Front of the thigh

Anatomical Description of The Dissection Part of Front of the Thigh

1. Front of the Thigh Dr. Mushfiqul Hoque Lecturer Dhaka National Medical College

2. Steps of dissection for femoral triangle An oblique incision from the anterior superior iliac spine to the top of the symphysis pubis along the inguinal ligament. A transverse incision at the junction of the upper third and lower two-thirds of the front of the thigh. A longitudinal incision joining the medial ends of the lst and 2nd incisions along the medial side of the thigh. Skin—Reflect laterally.  

3. Layers: Skin Superficial fascia Deep fascia or Fascia Lata: Modification: iliotibial tract Contains saphenous opening located 4cm below and lateral to the pubic tubercle, and it is closed by cribriform fascia 

4. Superficial Inguinal lymph nodes Arranged in T shaped manner Lower vertical group drains most of lower limb Upper lateral group drains infra umbilical part of anterior abdominal wall Upper medial group drains lymph from external genital organ 

5. Iliotibial Tract  Fascia lata is thickened laterally where it forms a 5 cm wide band Two important muscles: gluteus maximus and tensor fascia lata are inserted in it.  The iliotibial Tract stabilizes the knee in both extension and partial flexion. It is, therefore, constantly used during walking and running

6. Femoral Triangle: Borders Medially: medial border of adductor longus Laterally: medial border of sartorius Apex, directed downwards, formed by the point where medial and lateral borders meet Base: inguinal ligament Roof: skin-superficial fascia- deep fascia- Floor: medially: adductor longus and pectineus and laterally: psoas major and iliacus

7. Femoral Triangle: Contents Femoral artery and branches Femoral vein and tributaries Femoral sheath  Nerves:   Femoral nerve Nerve to pectineus Femoral branch of genitofemoral nerve Lateral cutaneous nerve of thigh Deep inguinal lymph nodes

8. Femoral Sheath Funnel shaped sleeve of fascia enclosing the upper part of femoral vessels Formed by downward extension of two layers of fascia of abdomen Anterior wall formed by fascia transversalis Posterior wall formed by fascia iliaca which covers the iliacus muscle Inferiorly, it merges with the connective tissue around femoral vessels.

9. Femoral Sheath Asymmetrical Lateral wall is vertical Medial wall is oblique being directed downwards and laterally 

10. Femoral Sheath Divided into 3 compartments by septa Lateral compartment contains femoral artery and femoral branch of the genitofemoral nerve Intermediate or venous compartment contains the femoral vein Medial compartment is called femoral canal: upper end of this canal is called femoral ring. The canal contains a lymph node named lymph node of rosenmuller or cloquet . This canal is the site for femoral hernia.  

11. Adductor/Hunter's/ Subsartorial canal Extends from the apex of femoral triangle to the tendinous opening of the adductor magnus below Triangular in cross section Contents:  Femoral artery Femoral vein The saphenous nerve Nerve to vastus medialis Branches of two divisions of obturator nerve 

12. Adductor/Hunter's/ Subsartorial canal Extends from the apex of femoral triangle to the tendinous opening of the adductor magnus below Triangular in cross section Contents:  Femoral artery Femoral vein The saphenous nerve Nerve to vastus medialis Branches of two divisions of obturator nerve 

13. Clinical Anatomy Upper group of superficial inguinal lymph nodes may be enlarged due to spread of infection or malignant growth from lymphatic territories drained in these nodes which includes infra umbilical parts of abdomen, external genitalia Lower group of superficial inguinal lymph nodes enlarged if the disease is in lower limb  Therefor syphilitic lesions involve medial members of the upper group