Which vessel does the femoral vein flow into? Neurovascular formations of the femoral triangle
Anatomy and projection of the femoral veins helps to understand the device circulatory system. Vascular network provides an approximate scheme, but is variable. Each person has a unique venous pattern. Knowledge of structure and function vascular system, will help avoid foot diseases.
Anatomical structure and topography of veins
The head center of the circulatory system is the heart. Vessels depart from it, which contract rhythmically and pump blood throughout the body. The fluid quickly flows to the lower extremities through the arteries, and returns steadily through the veins.
Sometimes these two terms are mistakenly confused. But the veins are only responsible for the outflow of blood. There are 2 times more of them than arteries, and the movement here is calmer. Due to the fact that the walls of such vessels are thinner and the location is more superficial, veins are used to collect biomaterial.
The bed of the system is a tube with elastic walls, consisting of reticulin and collagen fibers. Thanks to unique properties the fabrics retain their shape well.
There are three structural layers of the vessel:
- intima - the inner cover of the cavity located under the protective shell;
- media - central segment consisting of spiral-shaped, smooth muscles;
- adventitia - the outer covering in contact with a membrane of muscle tissue.
Between the layers there are elastic partitions: internal and external, creating the boundary of the covers.
The walls of the vessels of the femoral limbs are stronger than in other parts of the body. Strength is determined by the placement of the cores. The channels are embedded in the subcutaneous tissue, so they withstand pressure changes, as well as factors affecting the integrity of the tissue.
Functions of the venous network of the thigh
Features of the structure and location of the venous network of the lower extremities give the system the following functions:
- The outflow of blood containing cell waste and carbon dioxide molecules.
- Supply of synthesized glands, hormonal regulators, organic compounds, nutrients from the gastrointestinal tract.
- Circulation of blood circulation through the valve system, thanks to which movement resists the force of gravity.
With pathologies of the venous vessels, circulatory failures occur. Violations cause stagnation of biomaterial, swelling or deformation of pipes.
Projection of types of femoral veins
Valves occupy an important position in the anatomical projection of the venous system. The elements are responsible for right direction, as well as the distribution of blood along the channels of the vascular network.
The veins of the femoral extremities are classified by type:
- deep;
- superficial;
- perforating
Where do the deep vessels pass?
The mesh is laid deep from the skin, between the muscle and bone tissues. The deep vein system runs through the thigh, lower leg, and feet. Up to 90% of the blood flows through the veins.
The vascular network of the lower extremities includes the following veins:
- genital lower;
- iliac: external and common;
- femoral and general femoral;
- popliteal and paired branches of the lower leg;
- sural: lateral and medial;
- fibular and tibial.
The riverbed begins at reverse side feet from metatarsal vessels. The fluid then enters the anterior tibial vein. Together with the posterior one, it articulates above the middle of the lower leg, uniting into the popliteal vessel. The blood then enters the popliteal femoral canal. 5–8 perforating branches also converge here, originating from the muscles of the back of the thigh. These include lateral and medial vessels. Above the inguinal ligament, the trunk is supported by the epigastric and deep veins. All tributaries flow into the external iliac vessel, which merges with the internal iliac branch. The channel directs blood to the heart.
The common femoral vein passes through a separate wide trunk, consisting of a lateral, medial, and large saphenous vessel. There are 4–5 valves on the core section that set the correct movement. Sometimes there is a doubling of the common trunk, which closes in the area of the ischial tuberosity.
The venous system runs parallel to the arteries of the leg, foot and toes. By bending around them, the channel creates a duplicate branch.
Layout and tributaries of superficial vessels
The system is laid through the subcutaneous tissue under the epidermis. The bed of the superficial veins originates from the plexuses of blood vessels of the toes. Moving upward, the stream divides into lateral and medial branches. The canals give rise to two main veins:
- large subcutaneous;
- small subcutaneous
Great saphenous vein of thigh- the longest vascular branch. There are up to 10 pairs of valves on the mesh, and the maximum diameter reaches 5 mm. In some people, the large vein consists of several trunks.
The vascular system passes through the lower limbs. From back side The ankle channel extends to the lower leg. Then, going around the internal condyle of the bone, it rises to the oval opening of the inguinal ligament. The femoral canal originates in this area. Up to 8 tributaries also flow here. The main ones are: the external genital, superficial epigastric and iliac veins.
Small saphenous vein the channel begins on the front side of the foot from the marginal vessel. Curving around the ankle from behind, the branch stretches along the back of the lower leg to the popliteal region. From the middle of the calf, the trunk runs through the connective tissues of the limb in parallel with the medial cutaneous nerve.
Due to the additional fibers, the strength of the vessels increases, so the small vein, unlike the large one, is less likely to undergo varicose veins.
Most often, the vein crosses the popliteal fossa and flows into the deep or great saphenous vein. But in a quarter of cases, the branch penetrates deep into the connective tissue and articulates with the popliteal vessel.
Both surface trunks receive tributaries in different areas in the form of subcutaneous and skin channels. The venous pipes communicate with each other using perforating branches. When surgically treating leg diseases, the doctor needs to accurately determine the anastomosis of the small and deep vein.
