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Femoral canal located between the superficial and deep layers 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 emerging from the abdominal cavity enters the canal through deep hole - thigh ring , anulus femoralis. It is located in the very medial part of the vascular lacuna and has four edges.
Front thigh ring limited by the inguinal ligament, posteriorly by the pectineal ligament, lig. pectineale, or Cooper's ligament, located on the crest of the pubic bone (pecten ossis pubis), medial lacunar ligament, lig. lacunare, located in the angle between the inguinal ligament and the crest of the pubic bone. On the lateral side it is limited by the femoral vein.
Thigh ring facing the pelvic cavity and on the inner surface of the abdominal wall is covered by the transverse fascia, which here has the appearance of a thin plate, septum femorale. Within the ring is the deep inguinal lymph node Pirogov-Rosenmüller.
Superficial ring of the femoral canal (hole) is subcutaneous fissure, hiatus saphenus, a defect in the superficial layer of the fascia lata. The hole is closed by the cribriform 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. inguinal;
7 - margo falciformis et cornu superior, 8 - a, v. femoralis;
9 - os pubis; 10 - saccus herniae (hernial sac);
11 - v. saphena magna.
Walls of the femoral canal
Walls of the femoral canal They are a three-sided pyramid.
Anterior wall of the femoral canal formed by the superficial layer of the fascia lata between the inguinal ligament and the upper horn of the subcutaneous fissure - cornu superius.
Lateral wall of the femoral canal- medial semicircle of the femoral vein.
Posterior wall of the femoral canal- a deep layer of fascia lata, which is also called fascia iliopectinea.
Medial wall of the femoral canal no, since the superficial and deep layers of fascia at the long adductor muscle grow together.
Femoral canal length(the distance from the inguinal ligament to the superior horn of hiatus saphenus) ranges from 1 to 3 cm.
The femoral canal (canalis femoralis) is 1-3 cm long and has three walls. The lateral wall of the canal is formed by the femoral vein, the anterior wall by the crescent-shaped edge and the superior horn of the fascia lata (thigh). The posteromedial wall of the canal is formed by a deep layer of fascia lata, covering the pectineus muscle in this place. The subcutaneous ring (anulus saphenus) of the femoral canal is limited on the lateral side by a crescent-shaped edge and closed by a thin ethmoid fascia (fascia cribrosa). The deep femoral ring, which normally contains a small amount of loose tissue and the Pirogov-Rosenmüller lymph node, has four walls. The anterior 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 pectineal ligament (lig.peclinale), which is a periosteum reinforced by fibrous fibers in the crest of the pubic bone. 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 ramus of the pubis. 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 anterior surface of the thigh. It is primarily the femoral triangle, bounded by the adductor longus muscle (medially), the sartorius muscle (laterally), and the inguinal ligament (superior). Through this triangle under the skin and under the superficial layer of the fascia lata passes iliopectineal groove(sulcus iliopectineus), limited on the lateral side by the iliopsoas muscle, and on the medial side by the pectineus muscle. The femoral artery and femoral vein are adjacent to this groove. The groove continues downward into the femoral-popliteal, or adductor (gunter) canal (canalis adductorius), through which the femoral artery, vein and saphenous nerve pass. The walls of the adductor canal are the vastus medialis (laterally) and the adductor magnus (medially). The anterior wall of the adductor canal is a fibrous plate stretched between these muscles (lamina vastoadductoria, BNA). This plate has an opening - the tendon gap (hiatus tendineus), through which the saphenous nerve and the descending genicular artery emerge from the canal onto its anteromedial wall. The femoral artery and vein pass through the lower opening of the canal, formed by the tendon of the adductor magnus muscle and the posterior surface of the femur and opening into the popliteal fossa from above. The muscles on the thigh are covered by fascia lata.
Normally, this is a slit-like space called thigh ring, filled with loose connective tissue medial to the vascular lacuna.
· Closed at the top by a lymph node.
· On the side of the abdomen it is closed by the peritoneum, which in this place forms a fossa - fossa femoralis.
