Download Practical training № 4

Practical training № 4
Topic. Topographical anatomy of the anterior region of the thigh. Vascular and muscular
lacunas. Femoral, obturative and adductive canals. Surgical anatomy of the femoral hernias and
methods of their treatment.
Relevance of the topic: for the diagnostics and treatment of patients with the diseases of nerves and vessels,
traumatic injuries of soft tissues and bones, femoral hernias doctor has to know the topographical anatomy of this region
and must know the modern methods of the first aid.
Purpose of the lesson:
1. Study the topographical anatomy of the anterior region of the thigh.
2. Study the topography of neurovascular formations in the upper, middle and lower third of the thigh for their
exposure.
3. Master the methods of plastics of the hernial gates about femoral hernia.
4. Study and justify the symptoms of the injury of the femoral and abductive nerves.
Control questions:
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Topographical anatomy of the anterior region of the thigh.
Topographical anatomy of the anterior fascial bed, its content. Incisions for the disclosure of the phlegmons.
Topographical anatomy of the medial fascial bed, its content. Incisions for the disclosure of the phlegmons.
Topography and content of the vascular and muscular lacunas.
Surgical anatomy of the femoral canal.
Surgical anatomy of the femoral hernias.
Surgeries on the femoral hernias. Features of treatment jammed femoral hernias.
Surgical anatomy of the femoral triangle, obturative and adductive canals.
Surgical anatomy of the femoral artery.
Practical skills:
1. Show on the body:
- n. femoralis and its branches
- n. cutaneus femoris lateralis
- n. obturatorius
- v. saphena magna
- nodi lymphatici inguinales superficiales
- muscles of the anterior fascial bed
- muscles of the medial fascial bed
- lacuna vasorum and its content
- walls and holes of the femoral canal
- limits of the femoral triangle and its content
- a. femoralis and its branches
- walls and holes of the adductive canal and its content
- adductive canal and its content
2. Perform the methods of plastics of the hernial gates by:
- Lockwood-Bassini
- Rudgi
- Parlavecho
- Reich
3. Demonstrate the basic stages of the surgery on the jammed femoral hernia.
4. Perform incisions for the disclosure of the phlegmons of the anterior and medial fascial beds.
Computer questions for the practical training № 4
Topographical anatomy of the anterior region of the thigh. Vascular and muscular
lacunas. Femoral, obturative and adductive canals. Surgical anatomy of the femoral
hernias and methods of their treatment.
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From the top front surface of hip is limited by
From below front surface of hip is limited by
Into which compartments the space under inguinal ligament is divided?
What is lacuna vasorum limited by from below and from the back?
Which nerves go through subcutaneous tissue of the front area of hip?
Which arteries go through subcutaneous tissue of the front area of hip?
Which veins go through subcutaneous tissue of the front area of hip?
Which vessel goes through medial part of the surface layer of broad fascia of hip?
What is situated at the front fascial sheath of hip?
Which vein is projected on the bottom of fossa ovale?
What is femoral triangle limited by medially?
What is femoral triangle limited by laterally?
What is femoral triangle limited by from above?
What is bottom of femoral triangle formed by?
What lies at the base of femoral triangle?
Which nerve goes together with a. femoralis in the lower corner of femoral triangle?
Name the interrelationship of elements of neurovascular fascicle in femoral triangle from inside to outside
What is lacuna musculorum limited by from above and from the front?
What is lacuna musculorum limited by from below and from the back?
What is lacuna musculorum limited by laterally?
What is lacuna musculorum limited by medially?
What goes through lacuna musculorum?
What goes through lacuna musculorum?
Which muscles does n. femoralis innervate?
What is lacuna vasorum limited by from above and from the front?
What is lacuna vasorum limited by from behind and from below?
What is lacuna vasorum limited by medially?
What is lacuna vasorum limited by laterally?
What goes through lacuna vasorum?
What is inner foramen of femoral canal is limited by from the front?
What is anulus femoralis limited by from behind?
What is anulus femoralis limited by laterally?
What is anulus femoralis limited by medially?
What is front wall of femoral canal formed by?
What is back wall of femoral canal formed by?
What is lateral wall of femoral canal formed by?
Name the external foramen of femoral canal
Name the layers that cover hernia sac when a patient has femoral hernia
What goes through hiatus saphenus?