Perforator mesh location
The venous system connects the superficial and deep vessels of the thigh, leg, and foot. The mesh branches pass through soft fabrics, penetrating the muscles, which is why they are called perforating or communicative. The trunks have a thin wall, and the diameter does not exceed 2 mm. But with a lack of valves, the septum tends to thicken and expand several times.
The perforating mesh is divided into two types of veins:
- straight;
- indirect.
The first type connects the tubular trunks directly, and the second - through additional vessels. The mesh of one limb consists of 40–45 threading channels. The system is dominated by indirect branches. The straight lines are concentrated in the lower part of the lower leg, along the edge of the tibia. In 90% of cases, pathologies of perforating veins are diagnosed in this area.
Half of the vessels are equipped with directional valves that send blood from one system to another. The veins of the feet do not have filters, so the outflow here depends on physiological factors.
Indicators of the diameter of venous vessels
The diameter of the tubular element of the lower extremities ranges from 3 to 11 mm depending on the type of vessel:
The diameter of the vessel depends on the muscle tissue located in the area under study. The better developed the fibers, the wider the venous tube.
The indicator is affected by the proper operation of the valves. When the system is disrupted, a jump in blood outflow pressure occurs. Long-term dysfunction leads to deformation of the venous vessels or the formation of clots. Commonly diagnosed pathologies include varicose veins, thrombophlebitis, thrombosis.
Diseases of the venous vessels
According to WHO, pathologies of the venous system are registered in every tenth adult. The number of young patients is growing every year, and disorders are found in schoolchildren. Diseases of the circulatory system of the lower extremities are most often caused by:
- overweight;
- hereditary factor;
- sedentary lifestyle;
The most common dysfunctions of the venous system of the lower extremities:
Varicose veins are valvular insufficiency, and subsequently deformation of the small or large saphenous veins. More often diagnosed in women over 25 years of age who have genetic predisposition or excess weight.
Noticeable swelling of the thigh due to occlusion superficial the femoral vein is usually not observed, which is associated with well-developed collateral circulation and the possibility of blood outflow through deep thigh vein. Patients note aching pain along the medial surface of the limb according to the projection of Gunter's canal. Pain on palpation of the vascular bundle is also determined here.
Thrombosis common femoral vein manifests itself with more pronounced clinical symptoms. The developing occlusion of the mouth of the deep vein of the thigh “turns off” most of the main venous collaterals lower limb. Complete occlusion of the common femoral vein is characterized by sudden swelling of most of the limb. Upon examination, an increase in the volume of the lower leg and thigh, cyanosis of the skin, the intensity of which increases towards the periphery, is detected. There is an expansion of the saphenous veins in the distal part of the thigh and lower leg.
If thrombosis of the femoral vein obstructs the mouth of the great saphenous vein of the thigh, then hypertension developing in the superficial venous system leads to the inclusion of anastomoses that cross with the contralateral limb. In this case, there is an increase in the pattern of the saphenous veins in the pubic and groin areas. On palpation, the vascular bundle is painful throughout the entire thigh. There is a noticeable enlargement of the inguinal lymph nodes. Hyperthermia can reach 38°C. The period of pronounced venous stasis lasts 3 days, after which a slow decrease in edema occurs. Positive dynamics due to the inclusion of collateral systems in the blood circulation.
Main veins of the pelvis J
The following variants of thrombotic lesions of the pelvic veins are encountered, each of which has a corresponding clinical picture: : segmental thrombosis of the external or common iliac vein; widespread thrombosis of the iliofemoral segment; thrombosis of the internal iliac vein system.
In clinical practice, segmental occlusions of the external and common iliac veins are rarely observed. In the vast majority of patients, thrombosis rapidly spreads in the distal direction, since venous stasis below the level of occlusion creates conditions favorable to thrombus formation. The term “iliofemoral (iliofemoral) phlebothrombosis” is common in the literature. It is a collective concept that includes thrombotic lesions of the iliac and femoral veins, often involving the popliteal vein and veins of the leg.
Depending on the degree of disturbance of the venous outflow, two stages of development of phlebothrombosis of the iliofemoral segment are distinguished: prodromal, or compensation, and pronounced clinical manifestations, or decompensation.
The prodromal stage characterizes the initial stage of the development of thrombosis in the absence of pronounced disturbances in venous hemodynamics. Its main symptoms are increased temperature and pain of various localizations.
In some cases, an increase in temperature is the only sign of phlebothrombosis. The use of antibiotics in such cases does not lead to normalization of temperature. Pain can occur in the lumbosacral region, lower abdomen and in the lower limb on the affected side. They are first localized high, in the area of the inguinal fold, and only then spread in the distal direction. Pain syndrome and hyperthermia are caused by the phenomena of phlebitis and periphlebitis, as well as hypertension in the distal vascular bed. In the prodromal stage, blood flow in the vein is preserved, the thrombus is weakly fixed to the vessel wall, and the danger of pulmonary embolism is especially high.
