0:04 [Music]
0:08 hello right we're back in this lab again
0:10 today because the other lab is full of
0:12 students studying for exams which is
0:14 nice I like to see that I like to see
0:16 lots of students in the lab uh results
0:21 in um easy to Mark exam papers um and
0:22 passing students who have good knowledge
0:25 of course as well today I bring you a
0:29 leg so although in anatomically we talk
0:31 about the leg as being the bit distal to
0:34 the knee right and this being the thigh
0:38 so really I bring you a lower limb
0:41 and so um we were talking last week we
0:42 were looking at the pelvis we were
0:45 looking at the pelvic floor and I was
0:47 thinking about something that came up in
0:50 teaching which is the femoral triangle
0:52 we were talking about hernas and ingal
0:54 hernas and femoral hernas and things
0:55 like that and I thought since we were
0:57 looking at structures in the region of
1:00 the pelvis we could do a very little
1:02 step sideways anteriorly to the femoral
1:04 triangle so what is the femoral
1:07 triangle why are these
1:10 anatomical places useful to know
1:12 about and what goes through it what can
1:15 you find there all right should be
1:17 should be fairly short I don't do
1:18 anything briefly do [Music]
1:24 [Music]
1:27 I um right okay how much can anybody
1:28 really talk about the femoral triangle
1:30 so what is the femoral triangle so the
1:32 femoral triangle is a triangle in this
1:36 space here do you see where we are so so
1:39 here's the knee here's the pelvis here's
1:41 the pubis bone here's the anterior
1:44 superior iliac spine so really what
1:46 we're looking at is here's the inguinal
1:49 ligament so the ingal ligament is as
1:51 I've said before it's where the um the
1:54 external oblique muscle of the abdominal
1:57 walls comes down curls around and you
2:00 get the ingal canal forming there talked
2:01 about it very briefly when we looked at
2:02 the male reproductive
2:05 system so the ingal ligament then is
2:07 this is this ligament
2:09 where linking the anterior superior
2:14 iliac spine here to the the pubis
2:18 here pubic tubic pubic
2:21 tubic and the reason the ingal ligament
2:25 is so important really is because um
2:27 there's quite a lot going on here it's
2:29 the boundary between the lower limb and
2:31 the ab abdomino pelvic
2:34 cavity which means that if you're a
2:36 structure and you want to get from the
2:37 abdomino pelvic cavity into the lower
2:41 limb then um you may need to pass under
2:43 it and we see a bunch of structures here
2:46 doing that um and also what we tend to
2:48 not see in models we tend to also lose
2:51 in PR sections when we dissect is the
2:54 fascia so we have lots of fasal layers
2:55 don't we
2:58 um forming compartments in the body
3:00 covering muscle group groups holding
3:03 things together giving us our shape and
3:05 we've lost these in the models but
3:08 there's there's a filata which is like a
3:10 stocking covering the lower
3:13 limb and that ends of the ingal ligament
3:15 and that's where we meet a bunch of
3:18 fascial layers of the abdominal pelvic
3:19 cavity and the abdomino pelvic walls
3:21 they come together there so that's the
3:24 ingal ligament here and you and you can
3:26 palpate it on yourself particular if you
3:28 find those two bony landmarks so it's a
3:30 good anatomical landmark
3:33 and it forms part of the femoral
3:37 triangle so the femoral triangle is here
3:40 it's the here right so we've got the ingal
3:42 ingal
3:44 ligament this muscle
3:46 here this is
3:48 Sartorius so this is quadriceps
3:51 quadriceps femoris here and Sartorius is
3:54 going from um the anterior superior
3:58 iliac spine it's going from here around
4:03 to uh the pezan serenus um we're medial
4:04 here so this is the tibia around this
4:08 side anyway sorus aside the inguinal
4:10 ligament is forming the superior margin
4:14 of the Emeral triangle the medial edge
4:17 of Sartorius is forming the lateral wall
4:19 of the femoral triangle and then this muscle
4:20 muscle
4:23 here these are the adductors here in
4:25 this medial compartment this is adductor
4:30 longus the long adductor muscle here and
4:31 the adductor longus is forming the
4:34 medial border of the triangle so using
4:38 those edges we have a triangle and that
4:39 then is the femoral triangle that's all
4:46 is and you can see immediately on this
4:47 model we have some interesting
4:50 structures there so the reason the femal
4:53 triangle is useful is you have a patient
4:54 you're worried about their
4:57 cardiovascular system particular of
4:59 their extremities you want to palpate
5:01 their pulses right so you want to check
5:04 the pulse their pulses to the lower limb
5:05 so you find the femoral triangle and you