Where are incisions made to drain phlegmon of front fascial sheath of hip?
What anatomically weak point works as a hernia gate for patients with hip hernia?
In what direction crural ring is dissected when a patient has pinched hernia?
What is dissected when a patient has hip hernia?
Name the main operation methods of hip hernias?
Name the complications that can appear during operation on hip hernia through inguinal access
Which tissues are taken into stitch for strengthening the internal foramen of femoral canal while doing operations through
inguinal access?
Which tissues are taken into stitch for strengthening the external foramen of femoral canal?
Which tissues are taken into stitch while doing plastics of hernia gate through femoral access in Bassini way?
Name the interrelationship of elements of neurovascular fascicle in the middle third of femoral (from front to back)
Name the projecting line of a. femoralis
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A surgeon defined Kueyn’s line for exposure of a. femoralis. Where does the line go?
Name the branches of n. femoralis
What is observed when n. femoralis is damaged below Puopart’s ligament?
What is Gunter’s canal limited by laterally?
What is Gunter’s canal limited by medially?
What is Gunter’s canal limited by from the front?
What goes through the upper foramen of adductor canal?
What goes through the front foramen of adductor canal?
What goes through the lower foramen of adductor canal?
What is the lower foramen of adductor canal is limited by?
Where is exit foramen of obturative canal situated?
Name the interrelationship of elements of neurovascular fascicle in obturative canal from outside inside
What is observed when n. obturatorius is damaged?
What incisions are made to drain phlegmon of medial fascial sheath of hip?
Name the methods of herniotomy which are fulfilled to close hernia gates from hip side for patients with hip hernias
Name the methods of herniotomy which are fulfilled to close hernia gates from inguinal canal side for patients with hip
hernias
How is Lockwood’s incision made?
How is Rudzhi’s incision made?
How is plasty of hernia gate is made according to Lockwood method for patients with hip hernia?
How is plasty of hernia gate is made according to Lockwood method for patients with hip hernia?
How is plasty of hernia gate is made according to Lockwood-Bassini method for patients with hip hernia?
Which stage of operation will be the next one after the incision of skin, subcutaneous tissue, superficial fascia, aponeurosis
of external obliquus abdominis muscle according to Rudzhi method?
How is plasty of hernia gate is made according to Rudzhi method for patients with hip hernia?
!
From the top front surface of hip is limited by:
Lig. inguinale
#Crista iliaca
Arcus iliopectineus
Lig. pectineale
!
From below front surface of hip is limited by:
Line drawn two fingers higher than the base of patella
#Transverse line that unites epicondyles of femoral bone
Line drawn two fingers lower than the base of patella
Lig. patellae
!
Into which compartments the space under inguinal ligament is divided?
Muscle and vascular lacunes
#Hernial, muscle and vascular lacunes
Hernia and vascular lacunes
Muscle and vascular lacunes, femoral canal
!
What is lacuna vasorum limited by from below and from the back?
Cooper’s ligament
#Shaft of iliac bone
Arcus iliopectineus
Gimbernat’s ligament
!
Which nerves go through subcutaneous tissue of the front area of hip?
R.femoralis n.genitofemoralis, n.cutaneus femoris lateralis, r.r.cutanei anteriores n.femoralis, r.cutaneus n.obturatorius
#R.cutaneus n.ilioinguinalis, r.femoralis n.genitofemoralis, , n.n.clunii inferiores, n.n.clunii medii
N.n.clunii superiores, n.cutaneus femoris lateralis, n.n.clunii inferiores, n.n.clunii medii
R.genitalis n.genitofemoralis, r.cutaneus n.iliohypogastricus, r.r.cutanei anteriores n.femoralis, r.cutaneus n.obturatoriu
!
Which arteries go through subcutaneous tissue of the front area of hip?
A.a.pudendae externae, a.circumflexa ilium superficialis, a.epigastrica superficialis
#A.epigastrica inferior, a.circumflexa femoris medialis, a.circumflexa femoris lateralis
A.gluteus superior, a.femoralis, a.profunda femoris
R.profundus a.circumflexa femoris medialis, r.ascendens a.circumflexa femoris lateralis
!
Which veins go through subcutaneous tissue of the front area of hip?
