Front of the thigh Midinguinalpoint: Lies midway between the anterior superior iliac spine and the symphysis

s pubis. Midpoint of inguinal ligament: Lies midway between the anterior superior iliac spine and pubic tubercle. Fold of groin: is a shallow groove which separates the front of the thigh from the anterior abdominal wall. It represents the flexion crease of the thigh and overlies the inguinal ligament. Superficial Fascia The superficial fascia of the thigh is very rich in fat. It has two layers, a superficial fatty layer and a deep membranous layer which are continuous with the corresponding layers of the anterior abdominal wall. The membranous layer is loosely attached to the deep fascia of the thigh except near the inguinal ligament where it is firmly attachmed along a horizontal line. It begins a little lateral to the pubic tubercle and extends laterally for about 8cm. The contents of the superficial fascia include: 1. Veins: One vein (great saphenous vein) and its tributaries. 2. Arteries: Three small cutaneous arteries. 3. Nerves: Seven cutaneous nerves. 4. Lymphatics: Superficial inguinal lymph nodes. 5. Bursae: Prepatellar and subcutaneous infrapatellar bursae. Applied Anatomy: In ruptured urinary bladder, urine will be directed upward and laterally under the superficial facia but not downward through the thigh due to the firm attachment between the deep facia and superficial facia along the horizontal line below the inguinal ligament. Great (long) saphenous vein Introduction: It is the largest and longest superficial vein in the lower limb. It is called"Saphenous" (Saphes = easily seen) because it is easily seen in living subjects. Beginning: On the dorsum of the foot by the union of the medial end of the dorsal venous arch with the medial marginal vein of the medial side of the big toe. Course: Runs backwards on the medial aspect of the dorsum of the foot. Runs upwards in front of the medial malleolus (Fixed position) Ascends in company with the saphenous nerve in the superficial fascia over the medial side of the leg Passes one hand bredth behind the knee joint It ascends upwards and laterally in the thigh to reach the saphenous opening where it hooks around the falciform margin and pierces the cribriform fascia and ends by opening in the femoral vein. Valves: Contains 15-20 valves which prevent the back flow of venous blood by gravity. One valve is always present at sapheno- femoral junction.
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Tributaries: (1) Superficial epigastric vein. (2) Superficial external pudendal vein. (3) Superficial circumflex iliac vein. Communications: Connected with the deep veins by the perforating veins: Three medial perforators: Just above the ankle. One perforator: Just below the knee. One perforator: In the region of adductor canal. applied Anatomy: 1- Varicose vein: The perforating veins are provided with valves which permit flow of blood only from the superficial to the deep veins. Failure of these valves would permit blood to flow from the deep veins to the superficial veins due to the high pressure in the deep veins. The superficial veins will then become distended, dilated and tortuous (varicose veins). The management in sever cases may be by surgical removal of the long sophenous vein. 2- DVT: Venous return from the deep venous system to the hart is supported by the venous valves, the pulse of the arteries and the contraction of the surrounding muscles (venous pumb). In case of prolonged staying in bed after operation, stagnation of blood may lead to Deep Vein Thrombosis (DVT). 3- Graft: Long saphenous vein is used frequently as a graft in coronary pypass operations and other cases of arterial occlusions. 4- cut-down: In cases of chock, all superfecial veins are not visible. Long saphenous vein can be used to introduce I.V fluid to the body after a simple (cut-down) operation at its fixed position infront of medial maleolus. Cutaneous arteries Three small arteries, arsising from the femoral artery, are seen below the inguinal ligament (1) Superficial external pudendal artery: * Pierces the cribriform fascia * Runs medially in front of the spermatic cord. * Supplies the external genitalia. (2) Superficial epigasteric artery: * Pierces the cribriform fascia. * Runs upwards towards the umbilicus. * Supplies the lower part of the anterior abdominal wall.
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(3) Superficial circumflex femoral artery: * Pierces the cribriform fascia. * Runs laterally below the inguinal ligament. * Anastomoses at the anterior superior iliac spine with other arteries forming iliac anastomosis.

Cutaneous nerves The skin of the front of the thigh is supplied by 7 cutaneous nerves derived from the lumbar plexus. (1) Ilio-inguinal nerve (LI): * Emerges at the superficial inguinal ring. * Supplies the skin of the upper part of the medial side of the thigh. (2) Femoral branch of genitofemoral nerve (Ll, 2): * Pierces the deep fascia 2cm below the midinguinal point. * Supplies the skin over the femoral triangle. (3) Lateral cutaneous nerve of the thigh (L2, 3): * Emerges medial to the anterior superior iliac spine. * Divides into anterior and posterior branches. * Supplies the skin of the anterolateral side of the whole thigh. (4) Cutaneous branch of obturator (L2, 3): * Arises form the anterior division of the obturator nerve. * Supplies the skin on the medial side of the middle 1/3 of the thigh. (5) Medial cutaneous nerve of the thigh (L2, 3): * It is a branch of the femoral nerve. * Pierces the deep fascia at the junction of the middle 1/3 and the lower 1/3 of the thigh. * Supplies the skin on the medial side of the lower 1/3 of the thigh. (6) Intermediate cutaneous nerve of the thigh (L2, 3): * It is a branch of femoral nerve. * Pierces the deep fascia at the junction of upper 1/3 and middle 1/3 of the thigh. * Supplies the middle aspect of the skin of the front of the thigh till the knee. (7) Infrapatellar branch of the saphenous nerve (L3, 4): * Arises from the saphenous nerve before piercing the deep fascia on the medial side of the knee. * Supplies the skin over the ligamentum patellae. NB: Patellar plexus Site: In front of the patella, ligamentum patellae and the upper end of the tibia. Formation: Formed by contributions from: (1) Medial cutaneous nerve of the thigh. (2) Intermediate cutaneous nerve of the thigh. (3) Lateral cutaneous nerve of the thigh.
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(4) Infrapatellar branch of saphenous nerve.

