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FEMORAL TRIANGLE
A hollow area in the anterior thigh
It allows neurovascular structures to pass
Has both anatomical and clinical importance
Boundaries
• Superiorly: Inguinal ligament acts as a flexor retinaculum,
supports the contents during flexion of the hip supports the contents during flexion of the hip
• Laterally: Medial border of sartorius muscle
• Medially: Medial border of adductor longus muscle.
• Floor (posterior wall): Pectineus, adductor longus and
the iliopsoas muscles.
• Roof (anterior wall): Fascia lata, saphenous opening is in
the upper part of the triangle.2
Contents (medial-to-lateral direction):
• Femoral canal (most medial structure) containing lymphatics and lymph nodes.
- Important clinically because this can be a path for herniation of abdominal contents.
- Within the femoral sheath (transversalis fascia and psoas fascia form the femoral sheath below the inguinal ligament).
• Femoral Vein. Great saphenous vein joins the femoral • Femoral Vein. Great saphenous vein joins the femoral vein within the femoral triangle just below and lateral to the pubic tubercle; within the femoral sheath.
• Femoral Artery within the femoral sheath, responsible for arterial supply to the lower limb.
• Femoral Nerve (most lateral structure) not within the femoral sheath, innervates anterior compartment of the thigh.
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• A good way to remember the contents from lateral
to medial is: NAVEL
• N: Nerve
• A: Artery
• V: Vein
• E: Empty space ( to allow the vessels to distend, so
as to cope with different levels of flow)as to cope with different levels of flow)
• Lymph canal
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Clinical Relevance
• Palpation of femoral artery pulse inferior to where
the artery crosses the inguinal ligament
• Femoral artery is easily accessible because it is
located superficially in the triangle eg coronary
angioplastyangioplasty
• Femoral hernia – part of the bowel pushes into the
femoral canal, this manifests as lump or bulge in the
femoral triangle, requires surgical intervention to
treat. 6
Femoral Canal
• Compartment located in the anterior thigh
• Smallest and most medial part of the femoral sheath
• 1.3cm long
• Rectangular in shape
• Opening is at the femoral ring located superiorly
• Femoral ring is closed by femoral septum (connective tissue) pierced by lymphatics exiting the canal
• Femoral ring is closed by femoral septum (connective tissue) pierced by lymphatics exiting the canal
4 Borders
• Medial: lacunar ligament
• Lateral: femoral vein
• Anterior: inguinal ligament
• Posterior: pectineal ligament, superior ramus of the pubic bone, pectineus 7
Contents
• Lymphatic vessels – drains deep inguinal lymph nodes
• Deep lymph node – lacunar node
• Empty space allows for distension of the femoral vein
• Loose connective tissue
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• Loose connective tissue
Clinical Relevance
• Site of bowel herniation which presents as a lump, commoner in women due to wider pelvis
• Borders are not very extendible, can compress hernia, interfering with blood supply – strangulated hernia
Adductor canal (Hunter’s or subsartorial canal)
• Narrow conical tunnel in the thigh
• It is 15cm long, extending from the apex of the femoral triangle to the adductor hiatus of the adductor magnus
• Allows structures from the anterior thigh and posterior leg
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3 Borders
• Anterior: sartorius
• Lateral: vastus medialis
• Posterior: adductor longus and magnus
• Apex: adductor hiatus
Contents
• Femoral artery
• Femoral vein
• Nerve to vastus medialis
• Saphenous nerve
• Femoral artery and vein becomes popliteal artery and
vein after exiting the canal.
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vein after exiting the canal.
Clinical Relevance
• Administration of anaesthetic to block the saphenous
nerve with or without nerve to vastus medialis
• Adductor canal compression syndrome: entrapment of
the neurovascular bundle within the adductor canal
Popliteal Fossa
• Fat-filled compartment of the lower limb.
• With the knee flexed, it is a diamond-shaped depression posterior to the knee joint.
• Conduit for neurovascular structures entering and leaving the leg
Borders
• Superolateral border - biceps femoris
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• Superomedial border - semimembranosus, lateral to which is the semitendinosus
• Inferolateral border- lateral head of the gastrocnemius and plantaris.
• Inferomedial border - medial head of the gastrocnemius
• Roof – popliteal fascia and skin
• Floor - posterior surface of the knee joint capsule and posterior surface of the femur
• Superior boundaries - diverging medial and lateral
supracondylar lines of the femur.
• Inferior boundary - soleal line of the tibia.
The contents of the popliteal fossa include the:
• Termination of the small saphenous vein.
• Popliteal arteries and veins and their branches and
tributaries.
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tributaries.
• Tibial and common fibular nerves
• Posterior cutaneous nerve of thigh
• Popliteal lymph nodes and lymphatic vessels
The subcutaneous tissue contains:
• Small saphenous vein
• Terminal branch(es) of the posterior cutaneous
nerve of the thigh
• Medial sural cutaneous nerves.
• Lateral sural cutaneous nerves
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Popliteal Fascia
• Deep fascia continuous superiorly with the fascia
lata and inferiorly with the deep fascia of the leg.
• Forms a protective covering for neurovascular
structures
• Forms a loose retaining “retinaculum” (retaining
band) for the hamstring tendons.
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band) for the hamstring tendons.
• Pierced by the small saphenous vein.
Contents
• Popliteal artery and lymph nodes.
• NEUROVASCULAR STRUCTURES AND
RELATIONSHIPS IN POPLITEAL FOSSA
• All neurovascular structures from the thigh to the
leg do so by traversing the popliteal fossa.
• Nerves are encountered first, then the veins,
arteries lie deepest.
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Nerves in Popliteal Fossa.
• Sciatic nerve ends at the superior angle of the popliteal fossaby dividing into the tibial and common fibular nerves
Tibial nerve
• Medial, larger terminal branch of the sciatic nerve derived from the anterior divisions of anterior rami of the L4–S3 spinal nerves.
• Most superficial of the three main central components of the popliteal fossa (i.e., nerve, vein, and artery)
• Bisects the fossa as it passes from its superior to its inferior
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• Bisects the fossa as it passes from its superior to its inferior angle.
• Gives branches to the soleus, gastrocnemius, plantaris, and popliteus muscles.
• Medial sural cutaneous nerve is derived from the tibial nerve in the popliteal fossa.
- Joined by the sural communicating branch of the common fibular nerve to form the sural nerve
- Supplies the lateral side of the leg and ankle.
Common fibular (peroneal) nerve
• Lateral, smaller terminal branch of the sciatic nerve
• Derived from posterior divisions of the anterior
rami of the L4–S2 spinal nerves.
• Begins at the superior angle of the popliteal fossa.
• Leaves the fossa by passing superficial to the lateral
head of the gastrocnemius.
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head of the gastrocnemius.
• Winds around the neck of the fibula and divides
into its terminal branches.
• Posterior cutaneous nerve of the thigh supply the
skin that overlies the popliteal fossa.
Blood Vessels in Popliteal Fossa.
Popliteal artery
• Continuation of the femoral artery
• Begins when the latter passes through the adductor
hiatus.
• Ends at the inferior border of the popliteus by
dividing into the anterior and posterior tibial
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dividing into the anterior and posterior tibial
arteries.
• Muscular branches of the popliteal artery supply
the hamstring, gastrocnemius, soleus, and plantaris
muscles.
Structures passing through cribriform fascia or
passing through saphenous opening
• Great saphenous vein
• Superficial epigastric artery
• Superficial external pudendal artery
• Superficial circumflex iliac artery
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• Lymph vessels connecting superficial and deep
inguinal lymph nodes
