Femoral Triangle and Adductor

Canal

Dr. Heba Kalbouneh

Associate Professor of Anatomy and Histology

Femoral Triangle and

Adductor Canal

Is a triangular depressed area located in the upper part of

the medial aspect of the thigh immediately below the

inguinal ligament.

Femoral triangle

Superiorly: Inguinal ligament

(the base of the triangle)

Laterally:

Medial border of sartorius

Medially:

Medial border of adductor

longus

The apex: directed downwards

and is formed by the meeting

point of sartorius and adductor

longus

Floor:

Gutter shaped

from lateral to medial is made

by:

A. Iliacus

B. Psoas

C. Pectineus

D. Adductor longus

C

A B

D

Roof:

Formed by

1-Skin

2-Superficial fascia and

its contents

3-Deep fascia containing

the saphenous opening

Genitofemoral nerve

(femoral branch) Ilioinguinal nerve Great saphenous vein

Superficial inguinal

lymph nodes

Genitofemoral nerve

(femoral branch)

Contents of the femoral

triangle

1-Femoral nerve and its

branches

2-Femoral artery and its

branches

3-Femoral vein and its

tributaries

4-Deep inguinal lymph

nodes

5- Femoral sheath!!!

6-Femoral branch of

genitofemoral nerve

7-Lateral cutaneous nerve

of the thigh

Lateral

cutaneous

nerve of the

thigh

Femoral

nerve Femoral

artery

Femoral vein

Deep inguinal lymph nodes

Nerve Artery

Vein

Inguinal lymph nodes

NAVI gate

The femoral triangle from lateral to medial

Femoral

sheath

The femoral sheath is a funnel

shaped sheath of fascia

surrounding the upper 1.5

inches of femoral vessels

The femoral sheath

The femoral sheath is formed by a

downwards extension of the abdominal

fascia

Anterior wall: is a downward

prolongation of the fascia transversalis

of the anterior abdominal wall

Posterior wall: is a downward

prolongation of the fascia iliaca of the

posterior abdominal wall

Two Anterio-posterior septa divide the

sheath into 3 compartments:

1-Lateral compartment (arterial)

occupied by the femoral artery and

femoral branch of the genitofemoral nerve

2-Intermediate compartment (venous)

occupied by the femoral vein

3-Medial compartment (lymphatic)

occupied by the lymph vessels and one of

the deep inguinal lymph nodes (femoral

canal)

Femoral canal

Is the small medial compartment of

the femoral sheath.

0.5 inch in length (just admits the

tip of the little finger)

Base: directed upwards, towards the

abdominal cavity called the

femoral ring

The femoral ring is closed by a

condensation of extraperitoneal

tissue called femoral septum

Apex: directed downwards, its

closed by fusion of its wall

The Femoral canal contains:

1-a plug of fat

2-a constant lymph node—the node

of the femoral canal or Cloquet’s

gland, and lymph vessels

The canal has two functions: first, as

a dead space for expansion of the

distended femoral vein and, second,

as a lymphatic pathway from the

lower limb to the external iliac nodes

Note: the femoral ring is wider in females

because of their wider pelvis and therefore,

femoral hernia is commoner in females than in

males

The femoral ring is the base of the femoral canal.

Part of the intestine can sometimes pass through the femoral

ring into the femoral canal pushing the femoral septum before

it and causing a femoral hernia

Inguinal ligament

Ilium

Pectineal ligament

Lacunar ligament

Anteriorly: Inguinal ligament

Medially: Lacunar ligament (the

sharp free edge that connects the

inguinal ligament to the pectineal

ligament)

Laterally: Femoral vein

Posteriorly: Pectineal ligament

(the thickened periosteum along

the pectineal line of the superior

pubic ramus and continues

medially with the lacunar

ligament)

The boundaries of the

femoral ring are:

Inguinal ligament

Ilium

Pectineal ligament

Lacunar ligament

Because of these anatomic

structures, the neck of the sac is

unable to expand.

Once an abdominal viscus has

passed through the neck into the

body of the sac, it may be difficult

to push it up and return it to the

abdominal cavity

(irreducible hernia).

Furthermore, after the patient

strains or coughs, a piece of bowel

may be forced through the neck,

and its blood vessels may be

compressed by the femoral ring,

seriously impairing its blood

supply (strangulated hernia).

A femoral hernia is a dangerous

condition and should always be

treated surgically

Inguinal ligament

Pectineal ligament

Lacunar ligament

A protrusion of abdominal parietal peritoneum down through the femoral canal

to form hernial sac

The neck of the hernial sac is located

below and lateral to the pubic tubercle in femoral hernia

While in the inguinal hernia

The neck of the hernial sac is located above and medial to the pubic tubercle

Inguinal canal

Differential diagnosis of a femoral hernia

Consider diseases that may involve other anatomic structures close to the inguinal ligament.

Inguinal hernia: The swelling lies above and medial to the pubic tubercle.

Superficial inguinal lymph nodes: Usually, more than one lymph node is enlarged. In patients

with inflammation of the nodes (lymphadenitis), carefully examine the entire area of the body

that drains its lymph into these nodes.

