Femoral Vein (Page 86)

Femoral art. Adductor hiatus Femoral vein Dr. Sherif Fahmy Course of Femoral vein External iliac vein Inguinal ligament

Femoral vein Femoral canal (medial compartment of femoral sheath) Lateral Medial Dr. Sherif Fahmy Middle compartment of femoral sheath

Tributaries of Femoral Vein 1- Great saphenous vein. 2- Deep external pudendal vein. 3- Profunda femoris vein. 4- Lateral circumflex femoral vein. 5- Medial circumflex femoral vein N.B. Superficial inguinal veins drain into great saphenous vein. Dr. Sherif Fahmy

Femoral vein 1-Profunda femoris vein 2-Lateral circumflex femoral vein 3-Medial circumflex femoral vein 4- Deep external pudendal vein 5-Great saphenous vein Superficial external pudendal vein Superficial epigastric vein Superficial circumflex iliac Dr. Sherif Fahmy

Clinical point related to femoral vein: (Page 86) ➢Long catheter is inserted into the femoral vein in the femoral triangle to visualize right side of the heart (Heart angiography).

Femoral Sheath (Page 63)

Lateral Medial Fascia transversalis Fascia iliaca Dr. Sherif Fahmy Formation of femoral sheath 3 – 4 cm Two anteroposterior septa

Lateral compartment (contains femoral artery and femoral branch of genito-femoral nerve) Middle compartment (contains femoral vein) Medial compartment (femoral canal- contains lymph node, lymph vessel and fat) Compartments & Relations of Femoral Sheath Dr. Sherif Fahmy Fascia lata Inguinal ligament Lateral margin of saphenous opening Medial margin of saphenous opening Pectineus muscle

Femoral sheath is a downwards prolongation of deep fascia from abdomen around upper 4 cm of femoral vessels. Shape: Funnel shape. Walls: It has: Anterior wall: extends from fascia transversalis. Posterior wall: Extends from fascia iliaca. Relations: Anterior: Saphenous opening covered by cribriform fascia and fascia lata. Posterior: Pectineus muscle. Function of femoral sheath: It protects the upper parts of femoral vessels from friction with inguinal ligament. Dr. Sherif Fahmy

Compartments: 1- Lateral compartment: that contains femoral artery and femoral branch of genito-femoral nerve. 2- Middle compartment: that contains femoral vein. 3- Medial compartment (femoral canal): that contains lymph node, lymph vessels and fat.

Lumbar Plexus (Page 69)

L1 L2 L3 L4 Ilio-hypogastric n. Ilio-inguinal n. Genito-femoral n. Lateral cutaneous nerve of thigh Femoral n. Accessory obturator n. Obturator n. Lumbo-sacral trunk L5 Dr. Sherif Fahmy

Ilio-hypogastric n. Ilio-inguinal n. Lateral cutaneous nerve Femoral n. Genito-femoral n. Obturator n. Lumbo- sacral trunk Psoas major m. Iliacus Dr. Sherif Fahmy

Ilio-hypogastric n. (L1) Ilio-inguinal n. (L1) Lateral cutaneous n. (L2,3) Femoral n. (L2,3,4) Genitofemoral n. (L1,2) Lumbosacral trunk (L4,5) Dr. Sherif Fahmy Psoas major m. Obturator nerve (L2,3,4) Iliacus muscle Lumbar plexus Roots of lumbar plexus: Anterior primary rami of upper 4 lumbar nerves

Femoral Nerve (Page 72)

Course of Femoral Nerve

L1 L2 L3 L4 Femoral n. L5 Dr. Sherif Fahmy

Femoral n. Dr. Sherif Fahmy Psoas major m. Iliacus Inguinal ligament

Femoral nerve Psoas major Iliacus m. Femoral vessels inside femoral sheath Inguinal ligament

It ends 2 cm below inguinal ligament giving multiple branches Femoral nerve Dr. Sherif Fahmy

Branches of Femoral Nerve Muscular: -To iliacus, pectineus, sartorius and quadriceps femoris muscles. Cutaneous: -Medial & intermediate cutaneous nerves of thigh. -Saphenous nerve. Articular: -Hip and knee joints (through muscular branches to quadriceps femoris muscle).

Medial cut.n. of thigh Saphenous nerve Femoral n. Dr. Sherif Fahmy

Saphenous Nerve (Page 74)

Sartorius m. Saphenous nerve Femoral n. Dr. Sherif Fahmy Gracilis m.

Lateral Cutaneous Nerve of Thigh

Lateral cutaneous nerve of thigh

Nerve Injury of Femoral Nerve

Nerve Injury of Any Nerve Muscle (motor) loss: name the paralyzed muscles. Sensory loss: describe the area of loss of sensation. Disability: describe the lost actions. Deformity: Fixed deformed position of the paralyzed part. Late wasting changes: Decrease the size of paralyzed part.

Nerve Injury of Femoral Nerve Motor loss: paralysis of iliacus, pectineus, sartorius and quadriceps muscles. Sensory loss: loss of sensation at medial side & front of thigh, medial side of leg & foot till the root of big toe. Disability: Inability to extends the knee against resistance (Extension by ilio-tibial tract could be done) and weak flexion of hip. Deformity: Flexed knee and extended hip. Late wasting changes: decrease the size of the front of thigh. Dr. Sherif Fahmy

Veins of the Lower Limb (Page 83)

A- Superficial Veins 1- Great (long) saphenous vein. 2- Short (small) saphenous vein.

Dorsal venous arch Great saphenous vein Saphenous nerve Saphenous openinng Patella Medial malleolus Dorsal digital vein of big toe Dr. Sherif Fahmy

Short sphenous vein Sural nerve Popliteal vein Lateral end of dorsal venous arch Lateral malleolus

Applied Anatomy • Varicose veins: Dilated veins below damaged valves. • Coronary bypass operation: insertion of a graft from great saphenous vein before and after blocked part of a coronary artery. • Venous cut down: surgical opening over the vein to give blood or fluif transfusion in emergency cases.

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