 Good day everybody. Welcome to our next section. My name is Dr. Sanjay Sanyal, professor and course director of medical sciences. And the camera persons are the usual people, Zelliga Stewart, Jenny Glover and many others. Okay. So today I'm going to demonstrate the muscles of the artery compartment of the thigh and its special reference to the femoral triangle. So let's give a quick overview. This structure that you see, which I'm lifting up here, this is the inguinal ligament and it extends from the anticepialic spine to the pubic tubercle so this is the inguinal ligament. So therefore the space under that is the sub-inguinal space, which I've been talking about in the class. And the sub-inguinal space is divided into a lateral portion and a medial portion. The lateral portion is the muscular compartment and the medial portion is the vascular compartment. Okay. Having said that, let's come jump down and look at the boundaries of the femoral triangle and after that I'm going to tell you the muscles. So let's pick up where we had left off. The femoral triangle, the superior boundary or the base of the triangle is the inguinal ligament, which you can see here. And superiorly the femoral triangle is communicating with the structures in the abdomen. The lateral boundary of the femoral triangle is the sarcto-reus muscle and you can see this long muscle here. This is the tailor's muscle, the sarcto-reus which takes origin from the anticyclic spine again, goes anterior medially and goes all the way and gets inserted onto the base and serena of the goose foot, which is here. Okay. That's the medial boundary. Let's take the lateral boundary. Lateral boundary is this muscle here and this is the rectal longus. So therefore this is the femoral triangle. Let's continue with the femoral triangle. What do we see in the floor of the femoral triangle? We see this muscle here. This is, you have guessed it, if this is the rectal longus, this has to be the rectal bravest. And the other part of the floor of the femoral triangle is the pectinus muscle, which is located here. This is the pectinus muscle. So this is the floor of the rectal. In life this was covered by a tough fascia, which is called the fascialata, which I have dissected off. And there was an opening here, which is called, which was called the serenus opening. That also I have removed. And that serenus opening was covered by the cribriform fascia. Those were removed just to show you the contents of the triangle. So let's take a quick look at the contents of the femoral triangle. And we can see the contents of the femoral triangle here. This is the femoral nerve. And the femoral nerve, as I told you in the class, it runs through the vascular compartment, the muscular compartment and therefore it is separate from the rest and therefore it is a little away from the rest. And let me first tell you the contents. The next structure that you see here, this is the femoral artery. This is the continuation of the external iliac artery. Exactly just under the inguinal ligament, it changes its name and known as the femoral artery. I'll tell you the course a little later. And medial to that is the femoral vein. And femoral vein and medial to that this small space that you see here is the region of the femoral canal, which is the site of femoral hernia, especially in female patients. Having mentioned that, let's come back to each of these structures. This as I told you is the femoral nerve. And if you look at the femoral nerve and I lift it up and you can see that the femoral nerve gives up numerous branches in the femoral triangle itself and it completely distributes itself to all the muscles in the anterior compartment. So therefore the femoral nerve itself does not go anywhere after that. Notably, I would like you to notice one branch which the femoral nerve gives, which runs with the femoral artery. Can you see this branch here? This is the saphenous nerve, which I mentioned and this is the longest cutaneous branch in the body and this runs with the femoral artery. It runs in the adductor canal and after that it pierces the adductor canal and becomes cutaneous and it supplies the skin of the medial side of the leg right up to the medial side of the foot. So this is this saphenous nerve. This is the longest cutaneous branch and this is the only branch which goes outside the femoral triangle. So that's about the femoral nerve. The femoral artery. Let's look at the most important branch of the femoral artery and that you can see here. Can you see this big branch here? This is the profunda femoris artery and the profunda femoris artery is given out somewhere near the middle or the lower part of the femoral triangle and it goes medially, it goes posteriorly and then it pierces the attachment of the adductor magnus to the thigh and it forms the, disappears as the first, second, third and fourth perforators. And this profunda femoris is the one which I told you gives rise to the middle and the lateral circumference femoral which supplies the hip joint. And finally coming to the femoral vein. The femoral vein is the medial most structure here, this thin wall. Again in life this whole thing was covered by a tough femoral sheath which I have removed and I told you the function of the femoral sheath itself. What I would like you to notice the most notable thing about