Femoral triangle & inguinal lymph nodes Dr.N.Mugunthan
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The document discusses the anatomy of the femoral triangle region. It summarizes that the femoral triangle is bounded laterally by the sartorius muscle, medially by the adductor longus muscle, and superiorly by the inguinal ligament. The femoral triangle contains the femoral vessels and nerve within the femoral sheath in its upper region, and deep inguinal lymph nodes throughout. Femoral hernias occur when abdominal contents protrude through the femoral ring.
![Inguinal lymph nodes
2 Groups
• Superficial & deep
Superficial inguinal lymph
nodes [ inverted L shape]
• Horizontal group-along
the lower border of
inguinal ligament
• Vertical group – along
Great saphenous vein
• Deep inguinal lymph
nodes
• Along the femoral vein
© Dr.N.Mugunthan](https://image.slidesharecdn.com/femoraltriangleinguinallymphnodes-pdflecturenotesbydr-181017065103/85/Femoral-triangle-inguinal-lymph-nodes-Dr-N-Mugunthan-4-320.jpg)
![Boundaries cont…
Roof
• Skin
• Superficial fascia [great
saphenous vein, cutaneous
nerves, blood vessels &
lymphatics/nodes]
• Fascia lata
Floor
[From lateral to medial]
• Iliacus
• Tendon of psoas major
• Pectineus
• Adductor longus
© Dr.N.Mugunthan](https://image.slidesharecdn.com/femoraltriangleinguinallymphnodes-pdflecturenotesbydr-181017065103/85/Femoral-triangle-inguinal-lymph-nodes-Dr-N-Mugunthan-7-320.jpg)
![Contents
VAN – [medial to lateral]
Femoral vein & its tributaries
Femoral artery & its branches
(proximal 3-4 cm of vessels-
covered by femoral sheath)
Femoral nerve & its branches
Deep inguinal lymph nodes
Lateral cutaneous nerve of thigh
Femoral br.of genitofemoral
nerve
Fibro fatty tissue© Dr.N.Mugunthan](https://image.slidesharecdn.com/femoraltriangleinguinallymphnodes-pdflecturenotesbydr-181017065103/85/Femoral-triangle-inguinal-lymph-nodes-Dr-N-Mugunthan-9-320.jpg)
![Coverings
[from within outwards]
• Peritoneum of hernial sac
• Femoral septum
• Anterior wall of femoral
sheath
• Cribriform fascia
• Superficial fascia and skin
Femoral hernia cont…
© Dr.N.Mugunthan](https://image.slidesharecdn.com/femoraltriangleinguinallymphnodes-pdflecturenotesbydr-181017065103/85/Femoral-triangle-inguinal-lymph-nodes-Dr-N-Mugunthan-20-320.jpg)
Femoral triangle & inguinal lymph nodes Dr.N.Mugunthan
- 2. Learning objectives Superficial structures in the front of thigh Inguinal lymph nodes Femoral triangle Boundaries Contents oFemoral sheath oFemoral fossa, Femoral septum, Femoral ring, Femoral canal& Femoral hernia Applied anatomy of femoral triangle © Dr.N.Mugunthan
- 3. Superficial structures in the front of thigh Superficial fascia • Cutaneous nerves- lateral , medial & intermediate cutaneous nerve of thigh, ilioinguinal nerve, femoral br. of genitofemoral nerve • Cutaneous blood vessels- superficial epigastric artery, superficial external pudental artery, superficial circumflex iliac artery & corresponding veins • Superficial inguinal lymph nodes Deep fascia –fascia lata • Saphenous opening © Dr.N.Mugunthan
- 4. Inguinal lymph nodes 2 Groups • Superficial & deep Superficial inguinal lymph nodes [ inverted L shape] • Horizontal group-along the lower border of inguinal ligament • Vertical group – along Great saphenous vein • Deep inguinal lymph nodes • Along the femoral vein © Dr.N.Mugunthan
- 5. • Triangular depression in the upper 1/3rd of the front of thigh • Below the inguinal ligament with the apex directed below. • Also called Scarpa’s triangle. Femoral triangle © Dr.N.Mugunthan
- 6. Boundaries Lateral • Medial border of sartorius Medial • Medial border of adductor longus Base • Inguinal ligament Apex • Meeting point of sartorius & adductor longus © Dr.N.Mugunthan
- 7. Boundaries cont… Roof • Skin • Superficial fascia [great saphenous vein, cutaneous nerves, blood vessels & lymphatics/nodes] • Fascia lata Floor [From lateral to medial] • Iliacus • Tendon of psoas major • Pectineus • Adductor longus © Dr.N.Mugunthan
- 9. Contents VAN – [medial to lateral] Femoral vein & its tributaries Femoral artery & its branches (proximal 3-4 cm of vessels- covered by femoral sheath) Femoral nerve & its branches Deep inguinal lymph nodes Lateral cutaneous nerve of thigh Femoral br.of genitofemoral nerve Fibro fatty tissue© Dr.N.Mugunthan
- 12. Femoral sheath • Funnel shaped fascial prolongation around the proximal part of femoral vessels. • Blends with tunica adventitia of vessels 3-4 cm below the inguinal ligament. Formation • Anterior wall-fascia transversalis • Posterior wall-fascia iliaca. Femoral nerve is not enclosed within the sheath as it passes entirely beneath the fascia iliaca. © Dr.N.Mugunthan
- 13. Femoral sheath – 3 compartments • 2 anteroposterior septa divide the sheath into 3compartments Femoral sheath Lateral compartm ent Femoral artery Femoral br.of GF nerve Intermed iate compart ment Femoral vein Medial compart ment Femoral canal © Dr.N.Mugunthan
