The femoral triangle is a clinically significant anatomical region in the upper thigh, defined by specific muscles and ligaments, which serves as a crucial landmark for palpating pulses, accessing blood vessels for procedures, and understanding the potential for hernias.
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[Music]
hello right we're back in this lab again
today because the other lab is full of
students studying for exams which is
nice I like to see that I like to see
lots of students in the lab uh results
in um easy to Mark exam papers um and
passing students who have good knowledge
of course as well today I bring you a
leg so although in anatomically we talk
about the leg as being the bit distal to
the knee right and this being the thigh
so really I bring you a lower limb
and so um we were talking last week we
were looking at the pelvis we were
looking at the pelvic floor and I was
thinking about something that came up in
teaching which is the femoral triangle
we were talking about hernas and ingal
hernas and femoral hernas and things
like that and I thought since we were
looking at structures in the region of
the pelvis we could do a very little
step sideways anteriorly to the femoral
triangle so what is the femoral
triangle why are these
anatomical places useful to know
about and what goes through it what can
you find there all right should be
should be fairly short I don't do
anything briefly do [Music]
[Music]
I um right okay how much can anybody
really talk about the femoral triangle
so what is the femoral triangle so the
femoral triangle is a triangle in this
space here do you see where we are so so
here's the knee here's the pelvis here's
the pubis bone here's the anterior
superior iliac spine so really what
we're looking at is here's the inguinal
ligament so the ingal ligament is as
I've said before it's where the um the
external oblique muscle of the abdominal
walls comes down curls around and you
get the ingal canal forming there talked
about it very briefly when we looked at
the male reproductive
system so the ingal ligament then is
this is this ligament
where linking the anterior superior
iliac spine here to the the pubis
here pubic tubic pubic
tubic and the reason the ingal ligament
is so important really is because um
there's quite a lot going on here it's
the boundary between the lower limb and
the ab abdomino pelvic
cavity which means that if you're a
structure and you want to get from the
abdomino pelvic cavity into the lower
limb then um you may need to pass under
it and we see a bunch of structures here
doing that um and also what we tend to
not see in models we tend to also lose
in PR sections when we dissect is the
fascia so we have lots of fasal layers
don't we
um forming compartments in the body
covering muscle group groups holding
things together giving us our shape and
we've lost these in the models but
there's there's a filata which is like a
stocking covering the lower
limb and that ends of the ingal ligament
and that's where we meet a bunch of
fascial layers of the abdominal pelvic
cavity and the abdomino pelvic walls
they come together there so that's the
ingal ligament here and you and you can
palpate it on yourself particular if you
find those two bony landmarks so it's a
good anatomical landmark
and it forms part of the femoral
triangle so the femoral triangle is here
it's the here right so we've got the ingal
ingal
ligament this muscle
here this is
Sartorius so this is quadriceps
quadriceps femoris here and Sartorius is
going from um the anterior superior
iliac spine it's going from here around
to uh the pezan serenus um we're medial
here so this is the tibia around this
side anyway sorus aside the inguinal
ligament is forming the superior margin
of the Emeral triangle the medial edge
of Sartorius is forming the lateral wall
of the femoral triangle and then this muscle
muscle
here these are the adductors here in
this medial compartment this is adductor
longus the long adductor muscle here and
the adductor longus is forming the
medial border of the triangle so using
those edges we have a triangle and that
then is the femoral triangle that's all
is and you can see immediately on this
model we have some interesting
structures there so the reason the femal
triangle is useful is you have a patient
you're worried about their
cardiovascular system particular of
their extremities you want to palpate
their pulses right so you want to check
the pulse their pulses to the lower limb
so you find the femoral triangle and you
can find the pulse of the femoral artery
here likewise you can also check the
pulse of the poal artery and dorsalis
pedis and that sort of thing right and
you want to check and see if there's a
nice strong steady pulse um and that'll
tell you about the blood flow to the
lower limb now if this is the femoral
artery here femoral meaning thigh so all
these structures are kind of becoming
femoral here this here is the external
iliac artery so it's a branch from the
common iliac artery that's divided up
here and the external iliac artery we
just change its name to the femoral
artery once it passes inferior to the
ingal ligaments that's another reason
why the ingal ligament is important it's
an anatomical landmark so the vein next
to it is the femoral vein and that's
draining that way so it's the femoral
vein and then as it passes under the
ininal ligament that can becomes the
external iliac vein here right and then
the nerve is the femoral nerve and that
just that's just called the femoral
nerve from when it appears all the way
down here so it doesn't change its name
and can you see how we have vein artery
nerve so you find your feminal triangle
in your patient you can palpate the
artery and then you know that lateral to
the artery is the femoral nerve medial
to the femoral artery is the femoral
vein vanan van from inwards to
outwards uh finding the vein why is that
useful well say you want to stick a
needle into um the cardiovascular system
maybe you want to get to a renal vein
you can of course put um a needle um
and whatever thing you want to pass into
the renal vein you can pass it into the
the femoral vein up the internal iliac
vein into the common iliac vein then
into the inferior vena cava and you pop
out into one of the two renal veins if
you wanted to or you could send your
needle all the way up to the right
atrium of the heart and into bits of the
heart so actually by accessing and
finding this vein down here in the thigh