Superficial inguinal lymph nodes Site: lie in the superficial fascia below the inguinal ligament Arrangement: T-shaped, having an upper horizontal group and a lower vertical group. The upper nodes can be subdivided into upper lateral and upper medial groups. The upper medial group: Two or three in number. Present below the medial end of the inguinal ligament. Drains the anterior abdominal wall below the umbilicus, perineum including the external genitalia (except the testes), the urethra and lower part of anal canal(except the glans) and the lower part of the inguinal canal. The upper lateral group: Two or three in number. Present below the lateral part of the inguinal ligament. Drains the skin and fasciae of the buttocks and the back below the level of the umbilicus(iliac crest). The lower vertical group: Four to five in number. Present on both sides of the great saphenous vein. Drains the skin and fasciae of the lower limb except the buttocks (to upper lateral group) and the lateral side of the leg and foot (to popliteal nodes along the short saphenous vein). Efferents: Pierce the cribriform fascia and terminate into the deep inguinal nodes which lie along the upper part of femoral vein. Applied Anatomy: Painful enlargement of the superficial inguinal lymph nodes may indicate a disease of the superficial parts of the lower limb, infraumbilical part of the anterior abdominal wall, perineum, external genitalia (except the testes) and anus.

Subcutaneous bursae Introduction: Bursae are lubricating structures which are located at the sites of friction to avoid the usual wear and tear. (1) Subcutaneous prepatellar bursa: Lies in front of the lower part of the patella and the upper part of ligamentum patellae. (2) Subcutaneous infrapatellar bursa: Lies in front of the lower part of the ligamentum patella and tibial tuberosity. Applied Anatomy: Chronic enlargement of the subcutaneous prepatellar bursa is known as housemaid's knee because it commonly occurs in the housemaids who have to kneel regularly for sweeping the floors.
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Deep fascia of the thigh Fascia lata Definition: Fascia lata is a tough fibrous sheet which encloses the whole of the thigh like a sleeve. Attachment: (A) Superiorly: It is attached anteriorly to the inguinal ligament; laterally to the iliac crest; posteriorly to the sacrum, coccyx and sacrotuberous ligament; and medially to the pubis, pubic arch and ischial tuberosity. (B) Inferiorly: To the front and sides of the knee. Thickness: The fascia lata is thickened laterally to form the iliotibial tract. Applied anatomy: The fascia lata is attached to the inguinal ligament. Extended thigh, therefore, pulls the abdominal wall downwards and makes it tense. In order to relax the abdomen to examine it (by palpation), the legs are flexed to overcome the traction of the fascia lata. The deep facia of the thigh represents some important features which are: 1.The saphenous opening. 2.The ilio tibial tract. 3.The intermuscular septum. Saphenous opening Definition: It is an oval gap in the fascia lata of the front of the thigh. Site: Situated 1.5 inches (4cm) below and lateral to the pubic tubercle. Size: 3x1.5 cm. Covering: Covered by cribriform fascia (modified deep fascia). Margins: The upper, lower and lateral margins form a cresentic sharp edge called falciform margin. Relations to the femoral vessels: (1) The femoral artery: lies, behind its lateral margin. (2) The femoral vein: It is completely exposed in the opening. Structures passing through it: Great saphenous vein. The three superficial inguinal arteries (Superfecial external pudendal, superficial epigastric and superficial circumfles iliac arteries). Lymphatics communicating superficial and deep inguinal lymph nodes. Iliotibial tract
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Definition: The fascia lata is thickened laterally to form 2 inches wide strong band called iliotibial tract. Attachment: (A) Superiorly: It spilits into two laminae to receive the insertion of the tensor fasciae lata anteriorly and 3/4 of the gluteus maximus posteriorly. (NB: The superficial lamina is attached to the tubercle of the iliac crest and the deep lamina to the capsule of the hip). (B) Inferiorly: Is attached to the anterior surface of the lateral condyle of the tibia. Muscles attached to it: 1. Tensor fasiae latae. 2. Gluteus maximus. Function: It fixes the hip over the femur and the femur over the tibia. This leads to stabilization of the knee in extension and partial flexion and is therefore allows its continous use in walking and running. Intermuscular septa

Three intermuscular septa extend from the deep fascia to the linea aspera and divide the thigh into 3 compartments (1) Lateral intermuscular septum: * Extends from the lateral lip of the linea aspera to the ilio tibial tract. * It separates the anterior from the posterior compartment of the thigh. (2) Medial intermuscular septum: * Extends from the medial lip of the linea aspera to the deep facia on the medial side. * Separates the atnerior from the medial compartment of the thigh. (3) Posterior intermuscular septum: * Extends from the medial lip of the linea aspera to the deep facia on the posterior side. * Separates the medial from the posterior compartment of the thigh. * It is poorly defined.

Compartments of the thigh (1) Anterior compartment: Contains the quadriceps femoris which is supplied by the femoral nerve . (2) Medial compartment: Contains the adductor group of muscles which are supplied by the obturator nerve. (3) Posterior compartment: Contains the hamstring muscles which are supplied by the sciatic nerve.