Femoral triangle contents. Femoral triangle, trigonum femorale. Layers of the anterior thigh area. Superficial arteries and veins in the femoral triangle

The femoral triangle is limited externally by the sartorius muscle, m. sartorius, from the inside - by the long adductor muscle, m. adductor lon-gus; its apex is formed by the intersection of these muscles, and its base by the inguinal ligament. The height of the femoral triangle is 15 - 20 cm. At its bottom there is a deep triangle, or fossa, fossa iliopectinea, the walls of which are m. iliopsoas, etc. pectineus (attached to the lesser trochanter).

The skin in the area of ​​the femoral triangle is thin, tender, and mobile. The subcutaneous tissue contains blood vessels, lymph nodes and cutaneous nerves. Superficial arteries exit through a loosened area of ​​the fascia lata in the area of ​​the subcutaneous fissure, hiatus saphenus (Fig. 35). Superficial epigastric artery, a. epigastrica superficialis, runs in the subcutaneous tissue of the anterior abdominal wall from the middle of the inguinal ligament to the navel. The superficial circumflex iliac artery runs from the subcutaneous fissure to the superior anterior iliac spine parallel to the inguinal ligament. External genital arteries, aa. pudendae externae, only two, go inward, located anterior to the femoral vein above or, sometimes, below the place where the great saphenous vein of the leg enters it, v. saphena magna.

This vein is the main landmark in the subcutaneous tissue of the femoral triangle. Here, at the exit from the vascular lacuna, the femoral branch of the genitofemoral nerve, n. genitofemoralis, branches, innervating the skin under the medial part of the inguinal ligament. Near the superior anterior iliac spine, first in the thickness of the fascia lata, and below in the subcutaneous tissue, the lateral cutaneous nerve of the thigh, n. cutaneus femoris lateralis, passes, and along the inner edge of the m. sartorius pierce the fascia lata by the anterior cutaneous branches of the femoral nerve, rr. cutanei anteriores.

The cutaneous branch of the obturator nerve, i.e. cutaneus n. obturatorii, lying in the small pelvis on its lateral wall formed by the acetabulum, corresponding to the ovarian platform, reaches along the inner surface of the thigh to the level of the patella. This is the cause of pain that sometimes occurs in the knee joint during inflammatory processes in the hip joint or uterine appendages.

In the superficial superolateral and superomedial inguinal lymph nodes, lymph flows from the anterior abdominal wall below the umbilical horizontal, from the external genitalia, the skin of the anal triangle of the perineum, as well as from the fundus of the uterus (along the blood vessels of the round ligament of the uterus), lumbar and gluteal regions.

Lymph flows from the skin of the lower limb into the lower superficial inguinal lymph nodes. The efferent vessels of the superficial lymph nodes of the femoral triangle go to the deep inguinal nodes lying along the femoral artery under the superficial leaf of the fascia lata, numbering 3 - 7. From here the lymph flows into the nodi lymphatici iliaci externi, located around a. iliaca externa in the pelvic cavity.

The wide fascia, fascia lata, is especially dense on the outer surface of the thigh, where the iliotibial tract (tractus iliotibialis) is formed. It gives off three intermuscular septa: external, internal and posterior, septa intermuscularia femoris laterale, mediale et posterior, which are attached to the femur along the rough line, linea aspera, and divide the entire subfascial space of the thigh into three fascial beds: anterior, containing extensor muscles lower legs, posterior - flexors and medial bed, in which the adductor muscles of the thigh are located.

In the area of ​​the femoral triangle, the fascia lata at the inner edge of the sartorius muscle is divided into two plates. The deep plate runs medially behind the femoral vessels and connects to the fascia of the iliopsoas and pectineus muscles. The superficial plate runs in front of the femoral vessels and connects with the inguinal ligament at the top. It is heterogeneous in its structure: dense in the outer part, covering the femoral artery, forming a crescent-shaped edge, margo falciformis, and loose, perforated in the medial part, above the femoral vein - the ethmoid fascia, fascia cribrosa. In margo falciformis, there are upper and lower horns, cornua superius et inferius, limiting the subcutaneous ring of the femoral canal, hiatus saphenus. The lower horn is easily identified by the v bending over it. saphena magna, which, within the hiatus saphenus, flows into the femoral vein (see Fig. 35).

