Ali Yaghi. Omar Eyad. Ahmad Salman. 1 P a g e

Transcription

1 5 Ali Yaghi Omar Eyad Ahmad Salman 1 P a g e

2 **There are two types of groin hernia; the femoral hernia and the inguinal hernia. But how can we differentiate between the inguinal hernia and the femoral hernia? In position; The inguinal hernia is superior and medial to the pubic tubercle; the femoral hernia is inferior and lateral to it. **The abdominal aorta which is a continuation of the descending aorta of the thorax divides into 2 common iliac arteries, each of which divides into external iliac artery (for the lower limb)and internal iliac artery(for the pelvis region). **The common internal iliac artery gives a branch called the obturator artery, that passes anterio-laterally through the obturator foramen. **The external common iliac artery gives the inferio-epigastric artery. **Both, the obturator artery and inferio-epigastric, give a branch and anastomose (cross-link) together around the pubic bone. 2 P a g e

3 **Sometimes, the obturator artery isn't formed, so the inferio-epigastric compensates for it by making another branch called(the abnormal obturator). **The abnormal obturator artery is supposed to pass posterior to the pubic bone, but sometimes it passes behind the lacunar ligament. A kind of hernia is called strangulated hernia(the foramen is so tight that the hernia can't return to its normal place), the opening must be dilatedso to prevent a typical hernia turning into ischemic hernia and then into gangrene. Some patients have the abnormal obturator artery, which sometimes passes lacunar ligament, and that might present a problem. To dilate the opening, the lacunar ligament must be cut, which means that the abnormal artery will be cut as well. To avoid such case,the inguinal ligamentmust be cut first, the obturator foramen gets dilated and the then the inguinal ligament gets fixed back. 3 P a g e

4 Boarders: The Adductor Canal:is an aponeurotic tunnel in the middle third of the thigh, extending from the apex of the femoral triangle to the opening in the adductor magnus,which is called the opening; the adductorhiatus. Anterio-medial: Sartorius Muscle. Anterio-lateral: Vastus Medialis Posterior wall: adductor longus+ adductor magnus (which has the adductor hiatus). Contents of Adductor canal: 1- Femoral artery (that turns into popliteal artery in the popliteal fossa). 2- Popliteal vein (that turns into femoral vein in the popliteal fossa). 3- Saphenous nerve. Note:Saphenous nerve pierces the space between the Sartorius muscle and the Gracillis muscle and passes in the medial side of leg. Structures that pass through the adductor hiatus which is the medial compartment of the thigh: - Femoral artery and vein - Sub Sartoirial nerve plexus - Terminal part of obturator nerve Femoral nerve Root: L2,L3,L4. posterior division of ventral remi, it passes lateral to psoas major. Pathway: as it enters the femoral triangle, It divides into anterior and posterior branches, each one gives amuscular branch and a cutaneous branch. branches Anterior Posterior Muscular Sartorious, pectinius Quadracips femoris Cutaneous Medial and intermedius cutaneous nerves of the thigh Suphenousnerve 4 P a g e

5 Notes: The femoral nerve is the most lateral in comparison to the femoral artery and vein. Through the course of the femoral artery, the femoral vein is medial to it in the proximal region and crosses posteriorly to be lateral to it the distal part of it, the femoral nerve is lateral in position in the proximal region and when it pierces the adductor canal becomes medial to the femoral artery. Injections are usually made intravenously in the gluteal region, but in children below two years it isn t safe to inject them in the gluteal region because you might hit or damage the sciatic nerve which supplies a large portion of the lower limb, so in children below two years of age syringe injection is made intramuscularly in the front of the thigh. In diabetes patients the injection is cutaneous. If the femoral nerve is injured, all previous functions (in the table)will be inhibited, most affected move is extension of the knee, and the medial side of the leg wouldlose sensation. Obturator nerve Root: L2,L3,L4.Anterior division of ventral remi. Pathway: medial to the psoas muscle, passes in through the obturator foramen, and approaches the medial side of the thigh. Branches Anterior Posterior Muscular Adductor longus and pectineus. Adductor magnus and brevis. Cutaneous Medial side of the thigh. 5 P a g e

6 Femoral artery: **There are two points of transition between the abdominal wall and the lower limb; the Middle Inguinal point and the middle point of the inguinal ligament; The Mid-Point of The Inguinal Ligament is the point in the middle of the inguinal ligament, which is spans the distance between the pubic tubercle and the anterior superior iliac spine. The Mid Inguinal Point is the point in the middle of the distance between the anterior superior iliac spine and the top of the pubic symphysis. **The femoral artery can be used to sense the pulse of the lower limb, so that it gives an idea about the circulation of the lower limb sometimes in diabetic patients. **The femoral artery can also be used to take a sample of blood when measuring levels of blood gases like carbon dioxide and oxygen, because when measuring blood gases, a sample of arterial blood must be taken and not from the venous blood as in any other medical laboratory test. **The femoral artery is a continuation of the abdominal aorta which itself is a continuation of the descending aorta of the heart, this is a direct pathway to reaching the heart in vascular catheterization, so the femoral artery can be used in operations of vascular catherization. **Course of femoral artery: it begins in the mid-inguinal point and passes through the femoral triangle and the adductor canal and it ends in the adductor hiatus. 6 P a g e

7 Branches of the femoral artery: Femoral Artery. Superfical Deep Profunda femoris Descending genicular. Superficial external pudendal. Deep pudendal Medial circumflex femoral Superficial epigastric Lateral circumflex femoral. Superficial circumflex iliac Perforating artery **The superficial branches reach the superficial layer through the saphenous opening. **The femoral artery is very close to the femur, this has the following effects: It will be easy for the artery to be compressed in case of bleeding because it is against the bone, bleeding from the femoral artery is dangerous because it is directly connected to the aorta. Fractures offemur cut this artery which is dangerous. Cardiac catheter: the device passes first in the femoral artery, then to the common iliac artery, later it reaches the descending aorta, from it the aortic arch then to the ascending aorta. The last place to reach is the coronary artery. 7 P a g e