In case of thrombosis developing in the system internal iliac vein, Before the process transfers to the common iliac vein, pain in the rectal area, tenesmus and dysuric phenomena make one suspect this lesion. During a vaginal examination, painful cord-like infiltrates are detected in the parametrium.
The stage of pronounced clinical manifestations (decompensation) develops with the progressive spread of phlebothrombosis of the iliofemoral segment, occlusion of collateral tracts and decompensation venous outflow. This stage is characterized by a classic triad of signs: pain, swelling and discoloration of the limb. The symptoms are pronounced, the pain becomes intense and often changes its location, spreading to the groin area, thigh and calf muscles. There is a feeling of heaviness and tension throughout the limb. The severity of pain may require the use of analgesics. Some patients with pelvic vein thrombosis experience symptoms of “psoitis” (pain with maximum hip flexion, flexion contracture of the hip, “stuck heel” symptom). These phenomena are most likely associated with a pronounced periphlebitic process around the common iliac vein, which is located in close proximity to the iliopsoas muscle.
The swelling covers the entire limb from the foot to the inguinal fold. An increase in the volume of the limb occurs very quickly; patients can often name the day and hour of the onset of swelling. The development of edema is also influenced by disturbances in lymphatic drainage. In patients, a slowdown in lymph flow is detected, up to a blockade of regional lymphatic collectors involved in periphlebitis. This explains the development of swelling of the scrotum, buttocks and abdominal wall. As a rule, 3-4 days after the development of occlusion, venous stasis decreases, swelling subsides and becomes soft. The strengthening of the “pattern” of the saphenous veins on the thigh and in the groin area is most clearly expressed with widespread thrombotic occlusion and is more noticeable after the swelling of the limb has decreased.
The color of the skin of the limb varies from pale to deep cyanotic. In about a quarter of patients, the skin of the affected limb has a milky white color. Often, a similar color of the limb was noted in postpartum women, which at one time led to the appearance of the term “baby leg” due to the waxy pallor of the entire lower limb (especially the thigh), associated with concomitant arterial vasoconstriction, simulating acute arterial obstruction. This pseudoembolic form of venous pathology is called white phlegmasia(pnlegmasia alba dolens).
More often, diffuse cyanosis of the entire limb to the inguinal fold predominates, sometimes it spreads to the lower abdomen and buttock region. Less commonly observed is “spotty” cyanosis, which gives the limb a marbled color. The cyanosis of the skin is explained by the expansion of venules and capillaries, congestive venous congestion and increased oxygen utilization due to slower blood flow in the tissues. In the case of acute iliofemoral thrombosis, the so-called "blue phlegmasia"(phlegmasia coerulea aoiens) or, as it is called by the name of the author who first described “phlegmasia blue,” Gregoire’s disease.
Clinical manifestations“blue phlegmasia” (sharp pain in the limb, severe swelling and cyanosis, disappearance of pulsation of peripheral arteries), in most patients they undergo reverse development. Sometimes, on the contrary, the severity of hemodynamic disorders in the limb increases, and then develops venous gangrene. It is incorrect to identify venous gangrene with a severe form of acute iliofemoral thrombosis. Venous gangrene is based on total occlusion of both main and collateral venous outflow pathways from the affected limb. Great importance is attached to the severity of edema. This is the main difference between venous gangrene and the severe form of iliofemoral phlebothrombosis, in which some collateral blood outflow pathways are still preserved. Complete blockade of venous outflow leads to extremely severe hemodynamic disturbances, both regional (in the affected limb) and central; venous gangrene is usually wet.
The development of venous gangrene of the limb with phlebothrombosis is rare, but extremely severe and dangerous complication. Patients take a forced position in bed with maximum relaxation of the skeletal muscles, which is ensured by the limb being raised outward and moderately bent at the hip and knee joints. In these cases, the pulsation of the arteries in the foot is not detected, intoxication progresses; shock-like state. General condition patients are usually extremely severe. They complain of severe weakness, dizziness, and a feeling of tightness in the chest. Disturbances of central hemodynamics are associated mainly with the deposition of a huge amount of blood in the affected limb - up to 4-5 liters, which in turn leads to hypovolemic shock, which is the most common cause of death.
Upon examination, pallor of the skin, tachycardia, and a significant decrease in blood pressure. Some patients develop hepatic-renal failure as a consequence of intoxication caused by necrosis of limb tissue, and in the absence of emergency assistance creates an immediate threat to the patient's life.
Necrotic changes in the tissues of the affected limb are detected on the 4-8th day from the appearance of the first signs of venous thrombosis, if therapy for hypovolemic shock was successful. Most often, gangrene is observed in the distal parts of the limb, mainly the foot and distal part of the leg, in isolated cases of the thigh (Gerschey-Snyder gangrene), which dictates the need for emergency surgical intervention.