The cellular space of the femoral triangle, located between the superficial and deep plates of the fascia lata, contains the femoral artery and vein. It communicates along the course of the femoral vessels through the vascular lacuna, lacuna vasorum, with the subperitoneal floor of the pelvis; along the superficial branches of the femoral vessels through the holes in the ethmoidal fascia filling the hiatus saphenus - with the subcutaneous tissue of the femoral triangle; along the lateral artery surrounding the thigh - with the outer region of the hip joint; along the medial artery surrounding the thigh - with the bed of the adductor muscles; along the perforating arteries, through the holes in the tendons of the adductor muscles - with the posterior bed of the thigh and along the femoral vessels - with the adductor canal.

Fascia lata, along with the fascial bed of the femoral vessels, forms cases for the muscles of the superficial layer: m. tensor fasciae latae, inward from it - for mm. sartorius et adductor longus, and even more medially - for m. gracilis.

In the deep layer of the femoral triangle there are two muscles: outward lies m. iliopsoas, attached to the lesser trochanter, medially - m. pectineus, starting from pecten ossis pubis and also attached to the lesser trochanter. On m. pectineus, anterior to arcus iliopectineus, the femoral vessels pass through the vascular lacuna: artery on the outside, vein on the inside. Together with m. iliopsoas, under its fascia and arcus iliopectineus, the femoral nerve passes through the muscle lacuna, which divides into branches 2 - 3 cm below the inguinal ligament.

The femoral triangle, as is known, is bounded by the Pupart ligament, sartorius muscle, and adductor longus muscle. When studying the superficial layers of the area, attention is drawn to the presence of two layers (superficial, deep) of the superficial fascia and two layers of fiber. Lymph nodes, as well as superficial vessels, nerves, in particular v. saphena magna, located in the layer of fiber between two layers of fascia. This circumstance must be remembered when finding a vein for its ligation (Troyanova).

The fascia lata in the femoral triangle has two leaves. The deep leaf is located behind the femoral vessels, the superficial one - in front of them. Somewhat below the Poupartian ligament in the superficial layer there is an oval foramen, through which pass the superficial branches of the vessels of the femur, v. saphena magna, superficial nerves (cutaneous branches of the femoral nerve and n. lumboinguinalis).

Under the Pupart ligament there are two lacunae, separated by the iliopectineal ligament (lig. iliopectineum): lacuna musculorum, lacuna vasorum. The iliopectineal ligament is a thickening of the iliac fascia covering m. iliopsoas, which fills the muscle lacuna. The femoral nerve is also located in the muscle lacuna, directly adjacent to the lig. iliopectineum.

Through lacuna musculorum The leaks may spread (along the m. psoas) with tuberculous lesions of the upper lumbar or lower thoracic vertebrae.

Internal part of the space under the ligament of the pupart - lacuna vasorum- filled with vessels and lymph nodes. Outside lies the femoral artery, inward from it is the vein; both vessels have a common fascial sheath and are separated from each other by a septum.

The medial section of the vascular lacuna, which is the inner ring of the femoral canal, is filled with fiber and sometimes with the Rosenmüller lymph node.

At the femoral triangle, the femoral nerve divides into many branches, and the femoral artery gives off a number of small branches and the deep femoral artery, the main highway supplying the thigh area. The femoral artery and deep femoral artery are widely anastomosed due to a dense network of intramuscular vessels.

The obturator canal can be accessed through the bottom of the femoral triangle. If you cut off the pectineus muscle from the pubic bone and turn it outward, the external opening of the obturator canal with the neurovascular bundle passing through it is exposed. After exiting the canal, the obturator nerve divides into anterior and posterior branches that innervate the adductor muscles of the thigh.

In case of spastic paralysis (adductive spasm), A. S. Vishnevsky proposed exposing the obturator nerve for neurotomy here. He considered this approach the most rational and contrasts it with intrapelvic neurotomy of the obturator nerve according to Zelig. However, experience shows that the latter method of operation has significant advantages.

The femoral triangle is formed: above– inguinal ligament (base of the femoral triangle); laterally– tailor muscle; medially– adductor longus muscle. Under the superficial layer of the fascia lata in the femoral triangle, surrounded by a common vagina, pass the femoral artery and vein.

At the base of the triangle femoral vein lies medially,femoral artery– laterally, femoral nerve– outward from the artery under the deep layer of fascia lata. Towards the apex of the femoral triangle, the vein deviates posteriorly from the femoral artery.

Femoral nerve 3-4 cm downward from the inguinal ligament it is divided into muscular and cutaneous branches. The largest cutaneous branch of the femoral nerve is n. saphenus, which further accompanies the femoral artery.

