The front of the thigh

Femoral triangle(Scarpa’s triangle)

Is a triangular depressed area located in the

upper part of the medial aspect of the thigh

immediately below the inguinal ligament.

B o u n d a r i e s

Superiorly:The inguinal ligament

(the base of the triangle)

Laterally:The medial border of sartorius

muscle

Medially:The medial border of adductor

longus muscle

Floor: gutter shaped

from lateral to medial is made by

The iliopsoas muscle

The pectineus muscle

The adductor longus

The apex: directed downwards and is

formed by the meeting point of

Sartorius and adductor longus muscles

Roof : Formed by

1- skin

2- superficial fascia which

contains: A-superficial inguinal lymph nodes

B-femoral branch of the genitofemoral

nerve

C- branches of ilioinguinal nerve

D-superficial branches of the femoral

artery and corresponding veins

E- terminal part of the great saphenous

vien

3- deep fascia containing the

Saphenous opining

C o n t e n t s o f t h e f e m o r a l t r i a n g l e

1-Terminal part of the femoral nerve and its branches.

2- The femoral sheath

3- The femoral artery and its branches.

4- The femoral vein and its tributaries.

5- Deep inguinal lymph nodes

6- femoral branch of genitofemoral nerve

7- lateral cutaneous nerve of the thigh

The femoral sheath

Is a funnel-shaped sleeve of fascia

surrounded the femoral artery and vein and

the associated lymphatic vessels in the

femoral triangle for 2.5 cm below the

inguinal ligament.

Intermediate compartment (venous) occupied by the femoral vein Medial compartment

(lymphatic) occupied by the lymph vessels (also Called femoral canal

Two Anterio-posterior septa divide the sheath into 3 compartments:

Lateral compartment (arterial) occupied by the femoral artery and femoral branch

of the genitofemoral nerve

The femoral sheath is formed by a downwards

extension of the abdominal fascia.

Anterior wall: fascia transversalis

Posterior wall: fascia iliaca

F e m o r a l c a n a l Is the small medial compartment for

the lymph vessels. 1.3 cm In length.

Note: the femoral ring is wider in

femals because of their wider pelvis and

therefore, femoral hernia is commoner

in femals than in males

The femoral septum (is a

condensation of extraperitoneal

tissue), closes the ring.

Its upper opening is called the femoral

ring.

The femoral canal contains: 1- fatty connective tissue

2-all the efferent lymph vessels from

the deep inguinal lymph nodes and one

of the deep inguinal lymph nodes.

The femoral ring has the following

important relations:

Anteriorly : the inguinal ligament

Posteriorly: the superior ramus of

the pubis attached to it pectineus

and its covering fascia

Medially : the lacunar ligament

Laterally : Septa separating it from

the femoral vein

The part of the femoral sheath that

forms the femoral canal is not adherent to

the walls of the small lymph vessels; it is

this site that forms

a potentially weak area in the abdomen.

The lower end of the canal is normally

closed by the adherence of its medial

wall to the tunica adventitia of the

femoral vein.

A protrusion of peritoneum could be

forced down the femoral canal, pushing

the femoral septum. Such a condition is

known as a femoral hernia.

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

Femoral hernia

Adductor canal Adductor (Subsartorial) Canal

is an intermuscular cleft situated on

the medial aspect of the middle third of

the thigh beneath the sartorius muscle

It commences above at the apex of the

femoral triangle and ends below at the

opening in the adductor magnus.

In cross section it is triangular, having

.

Transverse section through the middle of the

right thigh as seen from above

1-Anteromedial wall

2-Posterior wall

3-Lateral wall

anterior

The adductor canal contains :

1-The terminal part of the femoral

artery

2-The femoral vein

3-The deep lymph vessels

4-The saphenous nerve

5-The nerve to the vastus medialis

6-The terminal part of the

obturator nerve

The Anteriomedially wall is formed by:

The sartorius muscle and fascia.

The posterior wall is formed by:

The adductor longus and magnus The lateral wall is formed by:

The vastus medialis

Subsartorial plexus of nerves:

Located on the fascia under the sartorius muscle

Formed by branches from

1-Medial cutaneous nerve of the thigh

2-Saphenous nerve

3-The anterior division of obturator nerve

3-As the femoral artery

descends downwards, its

upper half lies superficial

in the femoral triangle

while in the lower half it

lies deep in the

subsartorial (adductor)

canal

2-It lies midway

between the

anterior

superior iliac

spine and the

symphysis pubis

(midinguinal

point)

The femoral artery 1- It enters the thigh from

behind the inguinal ligament

as a continuation of the

external iliac artery.