V.v.pudendae externae, v.epigastrica superficialis, v.circumflexa ilium superficialis, v.saphena magna
#V.v.pudenda interna, v.epigastrica inferior, v.femoralis, v.obturatoria, v. saphena parva
V.v.glutea inferior, v.glutea inferior, arcus venosus dorsalis pedis
All the mentioned above
!
Which vessel goes through medial part of the surface layer of broad fascia of hip?
v. saphena magna
#v. saphena parva
v. femoralis
a. femoralis
!
What is situated at the front fascial sheath of hip?
M.quadriceus femoris
#A.et v.femoralis
N.femoralis
M.sartorius
!
Which vein is projected on the bottom of fossa ovale?
v. femoralis
#v. circumflexa femoris lateralis
v. obturatoria
v. femoralis profunda
!
What is femoral triangle limited by medially?
By lateral margo of musculus adductor longus
#By medial margo of m. sartorius
By lateral margo of musculus adductor brevis
By lateral margo of musculus adductor magnus
!
What is femoral triangle limited by laterally?
By medial margo of m. sartorius
#By lateral margo of musculus adductor longus
By lateral margo of musculus adductor brevis
By lateral margo of musculus adductor magnus
!
What is femoral triangle limited by from above?
Lig.inguinale
#Margo falciformis
Lig.pectineale
Arcus iliopectineus
!
What is bottom of femoral triangle formed by?
M.pectineus, m.iliopsoas
#M.adductor longus, m.sartorius
M.adductor brevis, m. gracilis
M.adductor magnus, m.iliopsoas
!
What lies at the base of femoral triangle?
A.femoralis, v.femoralis, n.femoralis
#A.pudendae externae, v.pudendae externae, n.pudendus
a.profunda femoris, v.saphena magna, n.saphenus
A.obturatoria, v.obturatoria, n.obturatorius
!
Which nerve goes together with a. femoralis in the lower corner of femoral triangle?
N. saphenus
#N. femoralis
N. obturatorius
Ramus femoralis n. genitofemoralis
!
Name the interrelationship of elements of neurovascular fascicle in femoral triangle from inside to outside:
V.femoralis, a.femoralis, n.femoralis
#V.femoralis, n.femoralis, a.femoralis
A.femoralis, v.femoralis, n.femoralis
N.femoralis, a.femoralis, v.femoralis
!
What is lacuna musculorum limited by from above and from the front?
Lig.inguinale
#Lig.pectineale
Lig.lacunare
Arcus iliopectineus
!
What is lacuna musculorum limited by from below and from the back?
Shaft of iliac bone
#Lig.pectineale
Crista iliaca
Lig.inguinale
!
What is lacuna musculorum limited by laterally?
Crista iliaca
#Arcus iliopectineus
Lig.lacunare
Lig.pectineale
!
What is lacuna musculorum limited by medially?
Arcus iliopectineus
#Crista iliaca
Lig.lacunare
Lig.pectineale
!
What goes through lacuna musculorum?
M.iliopsoas, n.cutaneus femoris lateralis, n.femoralis
#M.pectineus, r.genitalis n.genitofemoralis
M.psoas major, v.femoralis, a., v.et n.obturatorius
A.femoralis, v.femoralis, r.femoralis n.genitofemoralis
!
Which muscles does n. femoralis innervate?
m. sartorius and m. quadriceps femoris
#m. gracilis and m. biceps femoris
m. semimembranosus and m. adductor magnus
m. adductor longus m. adductor brevis
!
What is lacuna vasorum limited by from above and from the front?
Lig.inguinale
#Lig.pectineale
Lig.lacunare
Arcus iliopectineus
!
What is lacuna vasorum limited by from behind and from below?
Cooper’s ligament
#Shaft of iliac bone
Arcus iliopectineus
Gimbernat’s ligament
!
What is lacuna vasorum limited by medially?
Gimbernat’s ligament
#Arcus iliopectineus
V.femoralis
Cooper’s ligament
!
What is lacuna vasorum limited by laterally?
Arcus iliopectineus
#Lig.lacunare
V.femoralis
Cooper’s ligament
!
What goes through lacuna vasorum?
A.femoralis, v.femoralis, r.femoralis n.genitofemoralis
#M.iliopsoas, n.cutaneus femoris lateralis, n.femoralis
M.pectineus, r.genitalis n.genitofemoralis
M.psoas major, v.femoralis, a., v.et n.obturatorius
!