Venous gangrene occurs in 40% of cases in patients with malignant neoplasms. The highest incidence of the disease occurs between the ages of 40 and 70 years. In a significant percentage of cases, there is bilateral involvement of the lower extremities, which can be assumed to be associated with the spread of thrombosis to the inferior vena cava. In such a situation, the possibility of cross collateral outflow from the lower extremities is excluded. The severity of the patients' condition is also aggravated by local changes in the affected limb, intoxication and sepsis.
The prognosis for venous gangrene is extremely difficult. Mortality reaches, according to large clinics, 60%, with a significant proportion of patients dying before signs of obvious necrosis of limb tissue appear. Patients with suspected venous gangrene require immediate hospitalization.
Femoral vein (v. femoralis, PNA, BNA, JNA) see List of anat. terms.
Large medical dictionary. 2000 .
See what “femoral vein” is in other dictionaries:
This term has other meanings, see Vienna (meanings). Diagram of the human venous system. Vein is a blood vessel, according to ... Wikipedia
Femoral artery (arteria femoralis) and its branches- Front view. The rectus femoris and sartorius muscles are removed. femoral artery; medial circumflex femoral artery; pectineus muscle; adductor longus; femoral vein; tendon and tendon plate of the adductor magnus muscle; ... Atlas of Human Anatomy
Arteries of the lower limb. Femoral artery- Femoral artery, a. femoralis, is a continuation of the external iliac artery and begins under the inguinal ligament in the vascular lacuna. The femoral artery, emerging on the anterior surface of the thigh, goes down and medially, lying in the groove... ... Atlas of Human Anatomy
External iliac artery (arteria iliaca external), femoral artery (arteria temoralis) and their branches- Front view. common iliac artery; internal iliac artery; external iliac artery; inferior epigastric artery; femoral vein; external genital arteries; medial circumflex femoral artery; femoral artery; subcutaneous... Atlas of Human Anatomy
Spinal nerves - … Atlas of Human Anatomy
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Heart- (cor) is the main element of the cardiovascular system, ensuring blood flow in the vessels, and is a hollow, cone-shaped muscular organ located behind the sternum on tendon center diaphragm, between right and left... ... Atlas of Human Anatomy
Human circulatory system- Front view. common carotid artery; left brachiocephalic vein; aortic arch; pulmonary trunk; heart; axillary artery; brachial artery; ulnar artery; radial artery; abdominal aorta; inferior vena cava; aortic bifurcation; common iliac... Atlas of Human Anatomy
A vein is a blood vessel that carries blood to the heart. Veins receive blood from capillaries. Veins unite into venous system, part of the cardiovascular system. The vessels through which blood flows from the heart are called arteries. In several... ... Wikipedia
Region boundaries
upper the border of the anterior thigh - the line connecting the spina iliaca anterior superior and the pubic tubercle (projection of the inguinal ligament);
lower the border of the anterior thigh is a transverse line drawn 6 cm above the patella.
lateral the border of the anterior region of the femur is a line drawn from this spine to the lateral epicondyle of the femur;
medial border of the anterior thigh - a line running from the pubic symphysis to the medial epicondyle of the femur
The thigh is divided into anterior and posterior regions according to the lateral and medial boundaries.
Layers of the anterior thigh
Leather – thin, mobile, folded, rich in sebaceous and sweat glands. On the lateral surface it is thickened and less mobile. Langer's lines on the anteromedial surface go obliquely - from bottom to top and from outside to inside, on the anterolateral surface - in the form of an oval, corresponding to the position of m. tensor fasciae latae. Blood supply due to the arteries of the pharyngeal gland.
Cutaneous nerves: Under the medial part of the inguinal ligament, the femoral branch of the femoral genital nerve, r., branches out to innervate the skin. femoralis n. genitofemoralis. Below the superior anterior iliac spine in the subcutaneous tissue passes the lateral cutaneous nerve of the thigh, n. cutaneus femoris lateralis. Cutaneous branch of the obturator nerve, r. cutaneus n. obturatorii, reaches along the inner surface of the thigh to the level of the patella.
Subcutaneous tissue on the thigh is well expressed and superficial fascia, consisting of two sheets, is divided into several layers. In the subcutaneous tissue, in addition to the named cutaneous nerves, there are two groups of superficial lymph nodes (inguinal and subinguinal) and superficial branches femoral artery with accompanying veins: superficial epigastric artery (a. epigastrica superficialis), superficial circumflex ilium artery (a. circumflexa ilium superficilis), and external genital arteries aa. pudendae externae). In addition, v runs vertically on the anteromedial surface of the thigh. saphena magna
Proprietary fascia of the thigh (fascia lata) It is a rather thick fibrous plate, especially on the outer side, where the tendon fibers of the tensor fasciae lata muscle are woven into it. This thickened section of the native fascia is called the iliotibial tract and is used in surgery for plastic surgery. Surrounding the thigh on all sides, the fascia sends three intermuscular septa to the femur: medial, which also forms the fascial sheath of the femoral neurovascular bundle, lateral and posterior.
