 Good day everybody. Dr. Sanjay Sanyal, Professor Department Chair. This is going to be a continuation of the previous dissection, where we are going to show the perforating arteries of the branches of the profundum femoris. And we will show the continuation of the femoral artery as the perforated artery in all its branches. This is the prone cannabar. So this is the right side of the cannabar. We are standing on the right side of the cannabar and the camera person goes on the right side. So this is the hamstring muscle. So this is the biceps femoris. This is the semi-tendinosis. This is the semi-membranosus, and this is the sciatic nerve. So when we retract these, we can see this artery here. This is the first perforating artery. The perforating arteries are four arteries which come up from the profundum femoris. When the profundum femoris goes deep on the artery aspect of the thigh, between the insertion of the rectum magnus and the origin of the vestus medialis, it gives perforating arteries which are called perforating because they perforate through the rectum magnus and they come to the posterior aspect of the thigh. So this is the first perforating artery and it gives a branch. We can see it here. This branch, anastomosis with a branch from the inferior gluteal artery which is seen here and it also anastomosis with a medial circumflex femoral and a lateral circumflex femoral and all four of them form a cruciate anastomosis like this and that provides an important collateral circulation in iliofemoral occlusion. This is the second perforator and we can see it is coming out here. This is the third perforator and the fourth perforator is between the two halves of the hamstrings and we have separated them to show this is the fourth perforator. Now let's take a look at the course of the perforators. The first perforator as we see apart from the cruciate anastomosis, it goes between the bifurcation of the sciatic nerve and we can see it is supplying the hamstring muscles and the main perforator is then continuing on the other side and we can see it here and we can see it is dividing it to a descending branch ascending branch. The second perforator is doing pretty much the same thing. This was the continuation of the perforating artery where to cut it to retract this and we can see it is also going through the visor femoris and it's coming out here and it is anastomosing with the first perforating. The third perforator is also going through the short head of the biceps. It is entering the long head of the biceps and it is coming out and it is also anastomosing and the fourth perforating artery also is dividing and anastomosing with the other perforators. All these perforators, they are anastomose and they form a full line of arterial anastomosis located between the two halves of the hamstrings namely the semimembranosus, semitendinosus, medially visor femoris laterally and between the hamstrings and the adductor magnus. This is the adductor component of the adductor magnus and in by this means these perforating arteries supply all the muscles and the structures in the posterior aspect of the thigh. In this correction we must remember that there is no artery on the posterior aspect of the thigh separate for them. So therefore these perforating arteries are the main source of supply to the structures in the back of the thigh. Having mentioned that now let me come down and show you the popliteal fossa and the artery therein. So this is the popliteal fossa that we have opened out. This is the supramedial boundary from where the bicep femoris, the supramedial boundary from where the semitendinosus and the semimembranosus. The infrolateral boundary is formed by the lateral head of the gastrocnemius and under that this muscle, this is the plantaris muscle and the medial head of the gastrocnemius forms the infromedial boundary. So therefore this is the diamond-shaped fossa. Running through the popliteal fossa we have the nerves following nerves. This is the sciatic nerve which has divided in the back of the thigh and this lateral view, this is the common fibular nerve which runs infrolaterally under cover of the bicep femoris. This is the larger division, the tibial nerve which goes from one apex of the popliteal fossa and out through the other apex and it gives multiple branches. Then we have the next structure here, there's the popliteal vein and then we have the popliteal artery. So here the nerve, vein and artery form a very uniform relationship and which is pretty constant in many dissections. From lateral to medial and from superficial to deep we have the nerve, vein, artery and we can see that clearly here. Where does the femoral artery and the femoral vein become the popliteal artery? We can see a circular opening here and we can see that the popliteal artery and the popliteal vein are disappearing. That is called the adductor hiatus and I'm going to put my finger inside and my finger has disappeared in the adductor hiatus. This adductor hiatus is formed by this tendon that we can see here. This is the adductor tendon which is the hamstring component of the adductor magnus which is attached to the adductor tubercle of the femur. That is the medial boundary and the lateral boundary of the adductor hiatus is the adductor component of the adductor magnus. So there's a small opening between the two and that