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Blood Supply of the Anterior Fascial Compartments of the Thigh Femoral Artery main artery of lower limb Origin Continuation of Ext. Iliac artery below the inguinal ligament. Enters the thigh midway between the ant. Sup. Iliac spine & pubic Symphysis 1 Course:A- upper half of FA lies in FT. B- Lower Half lies in the adductor canal 2 Dr. Vohra 3 Dr. Vohra Branches • • • • Superficial: Sup. Ext. Pudendal Sup. Epigastric Sup circumflex iliac • • • • Deep: Profunda femoris Deep Ext. pudendal Descending genicular 4 Dr. Vohra Femoral nerve (L2,3,4) • arise from the lumber plexus in the abdomen descend in groove between psoas and iliacus muscles and give branch to iliacs . it enters the thigh posterior to the inguinal ligament and lateral to the femoral sheath. 2cm below the inguinal ligament it ends by dividing into anterior and posterior branches . The anterior division gives: a-Cutaneous nerves includes the anterior cutaneous nerve of the thigh. b-muscular branches to the sartoris and through which it gives genicular branch to the hip joint. • • • • • • The posterior division gives: a- Saphenous nerve (L3 L4). It is the longest branch of the the medial side of the foot. b- Muscular branches to the quadriceps femoris muscle (rectus femoris, vastus lateralis, medialis and intermedius(. 5 Dr. Vohra The medial side (adductor) of the thigh • • • • 6 Includes the adductor muscles which arise from the external surfaces of the pubic rami and the ramus of the ischium. they concerned with adduction at the hip joint, the muscles are: pectineus, adductor longus, adductorbrevis, adductor magnus, gracilis The nerve supply of these muscles is the obturator nerve (L2, 3, 4).except the hamstring portion of adductor magnus from sciatic N. and pectineus m. receive nerve supply from both femoral and obturator N. • Dr. Vohra 7 Dr. Vohra 8 Dr. Vohra 9 Dr. Vohra The obturator nerve • • • 10 Origin : L2,3,4 COURSEarises from the lumbar plexus in the abdomen it descends medial to the psoas m. at the lateral wall of the pelvis here it join the obturator vessels and enters the obturator canal where it divides into anterior and posterior branches: Anterior branch: Posterior branch: Dr. Vohra OBT. N 11 Dr. Vohra Obturator artery: Origin: It is a branch of Internal iliac artery Course ,passes through obturator canal,divides into anterior and posterior • Branches 1- muscular 2- articular to femoral head 3- anastamosic branch with medial cirum. Art. 12 Dr. Vohra ( subsartorial canal) adductor canal • Boundaries of the canal are: • (it is triangular in coss section.( • a- anteromedial wall. Formed by Sartorius muscle • b-anterolateral wall. Formed by Vastus medialis • c- posterior wall formed by Adductor longus and magnus. 13 Dr. Vohra adductor canal • An intermuscular cleft situated on the medial aspect of the middle 3rd of the thigh • Contents of (2A+1V+2N): • • • • Femoral artery descending genicular art. Saphenous nerve Nerve to vastus med • Femoral vein 14 Dr. Vohra Clinical Notes Varicose veins Femoral hernia 15 gluteal region Extends from the iliac • crest above to the .gluteal fold below The superficial fascia is • thick dense and fatty, 16 Dr. Vohra Muscles of the gluteal region • Superficial abductors and extenders – A group of large muscles that abduct and extend the femur. It includes the gluteus maximus, gluteus medius, gluteus minimus and tensor fascia lata. Deep lateral rotators – A group of • smaller muscles, that mainly act to laterally rotate the femur. It includes the quadratus femoris, piriformis, gemellus superior, gemellus inferior and obturator internus and obturator externus . : Glut. region 18 Dr. Vohra 19 Dr. Vohra Deep lateral rotators 20 Dr. Vohra The greater &lesser sciatic foramen: Sacrotuberous ligament ,Sacrospinous ligament 22 Dr. Vohra Greater S.F transmit : 1. piriformis 2. sup. Gluteal n. and vessels. 3.infer. Glut. N. and vessels . n. 5. post. Cut. N of thigh. 6.(PIN) pudendal n. ,Internal pudendal vesseles and nerve to obtur.inter lesser s. f. transmit 1-PIN 2-tendone of obtur. Intern . M Structure Pass From from GSF TO LSF : PIN. . 23 Dr. Vohra 4.sciatic Artery of gluteal region Superior gluteal arteryI • nferior gluteal artery • Gluteal nerve 25 Dr. Vohra