1. LOWER LIMB Anterior Compartment of the Thighs & Femoral Triangle
Dr. Kumar K.V

2. Superficial structures
Great saphenous vein
Drains the medial end of dorsal venous arch of foot
Passes upward directly in front of the medial malleolus.
Then ascends on medial side of the leg.
Passes behind the knee and curves forward around the medial side of the thigh.
Passes through the saphenous hiatus in the deep fascia and joins the femoral vein about 4 cm below and lateral to the pubic tubercle.

3. Veins Deep Veins: Mostly share names of arteries Superficial Veins
Ultimately empty into Inferior Vena Cava
Plantar
Tibial
Fibular
Popliteal
Femoral
External/internal iliac
Common iliac
Superficial Veins
Dorsal venous arch (foot)
Great saphenous (empties into femoral)
Small saphenous (empties into popliteal)

4. Superficial structures
Tributaries:
Superficial lateral femoral v.
Superficial medial femoral v.
External pudendal v.
Superficial epigastric v.
Superficial iliac circumflex v.

5. Superficial epigastric v.
Superficial circumflex iliac v.
External pudendal v.
Superficial lateral femoral v.
Superficial medial femoral v.
Great saphenous v.

6. Varicose veins

7. Superficial structures
Superficial fascia
Superficial arteries:
superficial epigastric a.
superficial iliac circumflex a.
external pudendal a.
Cutaneous nerves:
lateral femoral cutaneous n.
anterior and medial cutaneous branches of femoral n.
cutaneous branches of obturator n.

8. Cutaneous Nerves lateral femoral cutaneous n.
anterior and medial cutaneous branches of femoral n.
Cutaneous branches of obturator n.

9. Superficial structures
Superficial inguinal lymph nodes
. Superior group:
Lies just distal to the inguinal ligament
Receive lymph vessels from anterior abdominal wall below umbilicus, gluteal region, perineal region, external genital organs
Inferior group:
Lies vertical along the terminal great saphenous v.
Receives all superficial lymph vessels of lower limb, except for those from the posterolateral part of calf
Efferent vessels drain into the deep inguinal ln. or external iliac ln.

10. Deep fascia of the thigh
Fascia lata
The deep fascia encloses the thigh like a trouser leg.
Saphenous hiatus
A gap in the deep fasica which lies about 4 cm below and lateral to the pubic tubercle. The falciform margin is the lower lateral border of the opening, which lies anterior to the femoral vessels.
Filled with loose connective tissue called the cribriform fascia

11. Deep fascia of the thigh
Iliotibial tract laterally the deep fascia forms a thick band, from the iliac tubercle to the lateral condyle of tibial.
The fascia lata sends intermuscular septa to the linea aspera of the femur. These separate the thigh into three compartments each of which contains a group of muscles, the vessels and the nerves.

12. Inguinal Ligament & Femoral Sheath
Boundaries:
Anteriorly: lateral portion of inguinal ligament
Posterolaterally: ilium
Medially: iliopectinal arch
Contents:
Iliopsoas
femoral n.
lateral femoral cutaneous n.
Lateral femoral cutaneous n.
Iliopsoas
Iliopectinal arch
Femoral n.

13. Femoral Ring & Femoral Sheath
Boundaries:
Anteriorly: medial portion of inguinal ligament
Posteriorly: fascia of pecteineus and pectineal ligament
Medially: lacunar ligament
Laterally: iliopectinal arch
Contents:
Femoral sheath
Femoral a. and v.
Genital branch of genitofemoral n.
Lymphatic vessels
Femoral a.
Femoral v.
Femoral ring

14. Femoral triangle Femoral sheath A funnel- shaped sheath
Derived from transversalis fascia anteriorly and iliac fascia posteriorly
It surroumds the femoral vessels and lymphatic about 2.5cm belower the inguinal ligamemt.
Its lower end disappears at the lower margin of the saphenous opening where the sheath fuses with the adventitia of the vessels.

