Chapter 7

Front of the Thigh II:

Femoral Triangle,
Nerves and Vessels
Textbook of
Human Anatomy
Volume 3: Lower Limb
Author: Dr Yogesh Sontakke,
JIPMER, Pondicherry
©CBS Publishers & Distributors Pvt Ltd, New Delhi
 As per:
Competency based Undergraduate curriculum

AN15.1
• Describe and demonstrate origin, course, relations, branches (or
tributaries), and termination of important nerves and vessels of
anterior thigh
AN15.3
• Describe and demonstrate boundaries, floor, roof, and contents of
femoral triangle
• Chapter includes femoral triangle, femoral nerve, femoral artery, and
femoral vein

Medical Council of India, Competency based Undergraduate curriculum for the Indian Medical Graduate,
2018. Vol. 1; pg 1-80.
Human Anatomy/Yogesh Sontakke 2
 FEMORAL TRIANGLE

Q. Describe boundaries and contents

of femoral triangle

 Triangular subfascial space on front

of upper one-third of thigh just
below inguinal ligament
 Boundaries, Roof, and Floor

Boundaries
• Triangular
• Has apex, base, medial and lateral
boundaries, roof, and floor
• Base: Inguinal ligament
• Medial: Medial border of
adductor longus
• Lateral: Medial border of
sartorius
• Apex: Meeting point of medial
and lateral borders
 Boundaries, Roof, and Floor

Floor
Gutter-shaped and formed by four
muscles
from lateral to medial:
• Iliacus
• Psoas major
• Pectineus
• Adductor longus

Roof
Formed by
• Skin
• Superficial fascia
 Some interesting facts

Superficial fascia in roof of femoral triangle contains following

• Inguinal lymph nodes
• Femoral branch of genitofemoral nerve
• Branches of ilioinguinal nerve
• Superficial branches of femoral artery and accompanying veins
• Part of great saphenous veins

Deep fascia forming roof of femoral triangle include

• Saphenous opening – gives passage to great saphenous vein.
• Cribriform fascia – gives passage to various vessels [also called
fascia cribrosa, Hesselbach’s fascia]
 Footnote

Hesselbach contributed following structures in medicine

Hesselbach’s fascia
• Cribriform fascia of femoral triangle

Hesselbach’s triangle
• Inguinal triangle of abdominal wall lies between rectus abdominis,
inferior epigastric vessels, and inguinal ligament
• Site for direct inguinal hernia.

Hesselbach’s ligament
• Interfoveolar ligament extends from fascia transversalis of abdomen to
superior ramus of pubis
Human Anatomy/Yogesh Sontakke 9
 Contents of femoral triangle

Q. List contents of femoral triangle

• Are as follows
• Femoral artery and its branches
• Femoral vein and its tributaries
• Femoral nerve
• Deep inguinal nodes
• Lateral cutaneous nerve of thigh
• Femoral branch of genitofemoral nerve
• Femoral sheath
• Fibrofatty tissue
CONTENTS OF FEMORAL
TRIANGLE

Human Anatomy/Yogesh Sontakke 11

 Some interesting facts
Femoral artery

Extends downward and medially in femoral

triangle from midinguinal point to apex of
triangle

Gives following branches in femoral triangle

• 3 superficial branches:
• Superficial epigastric artery
• Superficial circumflex iliac artery
• Superficial external pudendal artery
Human Anatomy/Yogesh Sontakke 14
 Some interesting facts
Femoral artery
• 3 deep branches
• Profunda femoris artery
• Deep external pudendal artery
• Muscular artery
• Profunda femoris – largest branch of femoral
artery
 Some interesting facts
Femoral vein
• Lies on medial side of femoral artery at base
of triangle and posteromedial to femoral
artery of apex
Tributaries of femoral vein includes
• Great saphenous vein
• Profunda femoris vein
• Medial circumflex femoral vein
• Lateral circumflex femoral vein
• Deep external pudendal vein
 Some interesting facts
Femoral nerve
• Lies lateral to femoral artery, outside femoral
sheath
• Lies between iliacus and psoas major
muscles
 Some interesting facts

Femoral branch of genitofemoral nerve

(crural branch)
• Lies in lateral compartment of femoral
sheath along with femoral artery
• Pierces anterior layer of femoral sheath and
fascia lata to supply skin

