Comprehensive Overview of Thigh Anatomy by Dr. Mohammed Hussein M.B.Ch.B, MSC, PhD

•

Introduction

Introduction

•

Regional anatomy

Regional anatomy

•

Connections & Gateways of the thigh

Connections & Gateways of the thigh

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Compartments of the thigh

Compartments of the thigh

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 The Front and Medial Aspects of the Thigh

 The Front and Medial Aspects of the Thigh

•

Cutaneous nerves

Cutaneous nerves

•

Superficial nerves

Superficial nerves

•

Inguinal lymph nodes

Inguinal lymph nodes

•

Superficial and deep fasciae

Superficial and deep fasciae

•

 Lumbosacral plexus

 Lumbosacral plexus

Gray’s Anatomy for Students, 4

Gray’s Anatomy for Students, 4

th

th

 Edition

 Edition

Snell clinical anatomy by regions - 9th Edition

Snell clinical anatomy by regions - 9th Edition

Gluteal region

Connections & Gateways

Connections & Gateways

Abdominal wall

Thigh

Inguinal ligament

Anteriorly

Anteriorly

•

It is separated from the abdominal wall by the inguinal ligament.

•

It communicates with the abdominal cavity through the 

aperture

 between the

inguinal ligament and pelvic bone

Obturator canal

Obturator membrane

Obturator foramen

Medially

The 

obturator nerve 

obturator nerve 

and associated 

vessels

vessels

 pass between the thigh and

pelvic cavity through the obturator canal.

Inferior margin of gluteus maximus

Gluteal fold

Quadratus femoris

Posteriorly

Posteriorly

•

It is separated from the gluteal region by

•

Superficially 

by the gluteal fold

•

On deeper planes 

by the inferior margins of  the gluteus maximus and quadratus femoris.

Sciatic nerve

•

The thigh is divided into 

three compartments

by intermuscular septa between

the posterior aspect of the femur and the fascia lata.

Intermuscular septa

Anterior

Compartment

Posterior

Compartment

Medial

Compartment

Femoral Nerve

Sciatic Nerve

Obturator Nerve

Femoral  Nerve

Sciatic  Nerve

The Front and Medial Aspects of the Thigh

•

 Skin of the Thigh

•

 Superficial Fascia of the Thigh

•

 Deep Fascia of the Thigh (Fascia Lata)

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Cutaneous Nerves

Cutaneous Nerves

1.

The lateral cutaneous nerve of the thigh

2.

The medial cutaneous nerve of the thigh

3.

The intermediate cutaneous nerve of the thigh

4.

The femoral branch of the genitofemoral nerve

5.

The ilioinguinal nerve

6.

The obturator nerve

Femoral branch of genitofemoral nerve

Lat. cut. N. of thigh

Lat. cut. N. of thigh

Femoral nerve

1.

Medial cutaneous nerve of the thigh

2.

Intermediate cutaneous nerve of the thigh

Ilio-inguinal nerve

Obturator nerve

Post. Cut. N. of thigh

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The superficial veins form two major channels

1.

The great (long) saphenous vein

2.

The small (short) saphenous vein

•

Both veins originate from a dorsal venous arch in the foot

Great saphenous vein

Small saphenous vein

Femoral vein

Popliteal vein

Saphenous opening

Dorsal venous arch

Great saphenous vein

Small saphenous vein

Femoral vein

Popliteal vein

Saphenous opening

Dorsal venous arch

Tributaries of the great saphenous vein

Tributaries of the great saphenous vein

•

At the saphenous opening in the deep fascia, the great saphenous vein

usually receives three tributaries that are

•

The superficial circumflex iliac vein

The superficial circumflex iliac vein

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The superficial epigastric vein

The superficial epigastric vein

•

The superficial external pudendal vein

The superficial external pudendal vein

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These veins correspond with the three branches of the femoral artery

found in this region.

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An additional vein, known as the 

accessory vein

accessory vein

, 

usually joins the main

vein about the middle of the thigh or higher up at the saphenous

opening.

•

The normal flow of blood in the

lower limbs is from the skin and

subcutaneous tissues to the

superficial veins, which drain via

perforating veins 

perforating veins 

to the deep

veins, which  in turn drain into the

iliac veins and inferior vena cava

•

The normal flow of blood in the

venous system depends upon the

presence of 

competent valves

competent valves

, which

prevent reflux.

•

Venous return is supplemented with

contraction of the muscles 

contraction of the muscles 

in the

lower limb, which pump the blood

toward the heart.

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There are typical points where incompetent valves occur between the superficial

and the deep veins.

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In these regions the varicosities tend to become marked.

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The typical sites are:

1.

At the 

saphena varix

saphena varix

—the saphenofemoral

junction where the femoral vein is joined by

the great saphenous vein

2.

In the 

mid-thigh

mid-thigh

 perforating vein between the

great saphenous vein and the femoral vein

3.

At the 

junction of the small saphenous vein

junction of the small saphenous vein

and the popliteal vein

and the popliteal vein

4.

