The deep femoral ring is limited. Femoral canal (canalis femoralis). Central nervous system - m. N. scherba

Treatment of the vessels of the stump. Typically, amputations are performed under a tourniquet. This makes it possible to cross all soft tissues without blood. At the end of the operation, before removing the tourniquet in the stump, all large vessels are ligated, and the arteries are ligated with two ligatures, the lower of which must be stitched: one end of the ligature is threaded into a needle with which both walls of the artery are stitched. This additional fixation insures against slipping of the ligature. As a suture material, many surgeons prefer catgut, because when using silk, the formation of a ligature fistula is possible. The ends of the ligatures are cut off only after removing the tourniquet. Smaller vessels are ligated with stitching of the surrounding tissues.

Operations on the vessels of the lower extremity

Puncture of the femoral artery according to Seldinger. The puncture is carried out with the aim of introducing a catheter into the aorta and its branches, through which it is possible to carry out contrasting of the vessels,

to bed the cavity of the heart. The injection of a needle with an inner diameter of 1.5 mm is carried out immediately below the inguinal ligament along the projection of the femoral artery. Through the lumen of the needle inserted into the artery, a guidewire is first inserted, then the needle is removed and instead of it a polyethylene catheter with an outer diameter of 1.2-1.5 mm is put on the guidewire. The catheter together with the guidewire is advanced along the femoral artery, the iliac arteries into the aorta to the desired level. Then the guidewire is removed, and a syringe with a contrast agent is attached to the catheter.

Operations for varicose veins of the lower leg and thigh. At

varicose veins of the lower limb (v. saphena magna and v. saphena parva) due to insufficiency of the venous valves, the blood stagnates in the lower parts of the lower leg, as a result of which the trophism of tissues is disturbed, and trophic ulcers develop. This is also facilitated by the insufficiency of the valves of the perforating veins, due to which blood is discharged from the deep veins into the superficial veins. The purpose of operations is to eliminate blood flow through the superficial veins (with full confidence in the patency of deep veins!). Previously used operations to ligate the great saphenous vein at the place of its confluence with the femoral vein (in particular, the Troyanov-Trendelenburg operation) proved to be insufficiently effective. The most radical operation is the complete removal of the great saphenous vein according to Babcock. The principle of the method is to remove a vein using a special flexible rod with a clavate head inserted into it through a small incision under the inguinal ligament to the level of the knee joint, where venesection is also performed through a small incision. The conductor is taken out through this hole, the club-shaped head is replaced with a venextractor (metal cone with sharp edges). By pulling the extractor out by the guidewire at the upper incision, the vein is removed from the subcutaneous tissue. By the same principle, the distal part of the vein on the lower leg is removed.

Femoral canal,canalis femoralis, is formed in the region of the femoral triangle during the development of a femoral hernia. It is a short section medially from the femoral vein and extends from the femoral (inner) ring of this canal to the subcutaneous fissure, which becomes the external opening of the canal in the presence of a hernia.

Inner femoral ring

anulus femoralis, located in the medial part of the vascular lacuna. It is bounded in front by the inguinal ligament, behind by the comb ligament, medially by the lacunar ligament, and laterally by the femoral vein. From the side of the abdominal cavity, the femoral ring is closed by a section of the loosened transverse fascia of the abdomen - the femoral septum, septum femorale.

The femoral canal is isolated three walls

anterior, lateral and posterior. The front wall of the canal is the inguinal ligament and the upper horn of the sickle-shaped edge of the broad fascia of the thigh fused with it. The lateral wall is formed by the femoral vein, and the posterior wall is formed by the deep plate of the wide fascia covering the comb muscle.

Table of contents of the subject "Femoral canal (canalis femoralis). Abdominal hernia.":
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Femoral canal located between the superficial and deep leaves of the fascia lata. Femoral canal It has two holes- deep and superficial, and three walls. The deep opening of the femoral canal is projected onto the inner third of the inguinal ligament. The superficial opening of the femoral canal, or subcutaneous fissure, hiatus saphenus, is projected 1-2 cm downward from this part of the inguinal ligament.

A hernia leaving the abdominal cavity enters the canal through deep hole - thigh ring, anulus femoralis... It is located in the most medial part of the vascular lacuna and has four edges.

In front thigh ring limits the inguinal ligament, behind - the comb ligament, lig. pectineale, or Cooper's ligament, located on the crest of the pubic bone (pecten ossis pubis), medially - lacunar ligament, lig. lacunare, located in the corner between the inguinal ligament and the crest of the pubic bone. On the lateral side, it is bounded by the femoral vein.

Thigh ring facing the pelvic cavity and on the inner surface of the abdominal wall is covered with a transverse fascia, which here has the form of a thin plate, septum femorale. The deep inguinal lymph node of Pirogov-Rosenmüller is located within the ring.

Superficial annulus of the femoral canal (hole) is an subcutaneous fissure, hiatus saphenus, a defect in the superficial layer of the fascia lata. The opening is closed by a latticed fascia, fascia cribrosa (Fig. 4.8).

Femoral canal and femoral hernia.
1 - m. iliacus; 2 - m. psoas major,
3 - spina iliaca anterior superior; 4 - n. femoralis;
5 - arcus ilio-pectineus; 6 - lig. inguinale;
7 - margo falciformis et cornu superior, 8 - a, v. femoralis;
9 - os pubis; 10 - saccus herniae (hernial sac);
11 - v. saphena magna.

Femoral canal walls

Femoral canal walls represent a triangular pyramid.

Anterior wall of the femoral canal formed by the superficial layer of the wide fascia between the inguinal ligament and the superior horn of the subcutaneous fissure - cornu superius.