in your femoral triangle you could do
surgical procedures with a wire in the
heart or in other in other blood vessels
you see so it's an important anatomical
landmark and knowing that the nerve is
here and that the arter is right next to
it tells you to be very very careful um
now the femal triangle here as I've said
the the as I've said the lower limb is
covered in this falata stocking right
which you got to imagine it's a big long
stocking it comes all the way up here
one thing the other thing we can't see
on this model is the is the The
Superficial veins of the lower limb now
you know about the superficial veins of
the lower limb because you've probably
seen varicose veins so veins don't have
a muscular wall like arteries do
arteries are greater withstanding High
pressures um veins don't have a muscular
wall they're not so good withstanding
High pressures you've got to send your
blood all the way back from your toe up
your lower limb and up through your
pelvis abdomen back into your thorax
right so there's a lot of weight a lot
of pressure a lot of weight of Blood on
the veins and they've got valves in them
to make sure the blood flows in One
Direction but if you put too much weight
on these things then it can stretch and
you know you can have problems which
causes these varicose veins so the great
saffos vein
runs all the way up the leg so you can
find it anterior to the medial malleolus
and it runs up the the lower limb and
it's very superficial it's just
underneath the skin you'll see it in
skinny people you'll be able to see in
everybody down here but it's a really
really long vein it's the vein that um
used to get used in coronary bypass
surgery don't know if it still does you
could cut a bit out rejoin it turn it
around to the valves aren a problem and
then use it to repair colonary arteries
in the heart heart right cuz it's a nice
long vein it's easy to get to I don't
know how much that's still used um but
the great saffos vein drains into the
femoral vein here so there's actually a
a kind of a weakness in the fascia there
which the vein passes through um a
couple of other terms femoral canal and femoral
femoral
sheath so if this is the femoral
triangle these blood vessels and what
have you are passing with in the femoral
sheath beneath the ingal ligament now
the other thing I didn't mention was
that the floor of the femoral triangle
is made up of a couple of muscles here's
pconus here this here is soos Major
there's iliacus soos major and iliacus
come together to form ilos so we've got
ilos under here and we've got pconus
they're forming the floor now those
muscles are moving the femur
particularly the um sorus major or ilos
sorus muscle is is flexing the knee at
the hip right all right so it's doing this
this
movement what that means is there's
quite a bit of movement around here so
for one thing you want these blood
vessels to be able to move freely as the
hip is flexing so they're so the fascia
that I would talk was talking about
these fascia come together and blend and
they kind of form this sheath around
these blood vessels and in a nutshell
what that does is it allows all of these
structures to move nice and freely over
one another nothing catches so you can
flex your your hip and extend your hip
and do all sorts of things with your hip
and all this moves around it's all nice
and safe and and what have you so that's
the femoral sheath in there now the
femoral Canal is a little bit different
the femoral Canal is the space between
it's medial to the femoral vein so it's
between the femoral vein and the pubic
tubic and it runs underneath the ingal
ligament now that's the femoral Canal so
that's a space there and it's got a bit
of fat in it it might have some
superficial um might have some
lymphatics linking superficial and deep
ingal lymph nodes which we have around
here as well but what that means is
there's a bit of space for the femoral
vein to expand into if it needs to you
know so if pressure increases in the
thorax and the abdomen because you're
doing a Val Sala maneuver you're lifting
you know if some if pressure is impeding
blood flow back into the abdominal
pelvic cavity then the femoral vein can
expand into the femoral Canal but where
all this comes from is we were talking
about hernas right um it means that
there's a weakness here and it's
possible for abdominal contents like
Loops of small bowel to pass through the
the femoral canal through this space
here if they're forced out
and uh you get that to different degrees
it's fairly rare I think it's more
common in women than men because there's
a bit more space around here you got
wider pelvises and what have you
I might be wrong
then and it might be a temporary thing
the the femoral hernia might push in and
then pull back out again um no big deal
or it might get stuck which would cause
pain maybe nausea and if it if the the
small bowel gets pushed through and kind
of gets twisted and and you get a bit of
a volvulus and it gets uded you know so
the blood supply to the V of the bowel
get cut off massive pain feeling really
unwell nausea vomiting and of course
you'll be able to palpate a lump here
because that small bow whatever's
herniated through here will be forming a
mass in this small space you know now
where the femoral triangle is so you'll
go and palpate the femoral triangle and
say oh there's a mass there and you've
got these other symptoms right we know
what the problem is um so that's the
femoral Canal that's the Gap medial to
the femoral vein running under the ingal
ligament that's a
potential Canal between between the
abdominal pelvic cavity and the the V
the other thing is um you see where
these blood vessels are going we take
Sartorius off there's a canal under here
there's a subsartorial canal this stuff
runs under hey we should do that another
day oh there so much fun stuff to talk about
about
um so femoral triangle of course the the
anterior like the top the roof of the um
the femal triangle is formed from layers
of fascia and skin so we've talked about
the floor and the roof we've talked
about the walls and the edges we've
talked about the stroes that are passing
through we've talked about the femoral
sheath the femoral
triangle um try and palpate your femoral
pulse at some time when it's convenient
and you'll be in the femoral triangle
also you can palpate the Bony bits as
well and that's all thing you yeah anyway
all right short and sweet see you next time
time [Music]
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