It ascends in the thigh, lying at first laterally to femoral artery, then posterior and finally medially. It leaves thigh by passing behind inguinal ligament to become the external iliac vein. Tributaries : great saphenous vein + branches correspond to that of artery. Superficial circumflex iliac, superficial epigastric, and external pudendal veins drain into great saphenous vein.

Femoral Nerve It is the largest branch of lumbar plexus (L2,3&4). It arises from lateral side of psoas major ms. within abdomen to descend in interval between posas & iliacus. It enters thigh behind inguinal ligament, lying outside the femoral sheath, but within the femoral triangle lateral to femoral artery. It terminates about 1,5 in. below inguinal ligament, by dividing into anterior & posterior divisions. It supplies all Ms. of anterior compartment of thigh.

Branches of Femoral Nerve Anterior division : - 2 cutaneous branches : medial cutaneous N. of thigh + intermediate cutaneous N. -2 muscular branches : to sartorius + pectineus. Posterior division : -1 cutaneous branch : Saphenous N. -Muscular branches : to quadriceps femoris Ms. -Articular branches to knee joint.

Saphenous Nerve It descends medially crossing the femoral artery. It emerges on the medial side of knee between the tendons of sartorius & gracilis. It then descends on the medial side of leg in company with great saphenous vein. It passes in front of medial malleolus and along medial border of foot to end in big toe.

Superficial inguinal Lymph Nodes They are arranged into Horizontal & Vertical groups. Horizontal group : -lies below and parallel to inguinal ligament. -The medial members of this group receive afferent vessels from : 1-superficial lymph vessels from anterior abdominal wall below umbilicus. 2-lymph vessels from perineum, + urethra + lower ½ of anal canal + external genitalia (except lymph drainage of testes ends in lumbar (para-aortic) L.Ns. at level of L1 vertebra. -The lateral members of this group receive afferent vessels from back below level of iliac crest (skin of gluteal region)

Superficial inguinal Lymph Nodes Vertical group : -Lies along terminal part of great saphenous vein. -They receive most of afferent superficial lymph vessels of the lower limb (except lateral sides of foot & leg drained into popliteal L.Ns. + gluteal region drained by lateral membres of horizontal group. Efferent lymph vessels from vertical & horizontal groups of superficial inguinal L.Ns. : pass through saphenous opening to end in deep inguinal L.Ns. (lying along medial side of femoral vein).

Deep Inguinal Lymph Nodes They are located beneath the deep fascia along medial side of femoral vein. They receive afferent lymph vessels from : -superficial inguinal L.Ns. -popliteal L.Ns. -deep structures of thigh. Their efferent lymph vessels pass through femoral canal to end into external iliac lymph nodes.

Contents of Medial compartment of thigh Muscles: Gracilis , adductor longus , adductor brevis , adductor magnus , obturator externus. Blood supply: Profunda femoris Ar. +Obturator Ar. Nerve supply : Obturator nerve .

Muscles of medial fascial compartment of thigh

Muscles of medial fascial compartment of thigh - Adductor part ( pubic part ) - Hamstring part ( ischial part) + + Trochanteric fossa ( lateral area )

Adductor (Subsartorial) Canal : It is an intermuscular cleft lies in the middle third of medial side of the thigh beneath sartorius muscle. Its upper end lies at the apex of femoral triangle, while its lower end lies at the opening of Adductor magnus. What are the walls of Adductor canal ? What are the contents of Adductor canal ?

Boundaries and Contents of Adductor Canal Cross section of the middle of thigh Anteromedial wall (roof) : sartorius & its fascia. Posterior wall ( floor) : addctor longus + adductor magnus. Lateral wall : vastus medialis. Contents : 1- Terminal part of femoral artery. 2- Femoral vein. 3- Saphenous nerve. 4- N.to vastus medialis. 5- Terminal part of obturator N. 6- Deep lymph vessels.

Profunda Femoris Artery It arises from the lateral side of femoral artery, about 4cm. Below inguinal ligament. It descends with anterior division of femoral N. between adductor longus & brevis, then lying on adductor magnus, where it ends as 4th perforating artery. Branches : 1- Medial femoral circumflex artery : passes backward between Ms. that form floor of femoral triangle. It takes part in cruciate anastomosis. It gives off : ascending, transverse, muscular and acetabular branches. 2- Lateral femoral circumflex artery : passes laterally and gives off : ascending, transverse and descending branches. It takes part in cruciate anastomosis.

Profunda Femoris Artery 3- Four perforating arteries : 3 of these are branches of profunda, the 4th perforating is the terminal part of profunda. -They terminate by anastomosing with one another at the back of femur. -The 1st perforating artery takes part in cruciate anastomosis by anastomosing with the inferior gluteal artery. - The 4th perforating artery ( terminal part of profunda ) anastomosing with the muscular branches of popliteal artery. Profunda Femoris Vein It receives tributaries corresponding to the branches of the artery. It drains into femoral artery.

Obturator Artery It arises in the pelvis from internal iliac artery. It enters thigh by passing through the obturator canal (upper part of obturator foramen ) with company the obturator nerve. It divides into medial & lateral branches, which form a circle on the outer surface of obturator membrane It gives off : muscular branches + articular branch to hip joint and head of femur by passing through the acetabular notch and along the ligament of head of femur into the fovea.