Femoral artery is a continuation of the external iliac artery. In the vascular lacuna it is located on the pubic bone, where it can be pressed when bleeding from its branches. Departs from the femoral artery in the triangle deep lateral femoral artery– the main collateral during the development of roundabout circulation. Its branches are a. circumflexa femoris lateralis and a. circumflexa femoris medialis.

Bottom of the femoral triangle are ileo-

psoas and pectineus muscles, the edges of which form the sulcus iliopectineus. It passes into the sulcus femoralis anterior in

middle third of the thigh. The femoral vessels and n.saphenus, covered by the sartorius muscle, pass under the proper fascia here. Three perforating arteries depart from the deep artery of the thigh, which go through the intermuscular septa into the posterior fascial bed of the thigh.

Adductor canal(canalis adductorius) is a continuation

by pressing the anterior groove of the thigh. It is located under the fascia lata and is covered in front by the sartorius muscle. Front wall canal – aponeurotic plate (lamina vastoadductoria)

between m. vastus medialis and m. adductor magnus; lateral wall– m. vastus medialis; medial– m. adductor magnus.

The channel has three holes. Through top(input) hole canal pass through the femoral artery and femoral vein

and in. saphenus. The lamina vastoadductoria contains anterior from-

hole, through ĸᴏᴛᴏᴩᴏᴇ they leave the channel. saphenusia. genusdescendents.

In the adductor canal in relation to the femoral artery n. saphenus lies on its anterior wall; the femoral vein is located behind and lateral to the artery.

The femoral vessels leave the adductor canal into the popliteal fossa through the tendon gap of the adductor major muscle (hiatus adductorius), which is lower(on weekends)

Rice. 1. Lymphatic vessels and nodes in the femoral triangle: 1 - lnn. inguinales superficiales; 2 - hiatus saphenus; 3 - y. saphena magna; 4 - lnn. subinguinales superficiales (BNA). Rice. 2. Muscular and vascular lacunae: 1 - lig. inguinal; 2 - lig. iliopectineum; 3 - m. iliopsoas; 4 - n. femoralis; 5 - a. femoralis; 6 - v. femoralis; 7 - anulus femoralis; 8 - m. pectineus. Rice. 3. Superficial layers of the femoral triangle: 1 - vasa circumflexa ilium superficialia; 2 - vasa epigastrica superficialia; 3 - n. cutaneus femoris lateralis; 4 - ramus femoralis n. genitofemoralis; 5 - hiatus saphenus et margo falciformis; 6 - a. femoralis; 7 - v. femoralis; 8 - vasa pudenda externa; 9 - v. saphena magna; 10 - rami cutanei anteriores. Rice. 4. Deep layers of the femoral triangle: 1 - fascia lata; 2 - m. sartorius; 3 - n. femoralis; 4 - a. femoralis; 5 - v. femoralis; 6 - fatty tissue; 7 - m. pectineus; 8 - a. circumflexa femoris medialis; 9 - mm. adductores; 10 - n. obturatorius.

FEMORAL TRIANGLE [trigonum femorale(JNA, PNA), trigonum femorale (fossa Scarpae major), BNA; syn. Scarpov triangle] - a triangular area located in the upper part of the anterior thigh. The femoral triangle is bounded from above by the inguinal ligament (lig. inguinale), from the outside - by the inner edge of the sartorius muscle (m. sartorius), from the inside - by the outer edge of the long adductor muscle (m. adductor longus) (tsvetn. fig. 1-4). The apex of the femoral triangle is located at a distance of 10-15 cm from the inguinal ligament. The bottom of the femoral triangle is made up of the iliopsoas (m. iliopsoas) and pectineus (m. pectineus) muscles, between which the iliopectineal fossa, or the lesser fossa of Scarpa (fossa iliopectinea, fossa Scarpae minor) is formed. In the femoral triangle there is the great saphenous vein (v. saphena major), the femoral branch of the femoral-genital nerve (femoralis n. genitofemoralis), the anterior cutaneous branches of the femoral nerve (rr. cutanei anteriores n. femoralis), superficial, circumflex ilium, external genital and superficial epigastric arteries and veins (aa. and vv. circumflexae ilium superficiales, pudendae externae, epigastricae superficiales), as well as superficial and deep inguinal lymph nodes (nodi lymphatici inguinales superficiales and profundi). The femoral nerve (see) is located outward from the femoral artery and is separated from it by the iliopectineal fascia (fascia iliopectinea).