the femoral vein is this nerve can you see one long nerve coming all the way. Actually if you were to trace this, this nerve also we were to trace it right on the medial side of the leg and you can see it here under the skin also. Everybody has it. This is that long syphilis nerve I was talking about and the long syphilis nerve comes all the way on the medial side of the thigh and it comes and it pierces enters through the syphilis opening, pierces the triple form fascia and it opens into the femoral vein. So this is the long syphilis vein. Of course it has got many other tributaries but those are not so important and just to complete the story you can see one inguinal lymph node, deep inguinal lymph node so I preserved it just for the sake of showing it to you. So these are the contents and the important contents of the femoral triangle, the boundaries in this. And the last part of this is to show you the muscles which we have already mentioned in the anterior compartment. So this is the sartorius muscle the tailors muscle as you can see here. Let's remove the sartorius muscle from there out of the way and I've already told you these are the muscles of the rector compartment. Let's take a look at the muscles of the anterior compartment. Can you see this muscle here which I've lifted up? This is the quadriceps, the superficial most muscle of the quadriceps and that is the rectus femoris. Just under the rectus femoris, this muscle that we see here which is mostly tendinous in its anterior part here and a little fascia bar this is the vastus intermedius and if I lift up this fascia this by the way is the iliotibial tract. I'm going to just tell a quick word of that after this because it is not strictly part of it. If I lift this up can you see these fibers coming here? These are the vastus lateralis fibers and likewise if I were to lift up the sartorius and lift up the rectus femoris I can see these medial fibers coming here these are the vastus medialis. So rectus femoris vastus intermedius, vastus medialis, vastus lateralis. I would like you to notice that all of these fibers they're meeting here in above the patella this is the strong tough quadriceps tendon. The vastus medialis gives us to an expansion. Can you see some fibers here? As many as the vastus lateralis and the vastus medialis also gives us to some aponeurotic expansion. These are respectively referred to as the medial and the lateral particular retina column which are attached to the respective TBL condyles and they strengthen the anterior capsule of the knee joint. This is the quadriceps tendon and the quadriceps tendon gets inserted onto the base of the patella. Base of the patella is here. Then there's a thin aponeurotic expansion on the surface of the patella and then the apex of the patella is down here and from the apex of the patella we have this strong ligament continuing down and this is the patella ligament which gets inserted onto this elevation that you see here. This is the TBL tuberosity and this is where we do a knee hammer tap to elicit the knee jerk reflex. So these are the essential components of the anterior compartment. Yes, before we conclude as I promised this structure that you see here, this is the iliotibial tract. It is the thickest part of the facial and you can see that it's a tough aponeurotic band which gets inserted onto a special tubercle on the antrolateral aspect of the tibia and you can feel it here. That is called the antrolateral tubercle of Gerdi. I have not mentioned it till now in class but now you've got the luxury of hearing it for the first time. If I lift it up and if you look under this through the light, you can see a muscle which is embedded within the iliotibial tract. Guess what this is? This is the tensor-facial eta. When we were doing the gluteal region that time we could not see it because this is anterior but from here we can see the tensor-facial eta and we can see the bulge of the gluteus maximus behind here but that is not part of this dissection. So just to show you that, I have shown you and just to complete the story from the tensor-facial, from the iliotibial tract, the lateral intermuscular septum will go inside and it will cover the posterior part of the vastus lateralis and it will separate this from the posterior compartment. So these are the structures which I wanted to show you in the anterior compartment with the femoral triangle. Yes, and before I conclude, I told you that the apex of the femoral triangle is here and after that comes the adductor canal. So where is the location of the adductor canal? It is located under the sartorius and superficial to the adductor longus. So between these two is the adductor canal and you can very well see that the femoral artery and the femoral nerve, both of them are running in the adductor canal. So this is the middle portion. This portion is the adductor canal from here to here. This is the adductor canal and after that the femoral artery as I told you will continue. It will go behind the femur. It will pierce through the adductor hiatus and there it will go behind the knee. It will be known as the popliteal artery. Thank you very much ladies and gentlemen for watching. Thank you camera persons. If you have any questions or comments, put them in the comment section below. Dr. Sanjay Sanjay is signing out. Have a nice day.