What is inner foramen of femoral canal is limited by from the front?
Lig.inguinale
#Lig.pectineale
Lig.lacunare
Arcus iliopectineus
!
What is anulus femoralis limited by from behind?
Lig.pectineale
#Lig.inguinale
Lig.lacunare
Shaft of iliac bone
!
What is anulus femoralis limited by laterally?
Vagina of v.femoralis
#Lig.lacunare
Arcus iliopectineus
A.femoralis
!
What is anulus femoralis limited by medially?
Lig.lacunare
#Vagina of v.femoralis
A.femoralis
Arcus iliopectineus
!
What is front wall of femoral canal formed by?
Superficial layer of broad fascia of hip
#Deep layer of broad fascia of hip
Superficial fascia
Fascia cribrosa
!
What is back wall of femoral canal formed by?
Deep layer of broad fascia of hip
#Cornu superius margo falciformis
Superficial layer of broad fascia of hip
Cornu inferius margo falciformis
!
What is lateral wall of femoral canal formed by?
Vagina of v. femoralis
#Margo falciformis
A.femoralis
Arcus iliopectineus
!
Name the external foramen of femoral canal:
Hiatus saphenus
#Anulus femoralis
Fossa femoralis
Jobert’s fossa
!
Name the layers that cover hernia sac when a patient has femoral hernia
Skin, subcutaneous tissue, superficial fascia, subperitoneal tissue
#Skin, superficial layer of broad fascia of hip
Skin, deep layer of broad fascia of hip, fascia pectinea
Skin, subcutaneous tissue, superficial fascia, lamina vastoadductoria
!
What goes through hiatus saphenus?
Vasa lymphatica, v.saphena magna, a.pudenda externa, r.femoralis n.genitofemoralis
#A.femoralis, v.femoralis, r.femoralis n.genitofemoralis
Nodi lymphatici, r.genitalis n.genitofemoralis, m.iliopsoas, n.cutaneus femoris lateralis
M.pectineus, r.genitalis n.genitofemoralis, v.femoralis, a., v.et n.obturatorius
!
Where are incisions made to drain phlegmon of front fascial sheath of hip?
Along the external margo of m. rectus femoris
#Along the external margo of m. sartorius
Along the external margo of m. vastus lateralis
Along the inernal margo of m. sartorius
!
What anatomically weak point works as a hernia gate for patients with hip hernia?
Inner foramen of femoral canal
#Lateral inguinal fossa
Medial inguinal fossa
External foramen of femoral canal
!
In what direction crural ring is dissected when a patient has pinched hernia?
Medially
#Laterally
Up
Down
!
What is dissected when a patient has hip hernia?
Lig.lacunare
#Lig.inguinale
Lig.pectineale
Arcus iliopectineus
!
Name the main operation methods of hip hernias?
Lockwood-Bassini, Ruggi- Parlavecchio, Loteizen-Reich
#Kukudzhanov, Postempsky, Oppel
Meyo, Sapezhko, Lexer
Gerard, Spasokukotsky withKimbarovsky stitch, Martynov
!
Name the complications that can appear during operation on hip hernia through inguinal access:
All the mentioned below
#Damage of a. and v. femoralis
Damage of a. obturatorius
Damage of a. epigastrica inferior
!
Which tissues are taken into stitch for strengthening the internal foramen of femoral canal while doing operations through inguinal access?
Internal oblique abdominal muscle, Poupart’s ligament, periosteum of pubic bone, Cooper’s ligament
#External oblique abdominal muscle, transverse fascia, margo of rectus abdominal muscle, Gimbernat’s ligament
Poupart’s ligament, margo falciformis, fascia cribrosa, periosteum of pubic bone
Cornu superius falciformis, cornu inferius margo falcifornis, fascia pectinea, , Poupart’s ligament
!
Which tissues are taken into stitch for strengthening the external foramen of femoral canal?
Margo falciformis, fascia pectinea
#Internal oblique abdominal muscle, fascia cribrosa
Cornu superius margo falciformis
Cornu inferius margo falciformis
!
Which tissues are taken into stitch while doing plasty of hernia gate through femoral access in Bassini way?