4- The femoral artery then

descends almost vertically

toward the adductor

tubercle of the femur and

ends at the opening

(Adductor hiatus) in the

adductor magnus muscle by

entering the popliteal space

as THE POPLITEAL

ARTERY

5-Relations In the upper part of its course, femoral artery lies in the femoral

triangle (superficial)

1- Exposed to injuries 2- Good approach for taking femoral pulse

Anteriorly : (in the femoral triangle)

The femoral artery is covered by skin and fascia

Its upper part (1.5 inch) is covered by the anterior wall

Of the femoral sheath and crossed by

the femoral branch of genito-femoral

nerve

Its lower part is crossed

by the saphenous Nerve

Posteriorly:

1-Psoas major muscle, which separates it from

the hip joint

2-The pectineus muscle with profunda femoris

vessels in between

3-The adductor longus muscle with femoral

vein in between

Medially: the femoral

vein lies medial to the

artery in the upper part

of the femoral triangle,

then it lies

posteromedial and

finally posterior to the

artery at the apex of the

femoral triangle

Laterally:

The femoral nerve and

Its branches.

Femoral Artery Catheterization 1-Fine catheter can be inserted into the femoral artery as it descends through the femoral triangle.

2-The catheter is guided under fluoroscopic view along the external and common iliac arteries

into the aorta.

3-The catheter can then be passed into the inferior mesenteric, superior mesenteric, celiac, or

renal arteries.

4-Contrast medium can then be injected into the artery under examination and a permanent

record obtained by taking a radiograph.

Femoral Vein Catheterization 1-Femoral vein catheterization is used when rapid access to a large vein is needed.

2-The femoral vein has a constant relationship to the medial side of the femoral artery just below

the inguinal ligament and is easily cannulated.

3- Because of the high incidence of thrombosis with the possibility of fatal pulmonary embolism,

the catheter should be removed once the patient is stabilized.

Anatomy of the Procedure

1-The skin of the thigh below the inguinal ligament is supplied by the genitofemoral nerve; this

nerve is blocked with a local anesthetic.

2-The femoral pulse is palpated midway between the anterior superior iliac spine and the

symphysis pubis, and the femoral vein lies immediately medial to it.

3-At a site about two fingerbreadths below the inguinal ligament, the needle is inserted into the

femoral vein.

Because the femoral artery lies in the femoral triangle (superficial)

The following procedure can be done

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6- Branches of the femoral artery

THREE superficial branches and

TWO deep branch

I-Superficial branches

1-The superficial circumflex iliac

artery

2-The superficial epigastric

artery

3-The superficial external

pudendal

They supply cutaneous regions of the upper

thigh, lower abdomen, and perineum.

In the femoral triangle

II- DEEP BRANCHES

1-The deep external pudendal artery

2-The profunda femoris artery (Deep artery of thigh)

arises from the lateral side of the femoral artery about

(4 cm) below the inguinal ligament

it gives off:

A)

B) The medial femoral circumflex artery

C) Perforating arteries .

lateral femoral circumflex artery

2-descending branch: connects with a

branch of the popliteal artery near the knee

It divides into three terminal branches:

1-ascending branch, supplies the neck

and head of the femur;

3-transverse branch: anastomoses with

branches from the medial femoral

circumflex artery, the inferior gluteal artery,

and the first perforating artery to form the

cruciate anastomosis around the hip.

A) lateral femoral circumflex artery: Normally originates proximally from the

lateral side of the profunda femoris artery ,

but may arise directly from the femoral

artery

Profunda

femoris artery

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B) The medial circumflex femoral artery

normally originates proximally from the

posteromedial aspect of the profunda femoris artery

but may originate from the femoral artery

It gives off :

b) Ascending branch: shears in the trochonteric anastomosis

c) Transverse branch: shears in the cruciate anastomosis

a) Acetabular branch: which enters the hip

joint through the acetabular notch and

anastomoses with the acetabular branch of the

obturator artery.

C) Perforating arteries .

profunda

femoris

artery

The profunda femoris artery gives off perforating branches.

The first three arteries arise as branches

of the profunda femoris artery, while the fourth one is

the termination of the profunda femoris artery

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In the lower part of its course,

the femoral artery passes behind the

sartorius ( deep) muscle in the

subsartorial canal (adductor canal).

Relations of the femoral artery

In the subsartorial canal

Anteriomedially:

Skin and fascia

Sartorius muscle and fibrous roof

of the canal

Saphenous nerve which crosses from

lateral to medial

Anterolaterally:

vastus medialis

Nerve to vastus medialis

Posteriorly:

femoral vein

Branches of the femoral artery in the adductor canal

It gives off only one branch

The descending genicular 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

Other arteries that shear in the blood

Supply of the lower limb