Femoral Triangle Study Materials

FMORAL TRIANGLE the most hernia that strangulate Triangular intermuscular space in upper medial ⅓ of thigh. Boundaries :- superior (base): inguinal ligament Laterally: Medial border of sartorius. Medially: Medial border of adductor longus. Roof (anterior wall):- Skin & superficial fascia (with it's contents) Deep fascia (lata) with saphenous opening. Floor (from Lat to Medial): Iliacus, Psoas, pectineus & adductor longus Contents :- 1- (Nerve): Femoral nerve & it's branches; lat. cut. N. of thigh. 2- (Artery) Femoral artery & it's branches. 3- (vein): Femoral vein & it's tributaries. } Covered by Femoral sheath 4- (LN) deep inguinal LN. Fatty C.T Femoral sheath :- Fascia covering Femoral vessels for about 1 inch below ing. lig. Anterior wall is continuation of fascia transversalis/ while posterior wall is continuation of fascia iliaca. Compartments of femoral sheath are: Medial → Femoral canal. Intermediate → Femoral vein. Lateral → Femoral artery & Fem. br. of genitofemoral N. Femoral canal Medial compartment of femoral sheath, about ½ inch. For expansion of femoral vein. It's upper opening called Femoral ring & closed by Femoral septum. Contents are: Fatty C.T. One deep inguinal LN (Cloquet LN). Efferent lymph vessels from deep ing. LN. #Femoral ring :- - Upper opening of femoral canal, closed by femoral septum (condensation of extraperitoneal tissue). - Boundaries: - Anterior: inguinal ligament. - Imp - Medial: Lacunar ligament - Posterior: Pectineal Lig (superior ramus of pubis) - Lateral: femoral vein. #Femoral Hernia: - Protrusion of peritoneum into the femoral canal through the femoral ring (as canal is a weak area in abdomen). - It is more common in female, due to wide pelvis (wide ring). ADDUCTOR CANAL "Subsartorial / Hunter's canal" - Intermuscular cleft on medial aspect of middle ⅓ of thigh. - Begins above at apex of femoral triangle. - Ends below at adductor hiatus (opening in adductor magnus ms). - Cross section. It is triangular in *Boundaries: - Roof (anteromedial): Sartorius & fascia. - Lateral (anterolateral): vastus medialis. - Posterior wall: adductor longus & magnus *Contents: - (Nerve): Saphenous nerve, obturator N. (terminal part) & N. to vastus medialis. subsartorial plexus of nerves - (Artery): femoral artery. (&descending genicular br.) - (vein): femoral vein. - (LN): deep lymph vessels (connect popliteal LN to deep ing. to fascia lata - subsartorial plexus formed/inside canal at lower border of add. longus by saphenous N. Med. CN. of thigh & ant. divsion of obturator N. gives few cut filaments ABDOMEN Part 1: Abdominal wall. ABDOMINO-PELVIC CAVITY This cavity is divided into: pelvis & abdomen proper It's bounded by: Superiorly → diaphragm Inferiorly → pelvic diaphragm Anteriorly → ant. abd. wall. Posteriorly → post. abd. wall. Laterally → extension of ant-abd-wall muscles ANTERIOR ABD. WALL A.A.w part-1 The layers of ant. abdominal wall are: Skin Superficial fatty layer. Deep membranous layer - superficial fascia Deep abdominal muscles. External oblique has sup internal oblique joining transverses dorsimus fascia transversalis. Extraperitoneal tissue. parietal peritoneum VAN Abdominal aorta Common iliac external iliac internal iliac Femoral nerve Inguinal ligament iliacus Lacunar ligament Pectineal ligament Femoral sheath Femoral canal Fascia lata Tensor Fascia lata Sartorius Femoral artery Femoral vein Adductor longus Adductor magnus Femoral ring hernia way Adductor hiatus Femoral artery Sartorius Gracilis Semitendinosus patella ligamentum patellae UMBILICAL H. → usually resolve by 4-5 y of age. A CONGENITAL UMBILICAL HERNIA "Exomphales" = omphalocele 1. Exomphalos minors - Small defect (<3cm) at umbilicus, sac is peritoneum contains usually bowel. - Covering is Wharton's Jelly + layers of amniotic membrane. - treated by reduce contents, excise & repair the defect. - Complication by injuring the bowel may occur while Ligation of umbilical cord during labour. 2. Exomphalos majors - Large defect (>3cm) at abdomen centre, sac is peritoneum contains usually bowel ± Liver. - Covering are layers of amniotic membrane only. - treatment difficult as defect is very large & abdomen cannot receive the contents to repair may take one operation. - complication as rupture & peritonitis (cause of death.) B INFANTILE UMBILICAL HERNIA. (umbilical H) female (in times) - Caused by weakness of umbilical scar (infection, ↑I.A.P...elk) - Defect from umbilical scar, sac small with wide neck. - Usually closed spontaneously within 2 years. 4-5, defect >1.5 cm - treatment by surgery (proline stitching of defect) may done after 3 years C ADULT UMBILICAL H. Paraumbilical H. - usually in middle aged female [obese, multipara] - occur just above (more) or below umbilicus (never umbilical). - Defect in linea alba, narrow neck (more strangulation risk) with Crescente shaped sac. - Treated by suture of the defect (after excising sac) and two-layer overlapping repair "Mayo repair" mesh - (hernioplasty in large defect) - sespative hernia is through linea alba Q