The fascia lata of the thigh (fascia lata) within the femoral triangle is divided into superficial and deep layers, between which lie the femoral artery and vein, the femoral canal is formed inward from the latter (see). The adductor canal (canalis adductorius) begins from the apex of the femoral triangle. The deep femoral artery (a. profunda femoris) departs from the femoral artery into the femoral triangle. In the area of ​​the femoral triangle, femoral hernias can be located (see), purulent streaks can spread (along the v. femoralis) with primary and secondary purulent psoitis (see). The inguinal lymph nodes, located in the upper part of the femoral triangle, in some cases can be a source of adenophlegmon in this area. During surgical treatment of varicose veins (see) of the lower extremities in the femoral triangle, the terminal section of the great saphenous vein of the thigh is exposed for its ligation and intersection. This vein is accompanied by superficial lymphatic vessels, and deep ones - along the course of the femoral artery.

In the femoral triangle, digital compression of the femoral artery is performed during arterial bleeding from wounds of the lower limb, puncture and percutaneous catheterization of the femoral artery for therapeutic and diagnostic purposes. In the femoral triangle, the femoral artery and deep femoral artery are most often exposed during the surgical treatment of obliterating atherosclerosis of the lower extremities.

Bibliography: Kovanov V.V. and Travin A.A. Surgical anatomy of the lower extremities, p. 277, M., 1963; Lubotsky D. N. Fundamentals of topographic anatomy, p. 159, M., 1953; A p-son B. J. a. Maddock W. G. Callender’s surgical anatomy, p. 950 a. o., Philadelphia - L., 1958; Lanz T.u. Wachsmuth W. Praktische Anatomie, Bd 1, B., 1959.

S. S. Mikhailov, B. M. Khromov.

Femoral triangle, trigonum femorale, is formed in the upper third of the thigh on its anterior surface (Fig. 19). It is limited to the following structures:

1. Above – inguinal ligament;

2. Laterally – by the sartorius muscle;

3. Medially – long adductor muscle.

Within the femoral triangle, the own fascia of the thigh (fascia lata) forms an opening closed by a loose connective tissue plate - subcutaneous cleft, hiatus saphenus. This cleft is limited on the lateral side by a thickened edge of the fascia lata - a crescent-shaped edge that has an arched shape. Above, under the inguinal ligament, the falcate edge forms the superior horn, and below, above the sartorius muscle, the inferior horn.

If we examine the area of ​​the femoral triangle after removing the fascia lata and dissecting the muscles, we find the following (Fig. 20):

Bottom of the femoral triangle form two muscles:

1. iliopsoas muscle

2. pectineus muscle, covered with a deep layer of the lata fascia of the thigh - the iliopectineal fascia.

Between these muscles a iliopectineal groove, continuing downwards into the femoral groove.

In the upper part of the triangle, under the inguinal ligament, two spaces are formed - the muscular and vascular lacunae (Fig. 21).

Vascular lacuna(A) limited:

Above – inguinal ligament;

Below - the iliopectineal fascia;

Laterally – by the iliopectineal arch;

Medially – lacunar ligament.

Muscle lacuna(B) limited:

Laterally and below – the ilium;

Above – inguinal ligament;

Medially – iliopectineal arch

The iliopsoas muscle and femoral nerve enter the thigh through the muscular lacuna, and the femoral vessels (artery and vein) exit through the vascular lacuna.

In the medial corner of the vascular lacuna, one of the weak points of the abdominal wall is formed - deep femoral ring. This ring (Fig. 21, 22) is limited:

Above – inguinal ligament;

Laterally – femoral vein;

Medially – lacunar ligament;

Below - the pectineal ligament (thickening of the iliopectineal fascia).

Fine this ring is closed by the transversalis fascia and lymph nodes, but under certain conditions femoral hernias can emerge through it. In this case, the hernial sac, emerging onto the thigh, forms a new structure that does not exist normally - femoral canal(Fig. 23). Its walls become:

From the inside – the iliopectineal fascia;

Laterally – femoral vein;

Anteriorly – the inguinal ligament and the superior horn of the falciform edge of the fascia lata.

The subcutaneous cleft becomes the external opening of the femoral canal. Therefore, when examining a patient with acute abdominal pain, it is imperative to examine the area of ​​the femoral triangle so as not to miss a strangulated femoral hernia.