In this way, three fascial compartments of the thigh are formed. In addition, some muscles have their own fascial sheaths. Between the fascial sheaths of the muscles there are interfascial fiber gaps, and between the vastus muscles and femur– musculoskeletal gaps. They are connected to each other and to the cellular spaces of other areas. Purulent streaks spread almost freely through the following layers of fiber:
- paravasal fiber
- paraneural tissue
- paramuscular tissue
Muscles
Anterior group - flexors: quadriceps femoris and sartorius muscles
Medial group The muscles that adduct the thigh are: the pectineus muscle, the long, short and magnus adductor muscles, and the gracilis muscle.
To the back group include hip extensors: biceps femoris, semitendinosus and semimembranosus muscles
Femur
MUSCULAR AND VASCULAR LACUNA
Muscle lacuna formed by the iliac crest (outside), the inguinal ligament (in front), the body of the ilium above the glenoid cavity (back) and the iliopectineal arch (inside). The iliopectineal arch (arcus iliopectineus - PNA; formerly called lig. Iliopectineum, or fascia iliopectinea) originates from the Pupart ligament and is attached to the eminentia iliopectinea. It runs obliquely from front to back and from outside to inside and is closely intertwined with the fascial sheath of the iliopsoas muscle. The shape of the muscle lacuna is oval. The inner third of the lacuna is covered by the outer edge of the vascular lacuna.
The contents of the lacuna are the iliopsoas muscle, which runs in the fascial sheath, the femoral nerve and the lateral cutaneous nerve of the thigh. The long diameter of the lacuna is on average 8 - 9 cm, and the short diameter is 3.5 - 4.5 cm.
Vascular lacuna formed anteriorly by the Pupart ligament, posteriorly by the Cooper ligament located along the crest of the pubic bone (lig. Pubicum Cooped; now designated by the term lig. Pectineale), externally by the iliopectineal arch, internally by the gimbernate ligament. The lacuna has a triangular shape, the apex is directed posteriorly, towards the pubic bone, and the base is directed anteriorly, towards the Pupart ligament. The lacuna contains the femoral vein (medial position) and the femoral artery (lateral), ramus femoralis n. Genitofemoralis, tissue and Rosenmüller-Pirogov lymph node. The base of the vascular lacuna is 7–8 cm long and 3–3.5 cm high.
Femoral canal (canalis femoralis) located under the medial part of the Poupart ligament, medial to the femoral vein. This term refers to the path that a femoral hernia takes (in the absence of a hernia, the canal does not exist as such). The channel has the shape of a triangular prism. The internal opening of the canal is formed anteriorly by the Pupart ligament, internally by the lacunar ligament, externally by the sheath of the femoral vein, and posteriorly by the Cooper (pectineal) ligament. This opening is covered by the transverse abdominal fascia, which in this area is attached to the ligaments that limit the opening and to the sheath of the femoral vein. A lymph node is usually located at the inner edge of the vein. The outer opening of the canal is the fossa ovale. It is covered by the cribriform plate, lymph nodes, and the mouth of the great saphenous vein with the veins flowing into it.
The walls of the channel are: outside - the sheath of the femoral vein, in front - a superficial layer of the fascia lata of the thigh with the upper horn of its crescent-shaped edge, in the back - a deep layer of the fascia lata. The inner wall is formed by the fusion of both layers of the fascia lata of the thigh with the fascial sheath of the pectineus muscle. The length of the canal is very small (0.5 - 1 cm). In cases where the superior horn of the falciform edge of the fascia merges with the Pupart ligament, the anterior wall of the canal is absent. The external opening of the canal - hiatus saphenus - is a subcutaneous fissure in the superficial sheet of the fascia lata of the thigh, closed by a cribriform plate (lamina cribrosa). The edges of the hiatus saphenus are formed by compacted areas of the fascia lata: the lower horn, the upper horn and the external crescent-shaped edge of the fascia lata of the thigh. The length of hiatus saphenus is 3–4 cm, width 2–2.5 cm.
FEMORAL TRIANGLE (trigonum femorale) 
The femoral triangle, Scarpian, or Scarpa's triangle, is limited on the lateral side by the sartorius muscle, m. sartorius, with medial long adductor muscle, m. adductor longus; 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. 
Neurovascular formations of the femoral triangle
Femoral vessels, a. et v. femoralis, enter the femoral triangle from the vascular lacuna medially from the middle of the inguinal ligament. Next, they are located along the bisector of the femoral triangle to its apex. The femoral vessels are surrounded by a dense fascial sheath that passes onto their branches.
Topography of the femoral artery
femoralis is a direct continuation of the external iliac artery. Its diameter is 8-12 mm. At the level of hiatus saphenus, the artery is covered in front by a crescent-shaped edge subcutaneous fissure and lies outward from the vein of the same name. Here three superficial branches depart from the artery: a. epigastrica superficialis, a. circumflexa ilium superficialis and aa. pudendae externae superficialis et profundus.