15. Femoral sheath Femoral sheath Lateral compartment: femoral a.
Divided into three compartments by two fibrous septa
Lateral compartment: femoral a.
Middle compartment: femoral v.
Medial compartment: femoral canal

16. The femoral canal
About 1.3cm long , and its upper opening is called the femoral ring
Contains: a little loose fatty tissue, a small lymph node, and some lymph vessels.
The boundaries of the femoral ring
Anteriorly: the inguinal ligament
Medially: the lacunar ligament
Posteriorly: the pecten of pubis
Laterally: the femoral vein
Superior: covered by femoral septum

17. Femoral hernia
If a loop of intestine is forced into the femoral ring, it expands to form a swelling in the upper part of the thigh. Such a condition is known as a femoral hernia.
A femoral hernia is more common in women than in men (possibly because their wider pelvis and femoral canal ).

18. Femoral triangle Boundaries
A triangular depressed area situated in the upper part of the medial aspect of the thigh just below the inguinal ligament
Boundaries
Superiorly (base) : the inguinal ligament
Laterally: medial border of sartorius
Medially: medial border of adductor longus
Apex: continuous with adductor canal
Anterior wall: fascia lata
Posterior wall: consists of iliopsoas, pectineus and adductor longus from lateral to medial side

19. Femoral triangle Contents Femoral nerve Femoral sheath
Femoral a. and its branches
Femoral vein and its tributaries.
Femoral canal
Deep inguinal lymph nodes
Fatty tissue
VAN – VEIN, ARTERY, NERVE

20. Contents of the anterior fascial compartments of the thigh
Psoas major
Iliopsoas
Iliacus
Sartorius
Vastus lateralis
Quadriceps femoris
Rectus femoris
Vastusintermedius
Vastus medialis

21. Contents of the medial fascial compartments of the thigh
Pectineus
Adductor longus
Adductor brevis
Adductor magnus
Gracilis
Adductor tendinous opening

22. Femoral artery Femoral a. Continuation of the external iliac a.
Begins midpoint of inguinal ligament
Ends at the adductor tendinous opening by entering the popliteal fossa as the popliteal artery
Principal branch－deep femeral a.
arises from the posterolateral surface of the femoral artery about 5 cm below the inguinal ligament.
Medial femoral circumflex
lateral femoral circumflex
Four perforating arteries

23. Profunda femoris
Arises from the posterolateral surface of the femoral artery about 5 cm below the inguinal ligament.
Branches:
Lateral circumflex artery.
Medial circumflex artery.
Perforating arteries

24. deep femeral a.
Medial circumflex a.
Lateral circumflex a.
perforating arteries

25. Femoral vein Begins at the adductor tendinous opening
Continues as external iliac vein deep to inguinal ligament
Contains several valves

26. The deep inguinal lymph nodes
Lie medial to the femoral v.
Receive deep lymphatics of lower limb, perineal region, and efferent lymphatics from the superficial inguinal ln.
Drain into the external iliac ln.

27. Femoral nerve
Arises from the lumbar plexus in the abdomen, and enters the thigh posterior to the inguinal ligament and lateral to the femoral artery.
It ends by dividing into a number of branches 2 cm below the inguinal ligament.
Muscular branches to: pectineus, sartorius, quadriceps femoris

28. Femoral nerve Cutaneous branches:
Anterior cutaneous nerves of the thigh
Saphenous nerve is the longest branch of the femoral nerve. It accompanies the femoral vessels in the adductor canal, then accompanies the great saphenous vein to the medial side of the leg and food.
Saphenous nerve 隐神经 is the longest branch of the femoral nerve. It accompanies the femoral vessels in the adductor canal, then accompanies the great saphenous vein to the medial side of the leg and food.

29. Femoral n.
Femoral a.
Femoral v.
Saphenous nerve

30. Muscles of the Anterior Compartment of the Thigh
Sartorius.
Iliacus.
Psoas major.
Pectineus.
Quadriceps Femoris.

31. Sartorius Origin: Anterior superior iliac spine. Insertion:
Upper part of the medial surface of the shaft of the tibia.
Nerve Supply:
Femoral nerve.
Action:
-Flexion, abduction and lateral rotation of the thigh.
-Flexion and medial rotation of the leg.