5:09 can find the pulse of the femoral artery
5:12 here likewise you can also check the
5:14 pulse of the poal artery and dorsalis
5:15 pedis and that sort of thing right and
5:16 you want to check and see if there's a
5:20 nice strong steady pulse um and that'll
5:22 tell you about the blood flow to the
5:25 lower limb now if this is the femoral
5:27 artery here femoral meaning thigh so all
5:29 these structures are kind of becoming
5:33 femoral here this here is the external
5:36 iliac artery so it's a branch from the
5:38 common iliac artery that's divided up
5:41 here and the external iliac artery we
5:42 just change its name to the femoral
5:45 artery once it passes inferior to the
5:46 ingal ligaments that's another reason
5:48 why the ingal ligament is important it's
5:51 an anatomical landmark so the vein next
5:53 to it is the femoral vein and that's
5:56 draining that way so it's the femoral
5:58 vein and then as it passes under the
6:00 ininal ligament that can becomes the
6:05 external iliac vein here right and then
6:08 the nerve is the femoral nerve and that
6:09 just that's just called the femoral
6:11 nerve from when it appears all the way
6:13 down here so it doesn't change its name
6:15 and can you see how we have vein artery
6:18 nerve so you find your feminal triangle
6:20 in your patient you can palpate the
6:22 artery and then you know that lateral to
6:25 the artery is the femoral nerve medial
6:27 to the femoral artery is the femoral
6:31 vein vanan van from inwards to
6:34 outwards uh finding the vein why is that
6:36 useful well say you want to stick a
6:40 needle into um the cardiovascular system
6:42 maybe you want to get to a renal vein
6:47 you can of course put um a needle um
6:50 and whatever thing you want to pass into
6:52 the renal vein you can pass it into the
6:55 the femoral vein up the internal iliac
6:57 vein into the common iliac vein then
6:59 into the inferior vena cava and you pop
7:01 out into one of the two renal veins if
7:03 you wanted to or you could send your
7:05 needle all the way up to the right
7:07 atrium of the heart and into bits of the
7:09 heart so actually by accessing and
7:11 finding this vein down here in the thigh
7:14 in your femoral triangle you could do
7:16 surgical procedures with a wire in the
7:18 heart or in other in other blood vessels
7:20 you see so it's an important anatomical
7:22 landmark and knowing that the nerve is
7:24 here and that the arter is right next to
7:30 it tells you to be very very careful um
7:33 now the femal triangle here as I've said
7:35 the the as I've said the lower limb is
7:38 covered in this falata stocking right
7:39 which you got to imagine it's a big long
7:42 stocking it comes all the way up here
7:43 one thing the other thing we can't see
7:45 on this model is the is the The
7:47 Superficial veins of the lower limb now
7:49 you know about the superficial veins of
7:50 the lower limb because you've probably
7:53 seen varicose veins so veins don't have
7:55 a muscular wall like arteries do
7:57 arteries are greater withstanding High
8:00 pressures um veins don't have a muscular
8:01 wall they're not so good withstanding
8:03 High pressures you've got to send your
8:06 blood all the way back from your toe up
8:08 your lower limb and up through your
8:10 pelvis abdomen back into your thorax
8:13 right so there's a lot of weight a lot
8:15 of pressure a lot of weight of Blood on
8:18 the veins and they've got valves in them
8:20 to make sure the blood flows in One
8:22 Direction but if you put too much weight
8:24 on these things then it can stretch and
8:25 you know you can have problems which
8:28 causes these varicose veins so the great
8:30 saffos vein
8:34 runs all the way up the leg so you can
8:37 find it anterior to the medial malleolus
8:40 and it runs up the the lower limb and
8:41 it's very superficial it's just
8:42 underneath the skin you'll see it in
8:45 skinny people you'll be able to see in
8:47 everybody down here but it's a really
8:49 really long vein it's the vein that um
8:51 used to get used in coronary bypass
8:52 surgery don't know if it still does you
8:55 could cut a bit out rejoin it turn it
8:56 around to the valves aren a problem and
8:59 then use it to repair colonary arteries
9:00 in the heart heart right cuz it's a nice
9:02 long vein it's easy to get to I don't
9:04 know how much that's still used um but
9:08 the great saffos vein drains into the
9:11 femoral vein here so there's actually a
9:13 a kind of a weakness in the fascia there
9:16 which the vein passes through um a
9:19 couple of other terms femoral canal and femoral
9:21 femoral
9:24 sheath so if this is the femoral
9:27 triangle these blood vessels and what
9:30 have you are passing with in the femoral
9:32 sheath beneath the ingal ligament now