Lateral cutaneous nerve of thigh

• Branch of lumbar plexus
• Enters femoral triangle deep to inguinal
ligament, just medial to anterior superior
iliac spine
 Some interesting facts
Lateral cutaneous nerve of thigh
 Supplies skin of anterolateral aspect of
thigh

Deep inguinal nodes

 3–5 deep nodes medial to femoral vein
under cribriform fascia
 Deep nodes lie in femoral canal – called
gland of Cloquet or nodes of Rosenmüller
• Vertical part of superficial inguinal lymph
nodes lie along upper part of great
saphenous vein
Human Anatomy/Yogesh Sontakke 20
Human Anatomy/Yogesh Sontakke 21
 Some interesting facts
Identification of contents of femoral triangle
• Dissect out skin carefully to find content of roof of femoral triangle
• Insert finger through saphenous opening to feel crescent-shaped margin
• Identify 4 structures as follows
• Femoral nerve
• Just medial to anterior superior iliac spine, deep to deep fascia
• Femoral nerve
• Lies lateral to femoral sheath and femoral artery, under cover of deep
fascia and fat
• Femoral artery
• Clear fat and femoral sheath
• Lies between femoral nerve and femoral vein, runs from midpoint of
base to apex of femoral triangle
 Some interesting facts

Identification of contents of femoral triangle

• Femoral vein
• Thin-walled, receives great saphenous vein, lies medial to femoral
artery, and passes posteromedial to artery near apex of triangle
• Clear fat and contents of femoral triangle to identify following 4
structures forming floor of triangle (from lateral to medial)
• Iliacus (fleshy; brownish)
• Psoas major (tendon; whitish band)
• Pectineus (quadrangular; brownish)
• Adductor longus (brownish; triangular; apex – directed upward and
medially)
 FEMORAL SHEATH
Q. Write short note on femoral sheath
• Fascial sleeve enclosing upper part of femoral
vessels in femoral triangle
• Shape: Funnel-shaped; broad end directed
upward

Formation
• Derived from downward prolongation of two
fascias from abdomen to thigh
• Anterior wall of sheath – extension of fascia
transversalis of anterior abdominal wall
• Posterior wall of sheath – formed by fascia
iliaca covers iliacus muscle
 FEMORAL SHEATH

Termination
• Inferiorly blends with tunica
adventitia of femoral vessels and
disappears
• Lower margin of femoral sheath is
ill-defined
Compartment and contents
• Divided into three compartments by
medial and lateral septa
(anteroposteriorly running) as
follows
 FEMORAL SHEATH

Compartment and contents

• Lateral compartment
• Contains femoral artery and
femoral branch of genitofemoral
nerve
• Intermediate compartment
• Contains femoral vein
• Medial compartment (femoral canal)
• Contains lymph node of Cloquet or
Rosenmüller
Clinical Integration
• Femoral hernia
 Femoral canal

Q. Write short note on femoral canal

• Medial compartment of femoral sheath
• Laterally, separated from intermediate
compartment of femoral sheath with
femoral vein by medial septum
Shape
• Conical-shaped
• Wide (base) superiorly and narrow
inferiorly
Dimensions
• Length: 1.5 cm
• Width: 1.5 cm superiorly at base
 Femoral canal

Base (femoral ring)

• Called femoral ring
• Boundaries of femoral ring
• Anterior: Inguinal ligament
• Posterior: Pecten pubis/Pectineus
muscle
• Medial: Lacunar ligament
• Lateral: Medial septum separating
femoral canal and intermediate
compartment of femoral sheath
 Femoral canal
Femoral septum
• Condensation of extraperitoneal connective tissue closes
femoral ring
Femoral fossa
• Depression of parietal peritoneum overlies femoral ring
Content of femoral canal
• Lymph node of Cloquet or Rosenmüller
• Loose connective tissue
Clinical Integration
• Femoral hernia: Protrusion of abdominal contents into
femoral canal
Human Anatomy/Yogesh Sontakke 37
Human Anatomy/Yogesh Sontakke 38
Human Anatomy/Yogesh Sontakke 39
 Femoral Hernia
Definition
• Herniation of abdominal contents through femoral canal
• Femoral canal – medial compartment of femoral sheath
• More common in females due to wider femoral canal and smaller
femoral vessels
• Common in adults than children and never congenital
Composition of hernia
• Consists of coverings and loop of intestine, peritoneum, and blood
vessels
• Has neck and sac
• Neck – narrow part and sac – bulging part
 Femoral Hernia
Course of femoral hernia
• First femoral hernia passes downward through femoral canal then
forward through saphenous opening and then upward along superficial
epigastric vessels
• Downward → forward → upward
• For reduction of femoral hernia, reverse course should be followed
 Femoral Hernia