- Thigh ring(annulus femoralis) formed:
laterally- femoral vein (v. femoralis),
top and front- lig. inguinale and the upper horn (cornu superius) of the crescent-shaped edge of fascia lata,
medially– continuation of the lateral leg of lig. inguinale, folded down - lacunar ligament(lig. lacunare),
below and behind– continuation of the lacunar ligament along the os pubis - pectineal ligament (lig. pectineale).
- When a femoral hernia forms, a canal is formed that will have three walls and two openings - internal and external.
· Walls of the femoral canal:
lateral- femoral vein (v. femoralis);
back- deep leaf fascia lata;
front– lig. inguinale and cornu superius of the crescent-shaped edge of the fascia lata.
- Femoral canal openings:
- internal hole(input) - this is the femoral ring described above, corresponds to the location of the lateral inguinal fossa on the peritoneum of the anterior abdominal wall.
- outer hole(output) - corresponds to the subcutaneous fissure (area of the oval fossa), limited to:
laterally – crescent-shaped edge (margo falciformis),
above – upper horn of the falciform edge (cornu superius margo falciformis)
from below – lower horn of the falciform edge (cornu inferius margo falciformis)
The anatomical and physiological prerequisites for the occurrence of femoral hernias are stretching of the ligamentous apparatus of the femoral canal region, which is primarily facilitated by an increase in intra-abdominal pressure caused by repeated pregnancies, cough, constipation, obesity and heavy physical labor. Of particular importance is the weakening of the lacunar ligament, which in older women often looks flabby, drooping and easily succumbs to the pressure of a hernial protrusion.
In the occurrence of rare forms of femoral hernias, the main role is played by congenital predisposition in the form of defects in the ligamentous aponeurotic apparatus and protrusions of the peritoneum. Trauma, in particular hip dislocation or reduction of congenital hip dislocation, is of some importance.
In the process of formation, a femoral hernia goes through three stages:
1) initial, when the hernial protrusion does not extend beyond the internal femoral ring. This stage of the hernia is clinically difficult to distinguish, and at the same time, insidious parietal (Richter’s) infringements may be noted at this stage,
2) incomplete (canal), when the hernial protrusion does not extend beyond the surfaces of the fascia, does not penetrate the subcutaneous fatty tissue of Scarpa's triangle, but is located near the vascular bundle. With this form of hernia, searching for the hernial sac during surgery usually causes difficulties;
3) complete, when the hernia passes the entire femoral canal, its internal and external openings and exits into the subcutaneous tissue of the thigh. This stage of hernia is most often observed.
The contents of femoral hernias are usually loops of small intestine or omentum. Less commonly, the large intestine is found in the hernial sac, the sigmoid intestine on the left, and the cecum on the right. Sometimes the bladder comes out into the hernia. Occasionally, the contents of a femoral hernia may be an ovary with an epididymis, and in men, a testicle.
According to the passage of vessels and nerves, the following grooves and canals are distinguished on the lower limb:
The femoral canal (Latin name canalis femoralis) is located in the inguinal region, has a triangular slit-like shape, and normally contains adipose tissue, arteries, veins, and nodes of the lymphatic system. The walls of the femoral canal are formed by the anatomical structural elements of the fascia lata of the thigh, as well as the inner wall of the femoral vein.
A cavity in the thickness of the femoral canal is formed when sections of the large or small intestine or parts of the fold of the visceral peritoneum exit through its superficial fissure, resulting in a hernia appearing on the anterior surface of the thigh. Women and children under one year of age are more susceptible to the disease due to the peculiarities of the anatomical structure of the tissues of Scarp's triangle.
Anatomical structure of canalis femoralis
The femoral canal measures from 1 to 3.5 cm and connects the abdominal cavity with the anterior thigh. The topographic anatomy of the femoral canal includes several layers and walls, which are formed by the tendon structural elements of the human body:
- inside - a deep dense plate of the lata fascia of the leg (fascia pectinea), which serves as a sheath for the thigh muscles;
- externally – by the subcutaneous tendon plate of the fascia lata, namely by the upper seal of its crescent-shaped border;
- laterally – from the side, further from the median plane – by the inner surface of the femoral vein;
- on the medial side, closer to the median plane, the canal is limited by the fused plates of the tendinous fascia.