33. Tensor Fasciae Latae Origin: Outer lip of iliac crest. Insertion:
Through the ilio-tibial tract to the lateral condyle of the tibia
Nerve Supply:
Superior gluteal nerve.
Action:
Abduction of the thigh (with gluteus medius and minimus).
Maintenance of the extended knee (with gluteus maximus).

35. Iliacus Origin: Iliac fossa. Insertion:
Lesser trochanter of the femur.
Nerve Supply:
Femoral nerve.
Action:
Flexion of the thigh.
Helps in Medial rotation of thigh.

37. Psoas major
Origin:
Transverse processes and sides from 12th thoracic to 5th lumbar vertebrae.
Insertion:
Lesser trochanter of the femur.
Nerve Supply:
Branches from lumbar plexus.
Action:
Flexion of the thigh.
Helps in Medial rotation of thigh.

39. Pectineus Origin: Superior pubic ramus. Insertion:
Upper end of linea aspera of femur.
Nerve Supply:
Femoral nerve.
Obturator nerve.
Action:
Flexion of the thigh.
Adduction of the thigh.

41. Quadriceps Femoris Rectus Femoris
Origin:
Ant. Sup. Iliac Spine + Ilium above acetabulum
Insertion:
Quadriceps tendon and patella.
Nerve Supply:
Femoral nerve.
Action:
Extension of the knee joint.

43. Quadriceps Femoris Vastus Lateralis
Origin:
Inter-trochanteric line + linea aspera
Insertion:
Quadriceps tendon and patella.
Nerve Supply:
Femoral nerve.
Action:
Extension of the knee joint.

44. Quadriceps Femoris Vastus Medialis
Origin:
Inter-trochanteric line + linea aspera
Insertion:
Quadriceps tendon and patella.
Nerve Supply:
Femoral nerve.
Action:
Extension of the knee joint.

45. Quadriceps Femoris Vastus Intermedius
Origin:
Anterior and lateral surfaces of the shaft of the femur
Insertion:
Quadriceps tendon and patella.
Nerve Supply:
Femoral nerve.
Action:
Extension of the knee joint.

47. Adductor canal
An intermuscular cleft situated on the medial aspect of the middle third of the thigh beneath the sartorius.
Extends from apex of femoral triangle to adductor tendinous opening
Boundies
Anterior wall: adductor lamina and sartorius
Lateral wall : vastus medialis
Posteomedial wall: adductors longus and magmus
Contents
Saphenous n.
Femoral a. and femoral v.
lymphatic vessels and loose connective tissue

48. Blood vessels and nerve of medial side of thigh
Obturator a.
Arises from internal iliac artery in the lesser pelvis
passes through the obturator canal where it divides into anterior and posterior branches.
Obturator n.
Arises from the lumbar plexus in the abdomen.
Enters the thigh through the obturator canal where it divides into anterior and posterior branches.
Supplies medial group of muscles of thigh, obturator externus, and skin of medial side of thigh

49. Obturator n.

50. Arteries External iliac becomes……. Femoral becomes…… Femoral
Once passes the inguinal ligament
Lower limb
Branches into Deep femoral
Adductors, hamstrings, quadriceps
Branches into Medial/lateral femoral circumflex
Head and neck of femur
Femoral becomes……
Popliteal (continuation of femoral)
Branches into:
Geniculars
Knee
Splits into:
Anterior Tibial
Anterior leg muscles, further branches to feet
Posterior Tibial
Flexor muscles, plantar arch, branches to toes

51. Anterolateral crural region
Superficial veins
Dorsal venous arch: lies in the subcutaneous tissue over the heads of the metatarsal bones and drains on the medial side into the great saphenous v. and on the lateral side into the small saphenous v.
Great saphenous v.:
Drains the medial end of dorsal venous arch of food and passes upward directly in front of the medial malleolus.
Then ascends in company with the saphenous n. in the superficial fascia over the medial side of the leg.