In 

the calf 

the calf 

the three sites where perforators

occur, 5, 10, and 15 cm above the medial

malleolus between the great saphenous vein

and the deep veins of the calf

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In patients with occlusive coronary disease caused by atherosclerosis, the

diseased arterial segment can be bypassed by inserting a graft consisting of a

portion of the great saphenous vein.

•

The venous segment is reversed so that its valves do not obstruct the arterial

flow.

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Most lymphatic vessels in the lower limb drain into 

superficia

l

and 

deep inguinal nodes 

located in the fascia just inferior to

the inguinal ligament

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The 

superficial inguinal nodes

, approximately 10 in number

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Lie in the superficial fascia below the inguinal ligament and can

be divided into a horizontal and a vertical group

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The 

deep inguinal nodes

, up to 3 in number

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They are medial to the femoral vein.

D

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A small collection of  deep nodes posterior to the knee

close to the popliteal vessels.

Popliteal nodes (deep) (behind knee)

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Receive lymph from

1.

Superficial regions of  the

lower limb

2.

Back below iliac crest

including the lower half of

the anal canal

3.

Abdomen below umbilicus

4.

The perineum (but not the

testes)

Receive lymph from

1.

Deep lymphatics associated

with the femoral vessels

2.

The glans penis (or clitoris)

in the perineum

•

The superficial and deep inguinal nodes interconnected

and drain into the 

external iliac nodes 

via vessels that

pass along the medial side of  the femoral vein as it

passes under the inguinal ligament.

•

The space through which the lymphatic vessels pass

under the inguinal ligament is the 

femoral canal

.

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Fascial compartment for femoral artery

Fascial compartment for femoral vein

Femoral canal

Femoral nerve

Superficial Fascia of the Thigh

Deep Fascia of the Thigh

(Fascia Lata)

•

The outer layer of  deep fascia in the lower

limb forms a thick “

stocking-like

”

membrane, which covers the limb and lies

beneath the superficial fascia.

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The fascia lata is anchored superiorly to bone and soft

tissues along a line of  attachment that defines the upper

margin of  the lower limb.

Deep fascia of thigh

(Fascia lata)

Deep fascia of leg

(Crural fascia)

•

The fascia lata is thickened laterally into a

longitudinal band (the 

iliotibial tract

iliotibial tract

),

which descends along the lateral margin

of  the limb from the tuberculum of  the

iliac crest to the lateral condyle of the

tibia at Gerdy's tubercle

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Tuberculum of  the iliac crest

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The superior aspect of  the fascia

lata in the gluteal region splits

anteriorly to enclose the 

tensor

fasciae latae 

muscle and

posteriorly to enclose the

gluteus maximus

 muscle.

Tensor fasciae latae

Gluteus maximus

•

The tensor fasciae latae

 muscle is

partially enclosed by and inserts into

the superior and anterior aspects of

the iliotibial tract.

•

Most of the 

gluteus maximus muscle

inserts into the posterior aspect of

the iliotibial tract.

Tensor fasciae latae

Gluteus maximus

Iliotibial tract

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)

•

The tensor fasciae latae and gluteus

maximus muscles, working through

their attachments to the iliotibial

tract, 

hold the leg in extension 

once

other muscles have extended the leg

at the knee joint.

•

The iliotibial tract and its two

associated muscles also 

stabilize the

hip joint 

by preventing lateral

displacement of  the proximal end of

the femur away from the

acetabulum

.

•

The fascia lata has one prominent

aperture on the anterior aspect of

the thigh just inferior to the medial

end of  the inguinal ligament (the

saphenous opening

saphenous opening

),

which allows

the great saphenous vein to pass

from superficial fascia through the

deep fascia to connect with the

femoral vein.

Saphenous opening

Fascia lata

Deep fascia of leg

Great Saphenous vein

Dorsal venous arch

L1

L2

L3

L4

L5

S1

S2

S3

S4

L1

L2

L3

L4

1.

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3.

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L1

L1, L2

L2, L3

L2, L3, L4

L4

L5

S1

S2

S3

S4

1.

Sciatic 

n

erve

2.

Superior 

g

luteal 

n

erve

3.

Inferior 

g

luteal 

n

erve

4.

Posterior 

c

utaneous 

n

erve 

o

f 

t

high

5.

Pudendal 

n

erve

6.

Nerve 

t

o 

q

uadratus 

f

emoris

7.

Nerve 

t

o 

o

bturator 

i

nternus

8.

Nerve 

t

o 

p

iriformis

9.

Perforating 

c

utaneous 

n

erve

Major branches

Minor branches

Femoral nerve

Obturator nerve

Sciatic nerve

Superior & inferior

Gluteal nerves

Ilioinguinal nerve

Lat. cut. Nerve of thigh

Nerve to quadratus femoris and

nerve to obturator internus

Post. cut. nerve of thigh

Femoral branch of

genitofemoral nerve

Genitofemoral nerve