The fascia covering the large muscles of the upper part of the lower limb, at the level of the femoral triangle, splits into 2 plates. The plate located in the deep layers serves as a sheath for the pectineus and distal sections of the lumboiliac muscle.
The subcutaneous plate, which includes an oval fossa called the saphenous fissure, lies under the Pupart's ligament. It has a heterogeneous anatomical structure. Where the fossa ovale is located, the plate has a lattice structure with numerous passages for blood vessels and nerves. The fissure is the subcutaneous opening of the femoral canal. The deep opening (femoral canal, anulus femoralis) is located near the medial area of the vascular lacuna.
Description of the external outlet of the femoral canal
The subcutaneous fissure of the femoral canal (hiatus saphenus, superficial depression) is located closer to the middle of the relative sartorius muscle bundle, below the level of the inguinal ligament under the ethmoidal fascia, in the outer layer of the lata fascia. The outline of the boundaries of the subcutaneous fissure is as follows:
- outside - the upper horn of the crescent-shaped edge;
- laterally - the crescent-shaped edge of the fascia;
- deeper - the lower corner of the crescent edge.
Hiatus saphenus is the gateway to the lymphatic and blood vessels. The location of the lower horn of the fascia lata can be determined by the large saphenous vein of the lower extremity (v. saphena magna) surrounding it. This vein originates from the apex of the triangle of the thigh, reaches the subcutaneous fissure, bends around it along the lower horn of the fascia (cornu inferius), then, passing under the fascia in the thickness of the fatty tissue, flows into the vein of the thigh.
In the presence of contributing factors, periperitoneal benign connective tissue wen penetrates deep into the gap, which is a prerequisite for the development of hernias. Normally, the subcutaneous gap is 3–4 cm long and 2–2.5 cm wide; when a hernia forms, it is the external opening of the femoral canal.
During the surgical intervention When removing a hernia, there is a risk of bleeding. This is due to the possibility of damage to the large obturator artery, which encircles the median border of the ring of the femoral canal. A similar possibility is present when it has an uncharacteristic anomalous origin from the inferior epigastric artery.
Features of the structure of the inner ring
The deep femoral ring (anulus femoralis) serves as the internal opening of the canal. It is located in the area of the middle angle of the lacuna vasorum (vascular lacuna). The anterior surface of the ring is covered with a tendinous pedunculated arch (ligamentum inguinale), but more often it is referred to as the “pupart ligament”. From the side, a deep ring borders the dense sheath of the vein of the femoral leg.
The area between the pelvic bones and the Pupart ligament is delimited by the fascia of the iliacus and pectineus muscles into 2 spaces: the vascular and muscular lacunae. The muscle lacuna borders on the inside with the surface of the ilium; on top it is covered with the Pupart ligament; closer to the middle, its border is a compacted area of fascia (iliopectineal arch).
Large arteries and veins of the lower limb pass through the vascular lacuna and occupy the area under the Pupart ligament. It is separated from the muscle lacuna by the arcus iliopectineus (iliopectineal arch).
The space of the femoral ring is filled with connective loose fibrous tissue, as well as a node of the lymphatic system, named after Pirogov-Rosenmüller. The internal femoral ring from the lacunar ligament to the femoral vein has different sizes depending on the gender and age of the person. In men, its width varies from 0.9 to 1.2 cm, in females it is approximately 1.9 cm. This difference in the structure of the deep ring explains the increased frequency of development of hernias of the femoral leg in women.
Hernias in the thickness of the structural elements of the muscle lacuna are formed less frequently, since they firmly hold the contents of the abdominal cavity. More often, pathological protrusions appear in the area of the vascular lacuna, in its weakest part - the inner ring of the femoral canal.
Detailing the structure of the canal walls
The outline of the canalis cruralis is formed by 3 edges. The subcutaneous area of the canal is covered by an outer layer of fascia, which represents an elastic plate. The leaf originates from the lata tendinous fascia and is attached to the long bone of the thigh. The superficial layer also contains an oval fossa (subcutaneous fissure), which is covered by the ethmoidal fascia. A large number of vessels and nerve fibers pass through its numerous openings. Fascia cribrosa (latticed) is outlined along the perimeter by a thickened crescent-shaped edge with lower and upper horns.