- 14. Structures piercing femoral sheath • Anteriorly-superficial epigastric artery, superficial circumflex iliac artery & superficial external pudental artery (not the corresponding veins) • Laterally-femoral br.of genitofemoral nerve • Medially-great saphenous vein and lymphatics. © Dr.N.Mugunthan
- 15. Function of femoral sheath • Allows the femoral vessels to glide freely in & out beneath the inguinal ligament during movements of hip joint. © Dr.N.Mugunthan
- 16. Femoral canal • Medial compartment of femoral sheath • Conical in shape & 1.25cm long • Base is directed above,& forms oval shaped ring - femoral ring measuring 1.25cm • Ring is closed-femoral septum (condensation of extra peritoneal tissue covered by parietal peritoneum) • Septum is pierced by lymphatics connecting the deep inguinal with external iliac nodes. • Small recess of peritoneum over the femoral ring – femoral fossa © Dr.N.Mugunthan
- 17. Femoral ring Boundaries: • Anterior-inguinal ligament • Posterior-pectineus with its covering fascia. • Medial- base of lacunar ligament. • Lateral-femoral vein. Structures related to femoral ring • Spermatic cord (male) round ligament of the uterus (female) lie immediately above the anterior margin of the ring • Inferior epigastric vessels are close to its upper and lateral angle © Dr.N.Mugunthan
- 18. Contents of femoral canal 1. Lymph node - Cloquet’s node 2. Loose areolar tissue. Canal allows the expansion of femoral vein during increased venous return from the lower limb Femoral ring – wider in females (greater breadth of female pelvis & narrow diameter of femoral vessels in females) © Dr.N.Mugunthan
- 19. Femoral hernia • Hernia- abnormal protrusion of a viscera through the opening in the wall of the cavity containing it. • Femoral hernia-protrudes through the femoral ring • More common in females than males due to larger femoral ring. © Dr.N.Mugunthan
- 20. Coverings [from within outwards] • Peritoneum of hernial sac • Femoral septum • Anterior wall of femoral sheath • Cribriform fascia • Superficial fascia and skin Femoral hernia cont… © Dr.N.Mugunthan
- 21. Finally turns upward around upper margin of saphenous opening Pushes forward through the saphenous opening Bulges downward through the femoral ring into femoral canal Pushes out a hernial sac of peritoneum covered by femoral septum A section of intestine bulges through the ring Femoral hernia-pathogenesis © Dr.N.Mugunthan
- 22. Femoral vein • Continuation of popliteal vein from the 5th osseo- aponeurotic opening in the adductor magnus. • Ends as external iliac vein beneath inguinal ligament © Dr.N.Mugunthan
- 23. Course • In the adductor canal- upper part -lies behind the femoral artery & in lower part – posterolateral to femoral artery • In the femoral triangle- enters through the apex, posterior to artery & ascends lying medial to artery • In the femoral sheath-occupies middle compartment. Femoral vein cont… © Dr.N.Mugunthan
- 24. Tributaries: • Great saphenous vein. o superficial epigastric vein, superficial circumflex iliac vein & superficial external pudental vein • Profunda femoris vein. Femoral vein cont… © Dr.N.Mugunthan
- 25. • Continuation of external iliac artery • Extent: midinguinal point to the junction of middle & distal third of thigh (5th osseoaponeurotic opening of adductor magnus) • Continue as popliteal artery Femoral artery © Dr.N.Mugunthan
- 26. Femoral artery cont… • Passing through the lateral compartment of femoral sheath along with femoral branch of genitofemoral nerve • Related medially femoral vein • Laterally femoral nerve © Dr.N.Mugunthan
- 27. Branches: • Superficial epigastric artery, • Superficial circumflex iliac artery • & superficial external pudendal artery • Deep external pudendal artery • Profunda femoris artery • Unnamed muscular branches Femoral artery cont… © Dr.N.Mugunthan
- 28. Femoral nerve • Nerve of extensor (anterior) compartment of thigh • Largest branch of lumbar plexus • Root value -dorsal divisions of ventral rami of L2,L3 & L4. © Dr.N.Mugunthan
- 29. Course • Appears in the iliac fossa undercover of fascia iliaca between psoas major & iliacus. • Enters femoral triangle behind inguinal ligament lateral to femoral sheath & is separated from artery by psoas major tendon. • Trunk splits into anterior & posterior divisions by lateral cx. femoral artery 2-3 cm below the inguinal ligament. Femoral nerve cont… © Dr.N.Mugunthan
- 30. Femoral nerve - branches © Dr.N.Mugunthan
- 31. Applied anatomy • Femoral vein puncture & catheterization • Femoral artery catheterization – angiography procedure © Dr.N.Mugunthan
- 32. Take home message Inguinal lymph nodes Femoral triangle Boundaries & contents Femoral sheath Formation & contents of 3 compartments Femoral canal & Femoral hernia © Dr.N.Mugunthan