Poupart’s ligament, periosteum of pubic bone, Cooper’s ligament, margo falciformis, fascia pectinea
#Gimbernat’s ligament, arcus iliopectineus
Lower margo of internal oblique and transverse abdominal muscle, transverse fascia
All the mentioned above
!
Name the interrelationship of elements of neurovascular fascicle in the middle third of femoral (from front to back)
N.saphenus, a.femoralis, v.femoralis
#V.femoralis, a.femoralis; n.saphenus
V.femoralis, n.saphenus, a.femoralis
A.femoralis, v.femoralis; n.saphenus
!
Name the projecting line of a. femuralis:
Kueyn’s
#Lesgaft’s
Jakoby’s
Roser-Nelaton
!
A surgeon defined Kueyn’s line for exposure of a. femoralis. Where does the line go?
From the middle of Poupart’s ligament to the medial epicondyle of hip
#From the middle of Poupart’s ligament to the lateral epicondyle of hip
From the point on the border 2/5 of medial and 3/5 of lateral length of Poupart’s ligament to tuberculum adductorium
From the middle of Poupart’s ligament to tuberositas tibiae.
!
Name the branches of n. femoralis:
R.r.musculares, r.r.cutanei anteriores, n.saphenus
#N.cutaneus femoris lateralis, r.genitalis n.genitofemoralis
N.suralis, n.peroneus profundus, n.peroneus superficialis
N.tibialis, n.obturatorius
!
What is observed when n. femoralis is damaged below Puopart’s ligament?
Impossible to extend crus, disorder of sensibility in the area innervations of n. saphenus
#Impossible dorsal flexion of foot and toes, disorder of sensibility in the area innervations of n. peroneus superficialis
Sole flexion of foot is impossible, disorder of sensibility in the area innervations of n. ichiadicus
Disorder of adduction of hip, flexion of crus is impossible
!
What is Gunter’s canal limited by laterally?
M.vastus medialis
#M.sartorius
M.vastus lateralis
M.adductor longus
!
What is Gunter’s canal limited by medially?
M.adductor magnus
#M.vastus medialis
Lamina vastoadductoria
M.vastus lateralis
!
What is Gunter’s canal limited by from the front?
Lamina vastoadductoria
#M.pectineus
M.vastus medialis
M.adductor magnus
!
What goes through the upper foramen of adductor canal?
A.femoralis, v.femoralis, n.saphenus
#A.genus descendens, v.genus descendens, n.femoralis
A.profunda femoris, v.femoralis, n.obturatorius
A.femoralis, v.femoralis, n.femoralis
!
What goes through the front foramen of adductor canal?
A.genus descendens, v.genus descendens, n.saphenus
#A.femoralis, v.saphena magna, n.peroneus communis
A.profunda femoris, v.saphena parva, r.r.cutanei anteriores n.femoralis
A.femoralis, v.femoralis, n.saphenus
!
What goes through the lower foramen of adductor canal?
A.femoralis, v.femoralis
#A.genus descendens, n.femoralis
V.genus descendens, n.saphenus
A.genus descendens, v.genus descendens
!
What is the lower foramen of adductor canal is limited by?
M.vastus medialis, m.adductor magnus
#M.vastus lateralis, m.adductor longus
By superficial layer of broad fascia of hip
Lamina vastoadductoria, m.sartorius
!
Where is exit foramen of obturator canal situated?
Behind m. pectineus
#In front of m. pectineus
Behind m. adductor longus
In front of adductor brevis
!
Name the interrelationship of elements of neurovascular fascicle in obturative canal from outside inside:
N.obturatorius, a.obturatoria, v.obturatoria
#V.obturatoria, a.obturatoria, n.obturatorius
A.obturatoria, v.obturatoria, n.obturatorius
V.obturatoria, n.obturatorius, a.obturatoria
!
What is observed when n. obturatorius is damaged?
Difficilties with adduction of hip, impossible to put one leg on another, disorder of sensibility of the lower third of internal surface of the hip
#Difficulties with extension of hip, disorder of sensibility below Poupart’s ligament
Impossible to extend crus, disorder of sensibility in the area innervations of n. saphenus
Impossible dorsal flexion of foot and toes, disorder of sensibility in the area innervations of n. peroneus superficialis
!