9:34 the other thing I didn't mention was
9:37 that the floor of the femoral triangle
9:39 is made up of a couple of muscles here's
9:43 pconus here this here is soos Major
9:45 there's iliacus soos major and iliacus
9:47 come together to form ilos so we've got
9:49 ilos under here and we've got pconus
9:51 they're forming the floor now those
9:54 muscles are moving the femur
9:57 particularly the um sorus major or ilos
10:00 sorus muscle is is flexing the knee at
10:02 the hip right all right so it's doing this
10:03 this
10:05 movement what that means is there's
10:08 quite a bit of movement around here so
10:09 for one thing you want these blood
10:11 vessels to be able to move freely as the
10:14 hip is flexing so they're so the fascia
10:16 that I would talk was talking about
10:18 these fascia come together and blend and
10:20 they kind of form this sheath around
10:22 these blood vessels and in a nutshell
10:25 what that does is it allows all of these
10:27 structures to move nice and freely over
10:29 one another nothing catches so you can
10:31 flex your your hip and extend your hip
10:33 and do all sorts of things with your hip
10:34 and all this moves around it's all nice
10:37 and safe and and what have you so that's
10:39 the femoral sheath in there now the
10:42 femoral Canal is a little bit different
10:46 the femoral Canal is the space between
10:49 it's medial to the femoral vein so it's
10:52 between the femoral vein and the pubic
10:55 tubic and it runs underneath the ingal
10:57 ligament now that's the femoral Canal so
10:59 that's a space there and it's got a bit
11:02 of fat in it it might have some
11:05 superficial um might have some
11:07 lymphatics linking superficial and deep
11:09 ingal lymph nodes which we have around
11:11 here as well but what that means is
11:14 there's a bit of space for the femoral
11:17 vein to expand into if it needs to you
11:18 know so if pressure increases in the
11:21 thorax and the abdomen because you're
11:23 doing a Val Sala maneuver you're lifting
11:25 you know if some if pressure is impeding
11:27 blood flow back into the abdominal
11:30 pelvic cavity then the femoral vein can
11:33 expand into the femoral Canal but where
11:34 all this comes from is we were talking
11:37 about hernas right um it means that
11:39 there's a weakness here and it's
11:41 possible for abdominal contents like
11:45 Loops of small bowel to pass through the
11:47 the femoral canal through this space
11:50 here if they're forced out
11:52 and uh you get that to different degrees
11:54 it's fairly rare I think it's more
11:55 common in women than men because there's
11:58 a bit more space around here you got
11:59 wider pelvises and what have you
12:01 I might be wrong
12:04 then and it might be a temporary thing
12:05 the the femoral hernia might push in and
12:08 then pull back out again um no big deal
12:12 or it might get stuck which would cause
12:15 pain maybe nausea and if it if the the
12:17 small bowel gets pushed through and kind
12:19 of gets twisted and and you get a bit of
12:22 a volvulus and it gets uded you know so
12:23 the blood supply to the V of the bowel
12:27 get cut off massive pain feeling really
12:29 unwell nausea vomiting and of course
12:31 you'll be able to palpate a lump here
12:33 because that small bow whatever's
12:36 herniated through here will be forming a
12:38 mass in this small space you know now
12:40 where the femoral triangle is so you'll
12:42 go and palpate the femoral triangle and
12:43 say oh there's a mass there and you've
12:46 got these other symptoms right we know
12:50 what the problem is um so that's the
12:53 femoral Canal that's the Gap medial to
12:55 the femoral vein running under the ingal
12:56 ligament that's a
12:59 potential Canal between between the
13:01 abdominal pelvic cavity and the the V
13:03 the other thing is um you see where
13:06 these blood vessels are going we take
13:08 Sartorius off there's a canal under here
13:10 there's a subsartorial canal this stuff
13:12 runs under hey we should do that another
13:14 day oh there so much fun stuff to talk about
13:16 about
13:21 um so femoral triangle of course the the
13:25 anterior like the top the roof of the um
13:27 the femal triangle is formed from layers
13:30 of fascia and skin so we've talked about
13:31 the floor and the roof we've talked
13:33 about the walls and the edges we've
13:35 talked about the stroes that are passing
13:36 through we've talked about the femoral
13:39 sheath the femoral
13:48 triangle um try and palpate your femoral
13:50 pulse at some time when it's convenient
13:53 and you'll be in the femoral triangle
13:54 also you can palpate the Bony bits as
13:56 well and that's all thing you yeah anyway
14:01 all right short and sweet see you next time
14:03 time [Music]