Classification of femoral hernia

• Reducible femoral hernia
• When contents of hernia can be pushed back into abdominal cavity
• Irreducible femoral hernia
• When hernia cannot be pushed back due to adhesion between wall
of hernia sac and contents
• Obstructed femoral hernia
• When part of intestine in hernial sac gets obstructed due to
twisting or constriction
 Femoral Hernia

Classification of femoral hernia

• Strangulated femoral hernia –
• When there is loss of blood supply to herniated intestinal part
requires surgical correction to widen femoral ring and reduce
hernia
Footnote
• Reduction of hernia in their normal anatomical position
• Can be done manually or surgically based on type of hernia
 Some interesting facts
Abnormal obturator artery
• Usual obturator artery – branch of anterior
division of internal iliac artery
• Pubic branch of obturator artery
anastomoses with pubic branch of inferior
epigastric artery
• Occasionally obturator artery – replaced by
a large pubic branch of inferior epigastric
artery
• Called abnormal or aberrant or accessory
obturator artery
 Some interesting facts
Abnormal obturator artery
• Abnormal large pubic branch of inferior
obturator artery passes lateral to femoral
ring, adjacent to femoral vein
• If passes medial to femoral ring, may get
damaged during surgical widening of femoral
ring by cutting lacunar ligament
Meralgia parasthetica
• Compression of lateral femoral nerve deep to
inguinal ligament causes meralgia
parasthetica
• Results in tingling, numbness, and burning
pain in lateral part of thigh
 FEMORAL ARTERY
Q. Describe femoral artery under following heads: beginning, course,
termination, relations, branches, and applied aspects
• Major artery supplies lower limb
Beginning
• Continuation of external iliac artery at level of inguinal ligament at
midinguinal point
Course
• Runs downward and medially from midinguinal point to adductor
hiatus
• Upper part of femoral artery lies in femoral triangle, whereas lower
part lies in adductor canal
Human Anatomy/Yogesh Sontakke 48
 FEMORAL ARTERY
Termination
• Passes through adductor hiatus to enter in popliteal fossa
and continue as popliteal artery

Footnote
• Adductor hiatus – opening between adductor magnus muscle
and shaft of femur
• Lies about 8–10 cm above adductor tubercle
 FEMORAL ARTERY
Relations
• Relations in femoral triangle
• Anterior: Skin, superficial fascia, fascia
lata, and anterior wall of femoral sheath
• Posterior: Posterior wall of femoral
sheath, psoas major, pectineus, and
adductor longus
• Medial: Femoral vein in upper part of
femoral triangle
• Lateral: Femoral nerve
• Note: Femoral vein medial to femoral artery
at base of femoral triangle but gradually
shifts posterior to artery toward apex of
triangle
 FEMORAL ARTERY
Relations
• Relations in the adductor canal
• Anterolateral: Vastus medialis
• Posteromedial: Adductor longus and
adductor magnus
• Medial: Sartorius
• Note: Adductor canal – femoral artery
crossed anteriorly by saphenous nerve from
lateral to medial
• Femoral vein lies posterior to femoral artery
in upper part and lateral to artery in lower
part of adductor canal
 FEMORAL ARTERY
Branches
Q. List branches of femoral artery.
• In femoral triangle
3 superficial branches
• Superficial external pudendal artery
• Superficial epigastric artery
• Superficial circumflex iliac artery
 FEMORAL ARTERY
Branches
• In femoral triangle
3 deep branches
• Profunda femoris artery
• Deep external pudendal artery
• Muscular branches
• In adductor canal
• Descending genicular artery
• Muscular branches
 Some interesting
facts
• Superficial branches of femoral artery
• Muscular branches of femoral artery supplies muscles of thigh

Deep external pudendal artery

• Lies deep to superficial external pudendal artery
• Passes medially, deep to spermatic cord in male or round ligament of
uterus in female
• Supplies scrotum or labia majora
 Some interesting
facts
Descending genicular artery
• Last branch of femoral artery arises in adductor canal, just above
adductor hiatus
• Also called highest genicular artery
• Divides into two branches
• Saphenous branch – accompanies saphenous nerve up to knee
joint
• Muscular branch – supplies adjacent muscles
 Clinical integration

