Superficial veins of the Lower Limb:
In subcut fat
- Great saphenous vein
- Joint between dorsal vein of great toe + dorsal venous arch
- Ascends anterior to medial maleolus (site for cut down)
- Posterior to medial condyle of femur- one hand breadth posterior to medial border of patella.
- Anastamoses with the small saphenous vein
- Traverses the saphenous opening in fascia lata
- Empties into femoral vein
- Has valves – located just inferior to perforating veins.
- Lesser saphenous vein
- Joint between dorsal vein of little toe + dorsal venous arch
- Ascends posterior to lateral maleolus (site for cut down)
- Runs up lateral border of calcaneal tendon
- Inclines to midline of fibula and penetrates the deep fascia
- Goes up between the heads of gastrocnemius
- Empties into politeal vein in pop fossa
- Many perforating veins to deep veins.
Landmarks for saphenous opening in the deep fascia.
lies 3–4 cm inferolateral to the pubic tubercle. It is about 3 cm long and 1.5 cm wide.
Inguinal lymph nodes:
- Superficial Lymphatic vessels converge on and accompany saphenous veins.
- Ones with G saphenous vein –> superficial inguinal LNs–> external iliac LNs or deep inguinal LNs(medial to femoral vein)
- Small saphenous vein –> pop LNs
- Deep lymphatics accompany deep veins of leg–> pop LNs–> deep inguinal LNs–> external and common iliac LNs–> lumbar lymphatic trunks
Femoral muscle attachments
- Common insertion via patella tendon to tibial tuberosity
- Rectus femoris – AIIS
- Vastus medius – intertrochanteric line medial lip of linea aspera
- Vastus Lateralis – greater trochanter and lateral lip of linea aspera of femur
- Vastus intermedius – ant and lateral surface of shaft of femur
Femoral sheath:
3-4cm long
Contents – lateral to medial
- Femoral artery
- Femoral vein
- Femoral canal with Lymphatics
- Septa divide the space into three
Relations
- Lies on psoas major tendon
- Goes deep to inguinal ligament
Femoral canal
- Purposes – allow for expansion of femoral vein
- 1.25cm long, conical. Extends to proximal edge of saphenous opening
Femoral ring
- The proximal opening of femoral canal
- Laterally – vertical septum in front of femoral vein
- Posteriorly – superior ramus of pubis covered by pectineus and fascia
- Medially – lacunar ligament
- Anteriorly – medial inguinal ligament.
Femoral artery
- Continuation of external iliac artery–> branches – superficial epigastric, superficial circumflex iliac, superficial and deep external pudendal. Deep artery of thigh is the biggest branch- arise from lateral and posterior side and wraps around posterior femur giving perforating arteries to supply all three muscle compartments.
- Medial circumflex supplies most of head and neck of femur as well as the retinacular arteries which get torn during NOF#
- Lateral circumflex anastamoses with it but is less able to supply head and neck.
- Once giving the profunda femoris branch it becomes the superficial femoral artery and travels in adductor canal. Last branch is anastamotica magna which supplies superior internal and external articular branch of popliteal.
Femoral vein.
- Continuation of popliteal vein–> proximal to adductor hiatus–> ascends in adductor canal – lies postero lateral then posterior to femoral artery–> ends medial to artery, under the Inguinal ligament. –> external iliac vein. Deep vein of thigh enters 8cm below inguinal ligament.
Femoral nerve.
- Posterior division of anterior rami L2-L4
- Originates within psoas major on transverse processes–> posterolaterally in pelvis–> under Inguinal ligament –> femoral triangle–> muscle, skin and articular branches to hip and knee.
- Finishes as saphenous nerve – goes through adductor canal–> adductor hiatus and becomes superficial when passes between sartorius and gracilus–> cutaneous supply to anteromedial aspect of knee, leg and foot.
Obturator Nerve
- Anterior division of anterior rami of L2-4
- Forms on psoas major –> exits on medial border–> runs behind common iliac arteries, and laterally on pelvic wall–> obturator canal–> anterior and posterior division
- –> ant runs down between addcutor longus and brevis – supply both and gracilus.
- –> post run down obt externus and supplying it and adductor magnus.
- Innervates adductor compartment
- Cutaneous – medial thigh.
Patellar stability:
- Quadriceps tendon
- Vastus medialis
Adductor canal:
- Subsartorial/Hunter canal
- From apex of femoral triangle to adductor hiatus in adductor magnus.
- Boundaries –
- Ant and laterally – vastus medialis
- Post – adductor longus and magnus
- Medially – sartorius – also forms the roof
- Contents – femoral artery and vein, saphenous nerve, nerve to vastus medialis.
- Adductor hiatus – just proximal to medial supracondylar ridge.
Branches of Lumbar Plexus
Sensory Innervation of the lower limb