What incisions are made to drain phlegmon of medial fascial sheath of hip?
Incision 2-3 cm medially from Kuyen’s line
#Along lateral margo of m. gracilis
Along medial margo of m. sartorius
Along internal margo of m. rectus femoris
!
Name the methods of hernetomia which are fulfilled to close hernia gates from hip side for patients with hip hernias:
Lockwood-Bassini
# Ruggi- Parlavecchio
Loteizen-Reich
Meyo, Sapezhko, Lexer
!
Name the methods of hernetomia which are fulfilled to close hernia gates from inguinal canal side for patients with hip hernias:
Ruggi- Parlavecchio, Loteizen-Reich
Lockwood-Bassini
Kukudzhanov, Postempsky, Oppel
Meyo, Sapezhko, Lexer
!
How is Lockwood’s incision made?
Below and parallel to inguinal ligamentor upright
#With two transverse cuts that edge hernia protrusions
By horizontal cut around hernia protrusion
Above and parallel to lig. inguinale
!
How is Rudzhi’s incision made?
Above and parallel to lig. inguinale
#Below and parallel to inguinal ligament or upright
By horizontal cut around hernia protrusion
Up and medially to navel
!
How is plasty of hernia gate is made according to Lockwood method for patients with hip hernia?
Internal crural ring is liquidated through anchoring of inguinal ligament to Cooper’s ligament and periosteum of pubic bone with 2-3 stitches
#By anchoring of lower margo of internal obliquis and transverse muscles to lig. inguinale, and by other raw of interrupted suture the upper piece is
anchored
By anchoring of margos of internal obliquis and transverse muscles and transverse fascia of abdominal to inguinal ligament, Cooper’s ligament and
periosteum of pubic bone by one raw of interrupted suture
Inguinal ligamentis anchored to Coopers’ ligament and periosteum of pubic bone, cut down of transversal fascia and aponeurosis of external oblique muscle
!
How is plasty of hernia gate is made according to Lockwood-Bassini method for patients with hip hernia?
Internal crural ring is liquidated through anchoring of inguinal ligamentto Cooper’s ligament and periosteum of pubic bone with 2-3 stitches, and the
external foramen is liquidated by anchoring of second raw of stitches between margo falciformis and fascia pectinea
#Internal crural ring is liquidated through anchoring of inguinal ligamentto Cooper’s ligament with 2-3 stitches
Inguinal ligamentis anchored to Coopers’ ligament and periosteum of pubic bone, cut down of transversal fascia and aponeurosis of external obliquis muscle
By anchoring of purse suture around hernia gate and anchoring of interrupted suture on the front wall of vaginas of rectus abdominis muscles
!
Which stage of operation will be the next one after the incision of skin, subcutaneous tissue, superficial fascia, aponeurosis of external oblique abdominal
muscle according to Rudzhi method?
The back wall of inguinal canal is dissected, hernia sac is liquidated retrograde, dissect and treat it in typical method
#Inguinal ligamentis anchored to Coopers’ ligament and periosteum of pubic bone, cut down of transversal fascia and aponeurosis of external obliquis
muscle
Hernia gate is dissected by transverse cut, the lower margo of aponeurosis is anchored to back surface of upper piece by П-like stitches, and the free upper
margo of the piece is fixed to the front surface of the lower piece
By anchoring of purse suture around hernia gate and anchoring of interrupted suture on aponeurosises of abdominal muscles
!
How is plasty of hernia gate is made according to Rudzhi method for patients with hip hernia?
Inguinal ligament is anchored to Coopers’ ligament and periosteum of pubic bone, cut down of transversal fascia and aponeurosis of external oblique muscle
#Internal crural ring is liquidated through anchoring of inguinal ligament to Cooper’s ligament and periosteum of pubic bone with 2-3 stitches, and the
external foramen is liquidated by anchoring of second raw of stitches between margo falciformis and fascia pectinea
By anchoring margos of internal obliquis and transversal abdominal muscles to Coopers’ ligament and periosteum of pubic bone, with second raw of
interrupted stitches these muscles are anchored to margo of inguinal ligamentis
By anchoring of margos of internal obliquis and transverse muscles and transverse fascia of abdominal to inguinal ligament, Cooper’s ligament and
periosteum of pubic bone by one raw of interrupted suture