Lateral wall of the femoral canal- the medial semicircle of the femoral vein.

Posterior wall of the femoral canal- a deep leaf of the wide fascia, which is also called fascia iliopectinea.

Medial wall of the femoral canal no, since the superficial and deep leaves of the fascia in the adductor longus muscle grow together.

Femoral canal length(the distance from the inguinal ligament to the upper horn of hiatus saphenus) ranges from 1 to 3 cm.

MUSCULAR AND VASCULAR LACKS

Behind the inguinal ligament are muscle and vascular lacunae, which are separated by the ilio-comb arch. The arch extends from the inguinal ligament to the ilio-pubic eminence.

Muscle lacuna located laterally from this arch, bounded in front and above by the inguinal ligament, behind by the ilium, and on the medial side by the ilio-comb arch. Through the muscle lacuna, the iliopsoas muscle along with the femoral nerve emerges from the pelvic cavity into the anterior region of the thigh.

Vascular lacuna located medially from the ilio-comb arch; it is limited in front and above by the inguinal ligament, behind and below by the comb ligament, on the lateral side by the iliac-comb arch, and on the medial side by the lacunar ligament. The femoral artery and vein, lymphatic vessels pass through the vascular lacuna.

On the front of the thigh, there is femoral triangle (Scarpa's triangle), bounded at the top by the inguinal ligament, from the lateral side by the sartorius muscle, medially by the long adductor muscle. Within the femoral triangle, under the superficial leaflet of the wide fascia of the thigh, a well-defined ilio-comb groove (fossa) is visible, limited from the medial side by the comb, and from the lateral side - by the ilio-lumbar muscles covered with the ilio-comb fascia (deep plate of the wide fascia of the thigh) ... In the distal direction, the specified groove continues into the so-called femoral groove, from the medial side it is limited by the long and large adductor muscles, and from the lateral side - by the medial broad muscle of the thigh. Below, at the apex of the femoral triangle, the femoral groove passes into the adductor canal, the inlet of which is hidden under the sartorius muscle.

Femoral canal is formed in the region of the femoral triangle during the development of a femoral hernia. It is a short section medially from the femoral vein, extending from the femoral inner ring to the saphenous fissure, which becomes the external opening of the canal in the presence of a hernia. The inner femoral ring is located in the medial part of the vascular lacuna. Its walls are in front - the inguinal ligament, behind - the comb ligament, medially - the lacunar ligament, laterally - the femoral vein. From the side of the abdominal cavity, the femoral ring is closed by a section of the transverse fascia of the abdomen. At the femoral canal, 3 walls are distinguished: the anterior one is the inguinal ligament and the upper horn of the crescent edge of the broad fascia of the thigh fused with it, the lateral one is the femoral vein, and the posterior is the deep plate of the wide fascia covering the comb muscle.

Control questions for the lecture:

1. Anatomy of the abdominal muscles: attachment and function.

2. Anatomy of the white line of the abdomen.

3. Relief of the posterior surface of the anterior abdominal wall.

4. Formation process inguinal canal due to the lowering of the sex gland.

5. The structure of the inguinal canal.

6. The process of forming straight and oblique inguinal hernias.

7. The structure of the lacunae: vascular and muscular; scheme.

8. The structure of the femoral canal.

The femoral canal (canalis femoralis), 1-3 cm long, has three walls. The lateral wall of the canal is formed by the femoral vein, the anterior wall is formed by the sickle-shaped edge and the superior horn of the fascia lata (femur). The posteromedial wall of the canal is formed by a deep leaf of the wide fascia covering the comb muscle in this place. The subcutaneous ring (anulus saphenus) of the femoral canal is limited from the lateral side by a sickle-shaped edge and is closed by a thin ethmoid fascia (fascia cribrosa). In the deep femoral ring, which normally contains a small amount of loose tissue and the Pirogov-Rosenmüller lymph node, four walls are distinguished. The front wall of the deep ring is the inguinal ligament, the lateral wall is the femoral vein, the medial wall is the lacunar ligament (lig.lacunare), the posterior wall is the comb ligament (lig.peclinale), which is a periosteum supported by fibrous fibers in the region of the pubic bone crest. The lacunar ligament is formed by connective tissue fibers that extend from the medial end of the inguinal ligament posteriorly and laterally along the edge of the superior branch of the pubic bone. These fibrous fibers round off the acute angle between the medial end of the inguinal ligament and the pubic bone.

There are important topographic formations on the front of the thigh. This is primarily the femoral triangle, bounded by the long adductor femoris (medial), sartorius (lateral) and the inguinal ligament (top). Through this triangle, under the skin and under the superficial leaflet of the fascia lata, the thigh passes iliac crestal sulcus(sulcus iliopectineus), limited from the lateral side by the iliopsoas muscle, and from the medial side - by the comb muscle. The femoral artery and the femoral vein are adjacent to this groove. The groove continues downward into the femoral-popliteal, or adductor (hunter), channel (canalis adductorius), through which the femoral artery, vein and saphenous nerve pass. The walls of the adductor canal are the broad medial muscle of the thigh (lateral), the adductor major muscle (medial). The front wall of the adduction canal is a fibrous plate stretched between the indicated muscles (lamina vastoadductoria, BNA). In this plate there is an opening - a tendon gap (hiatus tendineus), through which the saphenous nerve and the descending knee artery exit from the canal to the antero-medial wall of it. The femoral artery and vein pass through the lower opening of the canal, formed by the tendon of the adductor major muscle and the posterior surface of the femur and opening into the popliteal fossa from above. The muscles in the thigh are covered with a broad fascia.