In the inner layers of the anterior region of the femur, the wall of the canal is the iliopectineal fascia - part of the deep plate fascia lata (fascia lata), in which the muscles of the same name are located.
The lateral section of the canalis cruralis is covered by a dense sheath of the femoral vessels, which passes into the vein passing under the ethmoidal portion of the fascia. The superficial portion of the great vein of the lower extremities, as well as the vessels of the subcutaneous arterial vessels, also lie here.
The contents of the canal are normal and pathological
In normal condition, the canal space from the deep ring to the subcutaneous fissure is filled with loose fibrous adipose tissue. When hernias form in the inguinal region, the contents of the femoral canal include the anatomical structures of the peritoneum located in the hernial sac, most often intestinal loops, and the visceral fold. Sometimes, hernial protrusions located on the right limb may contain the first section of the colon, and on the left leg - the final part of the colon.
The main sign of a femoral hernia is a hemispherical protrusion near the inner thigh in the groin region of the Scarpian triangle. It is necessary to distinguish canal hernias from inguinal hernias, varicose nodes of blood vessels, wen, and suppuration. The most effective diagnostic technique is ultrasound, which is used to determine the location and contents of the pathological formation.
The causes of protrusion of hernias on the anterior surface of the thigh are 2 main factors - weakening of the abdominal wall and increased intra-abdominal pressure. The disease can be indirectly triggered by rapid weight loss, abdominal trauma, scars after surgery, and hip dislocations.
Direct factors that directly affect the development of hernias include excessive physical activity, slow or insufficient bowel movements, intense coughing, and difficulty urinating. Hip hernias often occur in women who have had several pregnancies or after a long labor, in children of the first year of life with an insufficiently strong abdominal wall, as well as in persons with a hereditary predisposition.
MUSCULAR AND VASCULAR LACUNA
Behind the inguinal ligament there are muscular and vascular lacunae, which are separated by the iliopectineal arch. The arc extends from the inguinal ligament to the iliopubic eminence.
Muscle lacuna located lateral to this arch, limited anteriorly and superiorly by the inguinal ligament, posteriorly by the ilium, and on the medial side by the iliopectineal arch. Through the muscle lacuna, the iliopsoas muscle exits from the pelvic cavity into the anterior region of the thigh along with the femoral nerve.
Vascular lacuna located medial to the iliopectineal arch; it is limited in front and above by the inguinal ligament, behind and below by the pectineal ligament, on the lateral side by the iliopectineal arch, and on the medial side by the lacunar ligament. The femoral artery and vein and lymphatic vessels pass through the vascular lacuna.
On the anterior surface of the thigh there is femoral triangle (Scarpa's triangle), bounded above by the inguinal ligament, on the lateral side by the sartorius muscle, and medially by the adductor longus muscle. Within the femoral triangle, under the superficial layer of the fascia lata of the thigh, a well-defined iliopectineal groove (fossa) is visible, bounded on the medial side by the pectineus muscle, and on the lateral side by the iliopsoas muscles, covered by the iliopectineal fascia (deep plate of the fascia lata of the thigh) . In the distal direction, this groove continues into the so-called femoral groove, on the medial side it is limited by the long and large adductor muscles, and on the lateral side by the vastus medialis muscle. 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 area of the femoral triangle during the development of a femoral hernia. This is a short section medial to the femoral vein, extending from the femoral internal ring to the saphenous fissure, which, in the presence of a hernia, becomes the external opening of the canal. The internal femoral ring is located in the medial part of the vascular lacuna. Its walls are anteriorly - the inguinal ligament, posteriorly - the pectineal ligament, medially - the lacunar ligament, and 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. The femoral canal has 3 walls: the anterior wall is the inguinal ligament and the upper horn of the falcate edge of the fascia lata fused with it, the lateral wall is the femoral vein, the back wall is the deep plate of the fascia lata covering the pectineus 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 descent of the gonad.
5. Structure of the inguinal canal.
6. The process of formation of direct and oblique inguinal hernias.
7. Structure of lacunae: vascular and muscular; scheme.
8. Structure of the femoral canal.
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