organization of thigh

Applied Anatomy:

Femoral Hernia:

The femoral canal is a weak area through which abdominal contents may protrude into the thigh.
Note:

  1. A femoral hernia is relatively small since it contained in the limited femoral canal.
  2. It can be palpated below the inguinal ligament.
  3. It is frequently strangulated.
  4. In cases where an abnormal obturator artery exists, it is necessary to be cautious in dealing with the lacunar ligament to avoid division of the vessel, which may result in serious hemorrhage.
  5. It passes through the femoral canal and emerges through the saphenous opening. The latter is 4cm lateral to the pubic tubercle.
  6. The hernia ,as it emerges through the saphenous opening, is covered by the fascia transversalis and cribriform fascia.
  7. If the hernia continues to emerge in the subcutaneous tissue, it normally takes a recurrent course anterior to the inguinal ligament along the line of the inferior epigastric vessels.
 

Swellings in the femoral triangle:

Can be caused by:

  • Femoral hernia
  • Inflamed/ enlarged lymph nodes
  • Abcess
  • Lipoma
  • Aneurisms of the vessels
  • Neuromas
  • Muscle tumors
  • Psoas abcess, usually arising from TB spine
  • Saphena varix, e.t.c • X. Ectopic breast and testis

Surgical management of these conditions including femoral hernia repair requires sound knowledge of the topographic deposition of the contents.

 
Femoral Artery:

The artery can be pressed against the iliopubic eminence below the inguinal ligament at the mid-inguinal (femoral point), to reduce bleeding from a distal cut.


Anterior dislocation of the hip joint may compress or kink the artery due to its close proximity. It is separated merely by the iliopsoas tendon.


Femoral artery catheterization is now a common procedure


The pulsating artery is commonly used to locate the femoral vein just medial to it

 
 
Lateral cutaneous nerve of the thigh

This nerve is sometimes compressed as it passes through the inguinal ligament, causing pain and altered sensation in the lateral side of the thigh (meralgea paraesthetica).

Surgical treatment of this condition requires division of the inguinal ligament and freeing the nerve of any fascial compression.
 
Varicose Veins:

Varicose veins are dilated, elongated and tortuous veins. Some common causes include:

  • Valvular incompetence
  • Pelvic tumors
  • Long hours of standing
  • Pregnancy

 

 
 
Lymphatic Drainage:

Inguinal nodes can be mapped on a lymphangiogram

Done by injecting the territory of drainage with a radio opaque dye and taking a radiograph.

 
 
Compartment Syndrome:

Compression of nerves, blood vessels and muscles in the compartments

Fluid accumulation in a tight osteofascial compartment, causes vascular insufficiency in the distal regions.

Causes: Burns, bleeding, inflammation

Presentation; ( 5Ps): pain, palor, paraesthesia, paralysis, pulselessness

 
Fractures causing unnoticed blood loss:
If the femur is fractured even in abscence of major vessel tear , bleeding occurs from the marrow, bone and muscular vessels

Because of the tight fascia, considerable amounts of blood may be lost before any evidence of swelling is noticed.
 
Muscle herniae:

If the fascia lata is cut and not repaired well, contracting muscles may herniated through the defect. This may impair contraction.

 
Safe and danger sides of the thigh:

The medial side of the thigh is the danger side because of major nerves and vessels

. The lateral side of the thigh is the safe side
 
Muscle tears and bone avulsion:

Forceful contraction of the muscles may cause tears e.g. hamstring tears in footballers.


Strong tendons, may forcefully chip off (avulse) bone.
 
Obturator nerve injury

Sites and causes of injury

  • In the abdomen or pelvis by compression from tumors
  • Obturator externus
  • Obturator canal by obturator hernia

Effects of injury

  • Loss of hip adduction
  • Loss of sensation medial thigh
  • Impaired hip and knee joint sensation