Great saphenous vein: A localized dilatation of the terminal part of the great saphenous vein

(saphenous varix)

Psoas sheath: Tuberculous infection of a lumbar vertebra can result in the extravasation of pus

down the psoas sheath into the thigh.

Femoral artery: Aneurysm of the femoral artery

Femoral triangle

Surface anatomy

Adductor canal

(Subsartorial)

or

Hunter’s canal

John Hunter described the exposure

and ligation of the femoral artery in this

canal for aneurysm of the popliteal

artery; this method has the advantage

that the artery at this site is healthy and

will not tear when tied, as may happen

if ligation is attempted immediately

above the aneurysm

Is an intermuscular canal in the middle 1/3 of the

medial side of the thigh beneath the sartorius

It begins above at the apex of the femoral triangle

It ends below at adductor hiatus (the opening in the

adductor magnus).

In cross section it is triangular (has 3 walls)

1-Anteromedial wall

2-Anterolateral wall

3-Posterior wall (floor)

Adductor (Subsartorial) Canal

1 2

3

4

Transverse section through the middle of the

left thigh as seen from above

The Anteriomedial wall is formed by:

Sartorius and fascia

The posterior wall (floor) is formed by:

Adductor longus and magnus

The Anterolateral wall is formed by:

Vastus medialis

The posterior wall is

formed by:

Adductor longus and

magnus

Adductor longus

Adductor magnus

The adductor canal contains

1- Femoral artery

2- Femoral vein

3- Saphenous nerve

4- Nerve of vastus medialis

5- Obturator nerve

6- Subsartorial plexus of nerves

Subsartorial plexus of nerves:

Located on the fascia under the sartorius and is

formed by branches from

1- Medial cutaneous nerve of the thigh

2- Saphenous nerve

3- Obturator nerve

1-Enters the thigh from behind the inguinal

ligament as a continuation of the external iliac

artery.

2-Lies midway between the anterior superior

iliac spine and the symphysis pubis

Midinguinal point

The femoral artery

3-Its upper half lies superficial in the femoral

triangle while in the lower half it lies deep in

the subsartorial (adductor) canal

4-Ends at adductor hiatus by entering the

popliteal fossa as THE POPLITEAL ARTERY

(what does this mean?)

See next slides

Inguinal ligament

External iliac artery

Femoral artery

Adductor

hiatus

Popliteal artery

Saphenous nerve

In the upper part of its course, femoral artery

lies in the femoral triangle (superficial) covered

by skin and fascia

1-Exposed to injuries

2-Good approach for taking femoral pulse

3- Femoral Artery Catheterization

Branches of the femoral artery

THREE superficial branches

TWO deep branches

They supply cutaneous

regions of the upper

thigh, lower abdomen,

and perineum.

Superficial branches

1-Superficial circumflex iliac artery

2-Superficial epigastric artery

3-Superficial external pudendal artery

Deep branches

1-Deep external pudendal artery

2-Profunda femoris artery

Branches of the femoral artery in

the adductor canal

Descending genicular artery

Superficial external

pudendal artery

Superficial

circumflex

iliac artery

Superficial epigastric

artery

Deep external

pudendal

artery

Pudendal “to be

ashamed” in latin.

Refers to the

external genitalia

The femoral vein lies

medial to the artery in the

upper part of the femoral

triangle, then it lies

posterior and finally lateral

to the artery at the apex of

the femoral triangle

Saphenous nerve

crosses femoral artery

anteriorly

Saphenous

nerve

Adductor

hiatus

Femoral artery

Popliteal

artery

The profunda femoris artery

(Deep artery of thigh) arises

from the posterolateral side of

the femoral artery about (4 cm)

below the inguinal ligament

it gives off

A) Medial femoral circumflex

artery

B) Lateral femoral circumflex

artery

C) Perforating arteries

Internal iliac artery

External

iliac

artery

Common iliac artery

Obturator Artery

Obturator Artery

The obturator artery is a branch of the

internal iliac artery

It passes forward on the lateral wall of the

pelvis and accompanies the obturator nerve

It gives off muscular branches and an

articular branch to the hip joint

Femoral Vein

Enters the thigh by passing through the

adductor hiatus as a continuation of the

popliteal vein

Ascends through the thigh, lying at first on

the lateral side of the artery, then posterior to it,

and finally on its medial side

Leaves the thigh in the intermediate

compartment of the femoral sheath and passes

behind the inguinal ligament to become the

external iliac vein.

Tributaries

The tributaries of the femoral vein are the great

saphenous vein and veins that correspond to the

branches of the femoral artery drain into the

great saphenous vein

1- Superficial circumflex iliac vein

2- Superficial epigastric vein

3- Superficial external pudendal vein

Femoral vein

Great saphenous

vein

Profunda

femoris

artery

Femoral vein

Superficial

epigastric vein

Great saphenous vein

Superficial external

pudendal vein

Superficial

circumflex

iliac vein

Test Your Knowledge

1-Mention Branches of Femoral artery………………………………………………

2-Boundaries of adductor canal……………………………………………………

3-Branches of femoral nerve ………………………………………………………