Palpation of femoral artery

• Can be felt at midinguinal point by
pressing it against head of femur or
superior ramus of pubis
Compression of femoral artery
• To stop bleeding from distal part of
lower limb, femoral artery can be
compressed against head of femur at
midinguinal point
 Clinical integration

Femoral artery cannulation

• Critical cases, arterial cannulation
performed to measure arterial blood
pressure accurately as well as for
collecting arterial blood sample for
frequent arterial blood gas analysis

• This procedure, femoral arterial

catheter inserted in femoral artery
through small skin incision, under
ultrasound guidance
 Clinical integration

Femoral artery for angiography and

angioplasty
• One of preferred routes for
angiography and angioplasty
• Canula – inserted in femoral artery
through small skin incision
• This canula – used to reach ascending
aorta as follows
• Femoral artery → external iliac
artery → common iliac artery →
abdominal aorta → descending
aorta → ascending aorta
• Contrast dye – injected in coronary
artery to visualize coronary arteries
Human Anatomy/Yogesh Sontakke 61
 Clinical integration

Femoral artery in peripheral arterial

disease
• Commonly affected in peripheral
arterial disease that involves
narrowing of arteries other than that
of heart and brain
• May result in loss of femoral artery
pulsation, reduced blood supply to
lower limb, and even there may be
necrosis of toes
• Occurs commonly in smokers,
diabetic, and obese patients
 Clinical integration

Footnote
• Angiography – imaging technique
uses x-rays to view blood vessels
• Angioplasty – procedure to widen
narrowed blood vessels to restore
blood flow using mesh-like stent
Human Anatomy/Yogesh Sontakke 64
PROFUNDA FEMORIS ARTERY

Q. Write short note on profunda femoris

artery
• Also called deep femoral artery or deep
artery of thigh (profundus = deep) as lies
deep to femoral artery
• Largest branch of femoral artery
Beginning
• Arises from femoral artery, about 4 cm
below inguinal ligament
PROFUNDA FEMORIS ARTERY
Course
• Passes downward and posteriorly to femoral
vessels and leaves femoral triangle by
passing between pectineus and adductor
longus
• Then passes downward between adductor
longus and adductor brevis and later
between adductor longus and adductor
magnus
• Terminal part pierces adductor magnus as
fourth perforating artery to reach back of
leg
PROFUNDA FEMORIS ARTERY

Termination
• Continues as fourth perforating artery
Branches
Gives following branches:
• Medial circumflex femoral artery
• Lateral circumflex femoral artery
• Muscular branches
• Four perforating arteries
• Note: Fourth perforating artery –
continuation of profunda femoris artery
 Some interesting facts

• Profunda femoris artery arises from lateral side of femoral artery at

about 4 cm below inguinal ligament
• Largest branch of femoral artery and gives immediately lateral and
medial circumflex femoral artery arteries
 Some interesting facts
Lateral circumflex femoral artery
• Arises from lateral side of profunda femoris artery
• Passes horizontally between two divisions of femoral nerve
• Lateral circumflex femoral artery covered by sartorius and rectus
femoris
• Branches
• Ascending branch – passes upward, beneath tensor fascia latae to
anastomose with superior gluteal and deep circumflex iliac arteries
• Descending branch – runs downward between rectus femoris and
vastus lateralis and reaches up to knee
• Transverse branch – passes laterally, winds around femur, and
anastomoses with medial circumflex femoral, inferior gluteal, and
first perforator arteries to form cruciate anastomosis just below
greater trochanter
 Some interesting facts
Medial circumflex femoral artery
• Arises from medial side of profunda femoris artery
• Passes between pectineus and psoas major muscle and winds around
femur
• Branches
• Ascending branch
• Descending branch
• Transverse branch
• They participate in formation of anastomosis along femur and supplies
head of femur and adductor muscles
 FEMORAL VEIN
Q. List tributaries of femoral vein
Beginning
• Upward continuation of popliteal vein
at lower end of adductor canal
(through adductor hiatus)
Termination
• Continues upward as external iliac vein
behind inguinal ligament
 FEMORAL VEIN
Tributaries
• Great saphenous vein
• Medial and lateral circumflex femoral
veins
• Deep external pudendal vein
• Profunda femoris vein
• Veins accompanying the muscular
branches femoral artery
• Formative tributary – popliteal vein
 Some interesting facts

