Download الشريحة 1

• Objectives
• 1- to know the anatomical subdivisions of
the lower limb.
• 2- to understand the anatomy of each
division.
• 3- to have an idea about some clinical
points related to the lower limb.
The lower limb
Divided into:
1- The hip and thigh region.
2- The gluteal region.
3- The leg region.
4- The foot region.
The Thigh
•
• the region of the thigh includes the area from the
iliac crest to the knee, thus the uppermost limit of
the thigh are the iliac crest, the inguinal ligament,
the symphysis pubis, the ischiopubic ramus, the
ischial tuberosity, the sacrotuberous ligament and
the dorsum of the sacrum. The bones of the thigh
are the hip and the femur.
The Superficial fascia
•
Consist of
• Thick fatty superficial layer. This layer is
continuous with the similar layer of the abdomen,
the back, the perineum, and the leg.
• The membranous layer, it is the continuation of
the same layer of the abdominal wall but it fuses
with the inguinal ligament, pubic tubercle and
inferior ramus.
THE SUPERFICIAL FASCIA OF THE THIGH
The deep fascia ( fascia lata)
• the
deep
fascia
of
the
thigh
is
strong
membranous fascia, surrounds the thigh like
stock, It is thin in the gluteal region, while
laterally it forms a thick band extend from the
iliac crest to the lateral tibial chondyle called the
iliotibial tract.
Iliotibial tract
• Fascia lata attached superiorly to the :
• iliac crest, inguinal ligament, pubic crest and
symphysis, inferior pubic ramus and the ramus
of the ischium .
• Inferiorly it fuses with the patella at the knee,
with the femoral and both tibial chondyles , the
head of the fibula and continuous with the crural
fascia of the leg.
• Posteriorly: it fuses with the deep fascia of the
popliteal fossa.
The deep fascia (fascia lata)
• Fascia lata sends intermuscular septa to
the linea aspera of the femur these are,
medial, lateral and posterior intermuscular
septa separate the thigh in to 3
compartments.
•
Anteriorly and laterally the extensor
compartment. Supplied by the femoral
nerve.
• Medially the adductor compartment.
Supplied by the obturator nerve.
•
Posteriorly the flexor compartment
supplied by the sciatic nerve.
Anterolateral and medial compartment
Posterior compartment
Saphenous opening
It is an oval opening in the deep fascia(fascia lata)
situated in the upper part of the front of the thigh, the
great saphenous vein passes through it to terminates in
the femoral vein. its center is located 4cm below the
inguinal ligament lateral to the pubic tubercle, it is about
4cm long and 1.5 cm wide. The opening is covered by a
thin and perforated fascia called ciribriform fascia. the
lateral margin of the opening is sharp called the falciform
margin.
It transmit :
• The great saphenous vein
• The superficial inguinal arteries
• Efferent
vessels
from
inguinal lymph nodes.
the
superficial
Great saphenous vein
It is the longest and thickest walled superficial vein in the
body. It begins at the junction of the medial end of the
dorsal venous arch and the medial dorsal vein of the
great toe runs upwards and backwards anterior to the
medial malleolus accompany the saphenous nerve in the
medial side of the leg then ascend to the posteromedial
surface of the knee and inclines anterolaterally in the
thigh to enter the femoral vein through the saphenous
opening.
Femoral sheath
It is an extension of the transveralis fascia of the
abdominal cavity which surrounds the upper 2-3
cm of the femoral vessels below the inguinal
ligament.
• The sheath is divided into 3compartments
• the femoral artery occupy the lateral part of the
sheath while the vein is intermediate, medial to
the femoral vein the sheath surrounds the
tubular femoral canal, through which femoral
hernia may pass. The femoral sheath bounded
medially by the free concave margin of the
lacunar ligament.
Femoral canal
• It is a short fascial tube about 0.5 inch occupy the medial
compartment of the femoral sheath, inferiorly it is rapidly
diminish in width and closed by fusion of its walls. The
wide
upper end called the femoral ring which is
separated from the abdominal cavity only by peritoneum.
It contains fatty connective tissues, efferent lymph
vessels from the deep inguinal lymph nodes and one of
the deep inguinal lymph node.
• Boundaries of the femoral ring:
• Inguinal ligament------------anteriorly
• The sharp edge of the lacunar ligament--------- medially
• The pectin pubis-------- posteriorly
• The femoral vein ------- laterally