Obturator Nerve It arises from lumbar plexus (L2,3,4) emerging on the medial border of psoas muscle within the abdomen. It runs on lateral wall of pelvis to reach upper part of obturator foramen, where it divides into anterior & posterior divisions. Anterior division : - it descends in front of adductor brevis/ behind pectineus + adductor longus. -it gives muscular branches : to gracilis, adductor brevis, adductor longus / occasionally to pectineus. -it gives articular branches : to hip joint. -it supplies skin of medial side of thigh.

Obturator Nerve Posterior division : -it pierces obturator externus to descends behind the adductor brevis and in front adductor magnus. -it terminates by passing through opening in adductor magnus ( adductor hiatus) to supply knee joint. - it gives muscular branches : to obturator externus, adductor part of adductor magnus /occasionally adductor brevis.

Cruciate Anastomosis It lies in the back of thigh at the level of lesser trochanter of femur. It provides a connection between internal iliac & femoral arteries. The following arteries take part in the anastomosis : 1- inferior gluteal artery ( from intenal iliac artery). 2- medial femoral circumflex artery ( transverse branch). 3- lateral femoral circumflex artery : (transverse branch). 4- 1st perforating artery ( branch of profunda artery).

Cutaneous Nerves of Front of Thigh From the lumbar plexus : 1- Ilio-inguinal N. (L1 ). 2- Femoral branch of genitofemoral N. ( L1,2 ). 3- Lateral cutaneous N. of thigh. / L2,3 From Femoral N. : 1- Intermediate cutaneous N. of thigh. 2- Medial cutaneous N. of thigh. Obturator N./ on medial side of thigh. Patellar plexus : it is a network of nerves in superficial fascia in front of patella and ligamentum patellae. -It is formed of : -infrapatellar branch of saphenous N. -Lateral, intermediate and medial cutaneous nerves of thigh.

Blood supply of femoral head and Neck Fracture In the young, epiphysis of of head is supplied by small branch of obturator artery, which passes to head along ligament of head of femur. The neck of femur receives a profuse blood supply from medial femoral circumflex artery. These branches pierce capsule and ascend the neck. As long as epiphyseal cartilage remains, no communication occurs. In adult, after disappearance of epiphyseal cartilage, anastomosis occurs. Fracture of the neck interfere with blood supply from neck to head, so ischemic necrosis gradually takes place.

The neck of femur /coxa valga/coxa vara The angle btween neck and shaft of femur (angle of femoral inclination) is about 160 in child /and 125 in adult. Increase in the angle is referred to as coxa valga/as in congenital dislocation of hip/ adduction of hip joint is limited. A decrease in the angle is referred to coxa vara/ as in fracture of neck of femur / abduction of hip is limited.

The gluteal region The ligaments : Sacrotuberous, Sacrospinous. The foramina : 1-Greater Sciatic Foramen. 2-Lesser Sciatic Foramen. The muscles : Gluteus Max.,Med.,Minimus. Tensor fascia latae ,Piriformis,Obturator int., sup.&inf.gemelli, Quadratus femoris. The nerves: Sciatic N., Post.cut.N.of the thigh, Sup.&inf.gluteal N. , N.to Q.F., Pudendal N., N.To Ob.int. The arteries: Sup.,&inf.gluteal arteries.

What are structures passing through the greater sciatic foramen? Piriformis. Structures above piriformis: Sup.gluteal N.&vessels. Structures below piriformis: Inf.gluteal N.&vessels. Sciatic N. Post.cut.N.of the thigh. N.to Q.femoris. N.to obt.internus.---Pudendal N.---Int.pudendal vessels

What are structures passing through the lesser sciatic foramen? Tendon of obturator internus muscle. N.to obturator internus . Pudendal N. Internal pudendal vessels.

The Sciatic Nerve in gluteal region. Origin : sacral plexus (L4,5,S1,2,3) in pelvis. Course and relation: it leaves pelvis through grater sciatic foramen below piriformis. It crosses from above downwards: ischium,obturator int.&and 2gemilli,quadratus femoris. It leaves buttok by passing deep to long head of biceps femoris to enter the back of thigh. Branches: No branches in the gluteal region.

Structures deep to Gluteus Maximus Muscles: 1-gluteus medius. 2-lateral rotators of the thigh. Ligaments: 1- sacrotuberous. 2-sacrospinous. Bones: Lat.: greater trochanter. Med.: ischial tuberosity. Three synovial bursae . Foramina : 1-greater sciatic F. 2-lesser sciatic F.

Anastomosis in the gluteal region The cruciate anastomosis: provide connection between the internal iliac &femoral arteries. It lies at the level of Lesser trochanter. The following arteries take part in the anastomosis :1-Inf.gluteal , 2-1st perforating , 3-Med.femoral circumflex. 4-Lat.femoral circumflex.

Anastomosis in the gluteal region The Trochanteric anastomosis : provides the main blood supply of the head of femur. the arteries pass along femoral neck beneath the capsule of hip joint. The following arteries take part in the anastomosis: 1-Sup.gluteal.Ar. 2-Inf gluteal.Ar 3-Med. Femoral circumflex Ar. 4-Lat. Femoral circumflex Ar.