Common, superficial, and deep femoral arteries

• Some surgeons refer upper part of femoral artery up to beginning of
profunda femoris artery as common femoral artery divides into
• Superficial femoral artery, that, remaining part of femoral artery
• Deep femoral artery, that, profunda femoris artery.
• Similarly, parts of femoral vein – also termed as common, superficial,
and deep femoral veins
 Clinical integration
• Intravenous infusion
• Femoral vein – commonly used for intravenous infusions in infants,
children, and in patients with peripheral circulatory failure
 Clinical integration
Right heart catheterization
• Femoral vein – also used for right heart
catheterization
• Catheter inserted from femoral vein follows
following route
• Femoral vein → External iliac vein →
Common iliac vein → Inferior vena cava →
Right atrium → Right ventricle →
Pulmonary trunk
 Clinical integration
Deep venous thrombosis and
pulmonary embolism
• Formation of blood clot in deep veins
• Such clots from femoral vein gets
separated, may enter circulation, and
reach in vessels of lungs, where it can
result in pulmonary embolism
(blockage of pulmonary vessels)
 FEMORAL NERVE

Q. Write short note on femoral nerve

• Chief nerve of anterior compartment of thigh
Beginning
• Largest branch of lumbar plexus
• Arises from dorsal divisions of ventral primary
rami of L2, L3, and L4 spinal nerve
• Root value: L2, L3, L4
• Length: 2.5 cm in thigh
 FEMORAL NERVE
Course and relations

• In abdomen
• Begins on posterior abdominal wall
• Emerges out along lateral border of psoas
major muscle and runs further downward on
iliacus under cover of fascia iliaca

• In thigh
• Enters femoral triangle by passing behind
inguinal ligament, just lateral to femoral artery
 FEMORAL NERVE
Course and relations
• In thigh
• Lies outside femoral sheath because femoral
nerve lies posterior to fascia iliaca which
forms posterior wall of femoral sheath
• At about 2.5 cm below inguinal ligament,
femoral nerve divides into anterior and
posterior divisions
• Note: Lateral circumflex femoral artery passes in
between anterior and posterior divisions of
femoral nerve
 FEMORAL NERVE

Branches and distribution

• In abdomen
Muscular branches to:
• Iliacus
• Pectineus

• In thigh
• Anterior division
• Muscular branch for sartorius
• Cutaneous branches
• Medial cutaneous nerve of thigh
• Intermediate cutaneous nerve of thigh
• Posterior division
 FEMORAL NERVE
Branches and distribution

• In thigh
Posterior division
• Muscular branches for
• Rectus femoris
• Vastus medialis
• Vastus lateralis
• Vastus intermedius
• Articularis genu through branch to
vastus intermedius
• Cutaneous branch
• Saphenous nerve
 FEMORAL NERVE
Branches and distribution
• In thigh
• Posterior division
• Articular branches
• Nerve to rectus femoris supplies hip
joint
• Nerve to all vasti muscles supply
knee joint
• Note: Lateral cutaneous nerve of thigh –
separate branch of lumbar plexus
 Clinical integration
Femoral nerve injury
• May result due to wounds in groin
• Results in paralysis of quadriceps femoris and sensory loss over
anterior and medial side of thigh, and medial side of leg
Femoral nerve block
• Local anaesthetic agent – injected around femoral nerve to achieve
anaesthesia agent blocks nerve condition by inactivation of Na+
channels
• Available as gels for local applications or injection for nerve blocks
 Clinical integration of adductor canal

• Historic aspect: John Hunter first performed ligation of femoral artery

in adductor canal for treatment of popliteal artery aneurysm (abnormal
dilation)
• Adductor canal block: Local anaesthetic – injected in adductor canal to
block the saphenous nerve
 Clinical integration of adductor canal
• Adductor canal compression syndrome
• Hypertrophy of adjacent muscles may cause compression of
neurovascular bundle in the adductor canal
• May result in claudication symptoms due to femoral artery
compression or neurological symptoms due to saphenous nerve
compression
Footnote

Human Anatomy/Yogesh Sontakke 87

Thank
you…