Dr.Murali.M.S;M.B.AProf. of Surgery

D Y Patil Medical CollegeMauritius.

The thigh is the area between the pelvis and the knee.

The single bone in the thigh (femur).

Surface features of the Thigh

◦ Sartorius muscle◦ Quadriceps femoris

muscle◦ Adductor longus

muscle◦Femoral triangle

Thigh is divided to 3 groups of muscles called compartments.

Anterior compartment

Medial compartment Posterior

compartment

These three compartments are separated by fascia.

Fascia Lata

Anterior compartment

Medial (adductor) compartment

Posterior compartment

anterior compartment

posterior compartment

medial compartment

Fascial septa divide limb into compartaments

The anterior compartment muscles of the thigh flex the femur at the hip and extend the leg at the knee.

The posterior compartment muscles of the thigh extend the thigh and flex the leg.

The medial compartment muscles all adduct the thigh & medially rotates the thigh.

The anterior compartment of the thigh is homologous to the posterior compartment of the arm.

The posterior compartment of the thigh is homologous to the anterior compartment of the arm.

Thigh innervations:Anterior compartment from femoral

nerve L2,3,4.Medial compartment from obturator

nerve L2,3,4.Posterior compartment from sciatic

nerve L4,5,S1,2,3 (sacral plexus).

femurmedial lateral

Anterior compartment-

Extensors of the knee

Femoral Nerve

Medial compartment-

Adductors of the knee

Obturator Nerve

Posterior compartment-

Flexors of the knee

Sciatic Nerve

Thigh innervations

The outer layer of deep fascia in the lower limb forms a thick 'stocking-like' membrane, which covers the limb and lies beneath the superficial fascia.This deep fascia is particularly thick in the thigh and gluteal region and is termed the Fascia lata.

Anterior wall formed by transversalis fascia

Posterior by fascia iliaca

Three compartments Medial / Middle &

Lateral

Medial, short, is the femoral canal, contains lymph gland

Opens into abdomen via femoral ring - site of femoral hernia

Middle compartment contains femoral vein

Lateral, femoral artery and femoral branch of genito-femoral nerve

Femoral nerve is outside the sheath

Femoral Triangle:

Borders:

Superior: Inguinal Ligament

Medially: Adductor Longus

Laterally: Sartorius Muscle

Femoral Triangle:

Floor:

Iliopsoas muscle.Pectineus muscle.Adductor longus muscle.

Roof :Fascia Lata

Femoral Triangle:

Contents (medial to lateral): { VAN }

Femoral VeinFemoral ArteryFemoral NerveLymphatics

The base - is the inguinal ligament

The apex points inferiorly and is continuous with a fascial canal (adductor canal ). It descends medially down the thigh & posteriorly through an aperture in the lower end of one of the largest of the adductor muscles in the thigh (the adductor magnus muscle) to open into the popliteal fossa behind the knee

Adductor Canal:

Borders:

Lateral:Vastus medialis

muscle.

Posterior:Adductor longus

/magnus

Anteromedial:Sartorius muscle.

Adductor Canal:

Contents:

Saphenous nerve:Termination of

femoral nerve.

Nerve to vastus medialis.

Terminal parts of femoral artery and vein.

Deep lymph vessels.

External iliac becomes…….

◦ Femoral Once passes the inguinal

ligament Lower limb Branches into Deep femoral

Adductors, hamstrings, quadriceps Branches into Medial/lateral

femoral circumflex Head and neck of femur

Femoral becomes……◦ Popliteal (continuation of

femoral)

Blood Supply:Femoral Artery:

Superficial circumflex iliac.

Superficial epigastric.Superficial external

pudendal.Deep external

pudendal.Descending

genicular.Deep femoral

(profunda femoris)Lateral femoral

circumflex.Medial femoral

circumflex.

Deep Veins: Mostly share names of arteries◦ Ultimately empty into Inferior

Vena Cava Plantar Tibial Fibular Popliteal Femoral External/internal iliac Common iliac

Superficial Veins ◦ Dorsal venous arch (foot)◦ Great saphenous (empties into

femoral)◦ Small saphenous (empties into

popliteal)

Innervation:Femoral

Nerve Action:Hip flexion.Knee extension.

Muscles:

Iliopsoas. Sartorius. Quadriceps:

Rectus femoris.Vastus lateralis.Vastus

intermedius.Vastus medialis

Iliopsoas◦ Origin - Ilia,

sacrum, lumbar vertebrae

◦ Insertion – lesser trochanter

◦Action – flexor of thigh

◦ Innervation – femoral nerve

Sartorius• Origin: Anterior

superior iliac spine• Insertion: Medial side

of superior tibia,via pes anserinus

• Action: flex thigh at hip & flex leg at knee

• Innervation: Femoral nerve

Quadriceps femoris :

Rectus Femoris• Origin: Anterior

inferior iliac spine• Insertion: Tibial

tuberosity via patellar ligament, part of quadriceps femoris

• Action: Flex thigh at hip & extend leg at knee

• Innervation: Femoral nerve

Quadriceps femoris :Vastus Medialis• Origin: Intertrochanteric

line• Insertion: Tibial

tuberosity via patellar ligament, part of quadriceps femoris

• Action: Extend leg at knee

• Innervation: Femoral nerve

Quadriceps femoris :Vastus Lateralis

• Origin: Greater trochanter

• Insertion: Tibial tuberosity via patellar ligament, part of quadriceps femoris

• Action: Extend leg at knee

• Innervation: Femoral nerve

Quadriceps femoris :Vastus Intermedius• Origin: Anterolateral

surface of femur shaft• Insertion: Tibial

tuberosity via patellar ligament, part of quadriceps femoris

• Action: Extend leg at knee

• Innervation: Femoral nerve

A femoral hernia is when abd. Contents pass through a naturally occurring weakness called the femoral canal

One of the most common methods to gain central venous access in emergent situations is via femoral vein cannulation.

Emergency venous access during CPR

knee-jerk reflex, also called patellar reflex sudden kicking movement of the lower leg in response to a sharp tap on the patellar tendon, which lies just below the kneecap