Projection line of the femoral artery
1. The upper point is medial from the middle of the inguinal ligament, the lower point is behind the internal condyle (proposed by Dyakonov)
2. The upper point is one finger diameter medial from the middle of the line connecting the superior anterior iliac spine with the pubic tubercle, the lower point is the internal condyle of the femur (suggested by Pirogov)
3. The upper point is the border between the 2/5 internal and 3/5 external parts of the inguinal ligament, the lower point is the middle of the popliteal fossa (suggested by Bobrov)
4. The upper point is the middle between the spina iliaca anterior superior and the pubic symphysis, the lower one is the tuberculum adductorium of the medial epicondyle of the femur (Kaen line)
The pulsation of the femoral artery is determined immediately below the inguinal ligament in the fossa iliopectinea.
Topography of the femoral vein
V. femoralis lies medial to the artery, under the ethmoidal fascia, where the v. femoralis flows into it. saphena magna and the veins of the superficial arteries of the same name. Further down, the vein gradually moves to the posterior surface of the artery. At the apex of the femoral triangle, the vein disappears behind the artery.
Projection line of the great saphenous vein
The lowest point is the posterior edge of the medial femoral condyle.
The upper point is on the border of the medial and middle thirds of the inguinal ligament.
Deep femoral artery, a. profunda femoris, the main vascular collateral of the thigh, is sometimes equal in diameter to the femoral one. It usually arises from the posteroexternal, less often - from the posterior or posterointernal semicircle of the femoral artery at a distance of 1-6 cm from the inguinal ligament. The vein of the same name is always located medially to the deep artery of the thigh.
Femoral nerve at a distance of 3–4 cm downward from the level of the inguinal ligament, it is divided into a large number of muscle and skin branches. The largest cutaneous branch is n. saphenus, which accompanies the femoral artery for a greater extent. In the middle third of the femoral triangle n. Saphenus is located lateral to the femoral artery, and in the lower part of the femoral triangle passes anterior to it.
The bottom of the femoral triangle is the iliopsoas and pectineus muscles, covered with a deep layer of fascia lata. The edges of these muscles adjacent to each other form the sulcus iliopectineus, which towards the apex of the triangle passes into the sulcus femoris anterior. The femoral vessels and n.saphenus are located in this groove. This neurovascular bundle is then directed into the adductor canal.
Adductor canal (canalisadductorius) located under the fascia lata and covered in front by m. sartorius. Posteromedial wall the adductor canal is m. adductor magnus, lateral wall of the adductor canal- m. vastus medialis. The anteromedial wall of the adductor canal forms a broad adductor intermuscular septum, septum intermusculare vastoadductoria, stretched from the adductor magnus muscle to the m. vastus medialis
In the adductor canal there are three holes. Through top hole from the sulcus femoralis anterior the femoral vessels and n. pass into the canal. saphenus. Bottom hole is a gap between the bundles of the adductor magnus muscle or between its tendon and the femur; through it the femoral vessels pass into the popliteal fossa. Front hole in the septum intermusculare vastoadductoria is the place of exit from the canal (into the tissue under the m. sartorius) of the descending knee artery and vein, a. et v. descendens genus and n. saphenus. Vessels and p. saphenus can exit the canal separately; in these cases there will be multiple front holes. The length of the adductor canal (canalis adductorius) is 5-6 cm, its middle is 15-20 cm from the tuberculum adductorium femoris on the medial epicondyle of the femur. In the proximal direction, the adductor canal communicates with the space of the femoral triangle, distally - with the popliteal fossa, along a et v. descendens genus and p. saphenus - with subcutaneous tissue on the medial surface knee joint and shins. According to these connections, purulent processes may spread in this area. The fascial sheath of the femoral vessels is firmly fused with the upper edge of the septum intermusculare vastoadductoria, and below the vessels deviate from this plate by 1.0-1.5 cm, with the femoral artery lying anteriorly and medially, and the vein posteriorly and laterally. A. descendens genus (single or double) reaches the arterial network of the knee joint, sometimes forming a direct anastomosis with the anterior recurrent branch of the tibial artery, a. recurrens tibialis anterior. N. saphenus in the subcutaneous tissue of the leg joins v. saphena magna and reaches the middle of the inner edge of the foot.
Obturator canal It is a groove on the lower surface of the pubic bone, limited from below by the obturator membrane and muscles attached to its edges. External hole The obturator canal projects 1.2-1.5 cm downward from the inguinal ligament and 2.0-2.5 cm outward from the pubic tubercle. Deep (pelvic) hole The obturator canal faces the prevesical cellular space of the small pelvis. External hole The obturator canal is located at the upper edge of the external obturator muscle. It is covered by the pectineus muscle, which must be dissected when accessing the obturator canal. The length of the obturator canal is 2-3 cm; the vessels and nerve of the same name pass through it. The obturator artery anastomoses with the medial circumflex femoral artery and the inferior gluteal artery. The anterior and posterior branches of the obturator nerve innervate the adductor and gracilis muscles, as well as the skin of the medial thigh.
Posterior thigh area, regio femoris posterior
The cellular space of the posterior fascial bed of the thigh communicates proximally with the space under the gluteus maximus muscle - along the course of the sciatic nerve; distally - with the popliteal fossa along the same nerve; with the anterior bed of the thigh - along the perforating arteries and a. circumflexa femoris medialis.