is known as the adductor hiatus. This adductor hiatus forms the inferior limit of the adductor canal which we can see on the medial surface of the thigh from the anterior view and it is in this location that the femoral artery and the femoral vein become known as the popliteal artery in the popliteal vein. So from here onwards it is now the popliteal vein and the popliteal artery. This is one potential side of entrapment of the popliteal artery. Now let's take a look at the branches of the popliteal artery here and I have lifted up the popliteal artery and we can see five branches. One, two. This is the superior lateral superior medial genicular artery. Then we have the next branch. I have again lifted up the lower part of the popliteal artery here and we can see this branch. This is the middle genicular artery and further lower down we can see two more branches. One going laterally and one going medially. This is the inferior lateral genicular and the inferior medial genicular. So these five genicular arteries they form an anastomosis apart from supplying the knee joint they form a genicular anastomosis which is reinforced by two arteries from above and one from below. One artery from above is this one. This is the descending genicular branch of the femoral artery and we can see in this case it is shown coming through the adductor hiatus. This and then there is a descending branch from the lateral circumflex femoral artery which also comes down from the lateral aspect and from below we have a recurrent anti-ATBL recurrent artery. So one artery from below and two arteries from above and five arteries inside the popliteal fossa all of them form a genicular anastomosis and this genicular anastomosis forms a very important collateral circulation in femoral, popliteal occlusion. The popliteal artery position can be felt when we are testing a patient for peripheral vascular disease. When we gently flex the knee partially flex the knee and we can feel the pulsation of the popliteal artery against the posterior tibial condyle between the two heads of the gastrocnemius. That is one of the places where we can feel for popliteal artery pulsations. It should not be confused with an aneurysm of the popliteal artery which can sometimes occur where there will be a swelling and it will show a different kind of pulsation from that of a normal popliteal artery pulsation. This popliteal artery the popliteal veins can be endured in posterior dislocation of the knee. This popliteal artery apart from being a potential source of obstruction at the adductor hiatus it can also be obstructed by the medial head of the gastrocnemius and this is the medial head of the gastrocnemius which we have cut. The medial head of the gastrocnemius is larger than the lateral head and there is a very well defined classification called the popliteal artery entrapment syndrome by Love and Valen which describes six different types of obstruction of the popliteal artery, popliteal vein and functional obstruction. So that is another site of potential obstruction of the popliteal artery and the third site of obstruction of the popliteal artery I shall show you when I come a little lower down. In order to show the continuation of the popliteal artery we have sliced the origin of the medial head of the gastrocnemius and the lateral head of the gastrocnemius and we have reflected this up here and under that we can see this muscle this is the soleus muscle. We have cut tendocalcaneus and I have reflected it up and we can see this vessel here. This is the posterior tibial artery with its accompanying vinae cometantis. Vinae cometantis are accompanying veins of the arteries which are seen in the leg and in the hand. These vinae cometantis are the ones which circulate the venous blood up and they use the arterial pulsation to transmit the blood up. Now I'm going to put my hand under the soleus and you can see it is coming out here. This location is referred to as the tendinous arch of soleus. It is a fibritic arch which stretches from the tibia to the fibula to which the soleus muscle is attached and this tibial nerve and the popliteal artery and the popliteal vein they pass through that. So this is another potential side of obstruction of the popliteal artery. So therefore to summarize adductor hiatus, medial head of the gastrochemius, tendinous arch of soleus. These are the three potential sides of obstruction of the popliteal artery. At the tendinous arch of soleus the popliteal artery divides into a posterior tibial and anterior tibial. And the posterior tibial is the one which we can see here. It gives a branch which we can see this is this fibular branch. The posterior tibial then continues down and it enters into the foot and it forms the medial and lateral plantar arteries. The posterior tibial and the fibular artery they give mostly bony branches. They give branch nutrient arteries to the tibia, fibular respectively, medial and lateral malleolar and the calcaneal branches. This is a leg angiogram to show the branches of the popliteal and the tibial arteries in the leg. So this is the full circulation of the popliteal artery and its branches. That's all for now. Thank you very much for watching Dr. Sanjay Sanyal Sanyal. Davey knows the camera person. If you have any questions or comments please put them in the comment section below. Have a nice day.