Projection of the sciatic nerve determined by a line drawn from the middle of the distance between the ischial tuberosity and the greater trochanter to the middle of the popliteal fossa.
Rules for applying a tourniquet
Clamping of the femoral artery is performed below the middle of the Pupart ligament to the horizontal branch of the pubic bone
The tourniquet is used only for damage to the arteries of the extremities.
Do not apply a tourniquet to a bare wound. There should be no folds on the lining.
The injured limb is placed in an elevated position and the artery is pressed with fingers above the wound
The tourniquet is applied above the wound and as close to it as possible.
The first round should be tight, the subsequent rounds should be fixing.
The tourniquet is applied in a tiled manner without pinching the skin.
The tourniquet should not be crushing. The approximate force of application of the tourniquet is until the pulse disappears in the artery below the tourniquet.
With a properly applied tourniquet, the bleeding should stop, and the pulse in the artery below the tourniquet should not be detected, the skin becomes pale.
A note indicating the date and time of its application is attached under the last round of the tourniquet.
The part of the body where the tourniquet is applied must be accessible for inspection.
Be sure to carry out transport immobilization of the injured limb and anesthesia.
In cold weather, the limb must be insulated to avoid frostbite.
The duration of application of the tourniquet in the summer is no more than 1.5 hours, in the winter – no more than 1 hour.
If the time has expired, but the tourniquet cannot be removed:
press the damaged artery above the tourniquet with your fingers;
carefully loosen the tourniquet for 20-30 minutes to restore blood circulation in the injured limb;
reapply the tourniquet, but above or below the previous location and indicate the new time;
if necessary, repeat the procedure after half an hour or an hour.
Advantages:
A fairly quick and most effective way to stop bleeding from the arteries of the limb.
Flaws:
The use of a tourniquet leads to complete bleeding of the distal limbs due to compression of not only damaged great vessels, but also collaterals, which can lead to gangrene for more than 2 hours;
Nerve trunks are compressed, which causes post-traumatic plexitis with subsequent pain and orthopedic syndrome;
Stopping blood circulation in the limb reduces tissue resistance to infection and reduces their regenerative abilities;
The use of a tourniquet can cause severe vasospasm and lead to thrombosis of the operated artery;
Restoring blood circulation after using a tourniquet contributes to the development of tourniquet shock and acute renal failure
Typical sites for applying an Esmarch tourniquet to stop bleeding.
1 - on the lower leg; 2 - on the thigh; 3 - shoulder; 4 - shoulder (high) with fixation to the body;
5 - on the thigh (high) with fixation to the body
Primary surgical treatment of a soft tissue wound of the thigh
Modern primary surgical treatment of a wound consists of the following elements:
1) disinfection of the surgical field within a radius of up to 10 cm around the wound;
2) pain relief (general or local - depending on the wound and condition of the victim),
3) cutting the wound along its long axis to the bottom;
4) revision of the wound cavity by examining it (the wound is opened toothy hooks) 5) removal from the wound foreign bodies(shards of metal, wood, clothing, stones, earth, etc.);
6) cutting another scalpel damaged edges of the wound and the bottom within healthy tissues, 0.5-1.5 cm away from the edges (the size depends on the location of the wound, i.e. the nature of the tissue - are there any vital vessels, nerves, organs, etc. in the wound area? d.);
7) if impossible complete removal the bottom of the wound (as well as its edges) is removed only the most affected tissue within the anatomical limits;
8) carrying out after the surgeon changes gloves and instruments hemostasis in the wound by ligating the vessels with threads (mainly those that dissolve) or electrocoagulating them;
9) washing the wound with chemicals antiseptics(solutions of furatsilin, chlorhexidine, iodopirone, etc.);
10) insertion of drainage into the wound - a rubber strip or vinyl chloride or silicone tube (depending on the nature of the wound and the degree of its contamination with microflora);
11) closing the wound with sutures after careful removal of damaged tissue.
Conditions for applying the primary suture after PHO:
Satisfactory condition of the victim
Early and radical primary surgical treatment of the wound.
There are no signs of an incipient infectious complication of the wound.
Early prophylactic use of antibiotics (the term is ambiguous and debatable).
Possibility of daily observation of the victim until the sutures are removed by a qualified surgeon.
The presence of full skin and the absence of skin tension.
A common set of tools is used for PHO
A forceps is used to process the surgical field. There may be two of them. 2. Clothes clips - for holding the dressing material. 3. Scalpel – there should be both pointed and belly, several pieces, because They have to be changed during the operation, and after the dirty stage of the operation they have to be thrown away. 4. Billroth, Kocher, “mosquito” hemostatic clamps are used in large quantities. 5. Scissors – straight and curved along the edge and plane – several pieces. 6. Tweezers - surgical, anatomical, claw, they should be small and large. 7. Hooks (retractors) Farabefa and serrated blunt – several pairs. 8. Probes – button-shaped, grooved, Kocher. 9. Needle holder. 10. Different needles - set .
Deep veins of the lower limb, vv. profundae membri inferioris, identical with the arteries that they accompany.
They begin on the plantar surface of the foot on the sides of each toe with the plantar digital veins, vv. digitales plantares, accompanying the arteries of the same name.
Merging, these veins form the plantar metatarsal veins, vv. metatarsales plantares. Perforating veins extend from them, vv. perforantes, which penetrate the dorsum of the foot, where they anastomose with deep and superficial veins.
Heading proximally, vv. metatarsales plantares flow into the plantar venous arch, arcus venosus plantaris. From this arch, blood flows through the lateral plantar veins, which accompany the artery of the same name.
The lateral plantar veins connect with the medial plantar veins to form the posterior tibial veins. From the plantar venous arch, blood flows through the deep plantar veins through the first interosseous metatarsal space towards the veins of the dorsum of the foot.
The origin of the deep veins of the dorsum of the foot is the dorsal metatarsal veins of the foot, vv. metatarsales dorsales pedis, which drain into the dorsal venous arch of the foot, arcus venosus dorsalis pedis. From this arch blood flows into the anterior tibial veins, vv. tibiales anteriores.
1. Posterior tibial veins, vv. tibiales posteriores, paired. They are directed proximally, accompanying the artery of the same name, and receive on their way a number of veins that arise from the bones, muscles and fascia of the posterior surface of the leg, including the rather large peroneal veins, vv. fibulares (peroneae). In the upper third of the leg, the posterior tibial veins merge with the anterior tibial veins and form the popliteal vein, v. poplitea.
2. Anterior tibial veins, vv. tibiales anteriores, are formed as a result of the fusion of the dorsal metatarsal veins of the foot. Moving to the lower leg, the veins go up along the artery of the same name and penetrate through the interosseous membrane onto the back surface of the lower leg, taking part in the formation of the popliteal vein.
The dorsal metatarsal veins of the foot, anastomosing with the veins of the plantar surface through perforating veins, receive blood not only from these veins, but mainly from the small venous vessels of the ends of the fingers, which, merging, form vv. metatarsales dorsales pedis.
3. Popliteal vein, v. poplitea, having entered the popliteal fossa, it goes laterally and posteriorly from the popliteal artery, the tibial nerve, n. tibialis. Following the course of the artery upward, the popliteal vein crosses the popliteal fossa and enters the adductor canal, where it receives the name femoral vein, v. femoralis.
The popliteal vein receives the small veins of the knee, vv. geniculares, from the joint and muscles of this area, as well as the small saphenous vein of the leg.
4. Femoral vein, v. femoralis, sometimes a steam room, accompanies the artery of the same name in the adductor canal, and then in the femoral triangle, passes under the inguinal ligament in the vascular lacuna, where it passes into v. iliaca externa.
In the adductor canal, the femoral vein is located behind and somewhat lateral to the femoral artery, in the middle third of the thigh - behind it, and in the vascular lacuna - medial to the artery.
The femoral vein receives a number of deep veins that accompany the arteries of the same name. They collect blood from the venous plexuses of the muscles of the anterior surface of the thigh, accompany the femoral artery on the corresponding side and, anastomosing with each other, flow into the femoral vein in the upper third of the thigh.
1) Deep vein of the thigh, v. profunda femoris, most often comes with one barrel, has several valves.
The following paired veins flow into it:
a) perforating veins, vv. perforantes, go along the arteries of the same name. On the posterior surface of the adductor magnus muscle, they anastomose with each other, as well as with v. glutea inferior, v. circumflexa medialis femoris, v. poplitea;
b) medial and lateral veins circumflexing the femur, vv. circumflexae mediates et laterales femoris. The latter accompany the arteries of the same name and anastomose both with each other and with the vv. perforantes, vv. gluteae inferiores, v. obturatoria.
In addition to these veins, the femoral vein receives a number of saphenous veins. Almost all of them approach the femoral vein in the area of the saphenous fissure.
2)Superficial epigastric vein, v. epigastrica superficialis, accompanies the artery of the same name, collects blood from the lower parts of the anterior abdominal wall and flows into v. femoralis or in v. saphena magna.
Anastomoses with v. thoracoepigastrica (flows into v. axillaris), vv. epigastricae superiores et inferiores, vv. paraumbilicales, as well as with the vein of the same name on the opposite side.
3)Superficial vein circumflexing the ilium, v. circumflexa superficialis ilium, accompanying the artery of the same name, runs along the inguinal ligament and flows into the femoral vein.
4) External genital veins, vv. pudendae externae, accompany the arteries of the same name. They are actually a continuation of the anterior scrotal veins, vv. scrotales anteriores (in women - the anterior labial veins, vv. labiales anteriores), and the superficial dorsal vein of the penis, v. dorsalis superficialis penis (in women - the superficial dorsal vein of the clitoris, v. dorsalis superficialis clitoridis).
5) Great saphenous vein of the leg, v. saphena magna,- the largest of all saphenous veins. It drains into the femoral vein. Collects blood from the anteromedial surface of the lower limb.