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SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
From lateral to medial, the femoral triangle contains the femoral nerve and its branches; the femoral artery and its branches, including the profunda femoris; and the femoral vein with its main tributary, the long saphenous vein.
Knee and lower leg
Published in Pankaj Sharma, Nicola Maffulli, Practice Questions in Trauma and Orthopaedics for the FRCS, 2017
Pankaj Sharma, Nicola Maffulli
The saphenous nerve arises from the femoral nerve in the femoral triangle. It passes down in the femoral triangle to enter the adductor canal. It then pierces the fascia lata between the tendons of the sartorius and gracilis, and passes inferiorly on the medial side of the leg close to the greater saphenous vein.
Answers
Published in Calver Pang, Ibraz Hussain, John Mayberry, Pre-Clinical Medicine, 2017
Calver Pang, Ibraz Hussain, John Mayberry
This question focuses on the anatomy of the femoral triangle, an area within the anterior thigh. The femoral triangle has three borders: the superior, lateral and medial. In addition, the anterior (roof) border of the triangle is formed by the fascia lata and the posterior (base) is formed by the pectineus, iliopsoas and adductor longus muscle. Many neurovascular structures lie within the triangle which include, from lateral to medial, the femoral nerve, femoral artery, femoral vein and femoral canal, of which the artery, vein and canal are contained within the femoral sheath.
Sentinel lymph node biopsy based on anatomical landmarks and locoregional mapping of inguinofemoral sentinel lymph nodes in women with vulval cancer: an operative technique
Published in Journal of Obstetrics and Gynaecology, 2023
Fong Lien Kwong, Miski Scerif, Jason KW Yap
Surgical technique: We start by identifying the anterior superior iliac spine and pubic tubercle to map the course of the inguinal ligament. We then palpate the femoral artery to identify its location and a handheld Doppler may be used in obese women. Situated on its medial side in the femoral triangle is the femoral vein and the latter is joined on its medial side by the saphenous vein at the saphenofemoral junction. We make a 3-4cm incision inferior to and parallel to the inguinal ligament. The incision extends over the femoral vein and slightly above the saphenous vein (Figure 1). Radiolocalisation of the SLN was achieved after identifying and excising the node with the highest signal count using a handheld gamma counter. The groin was re-examined and dissection continued until there was no residual radioactivity. All histological specimens were analysed using ultrastaging with immunohistochemistry. Ipsilateral unilateral inguinal SLN biopsies were conducted for lateral tumour and bilateral excisions for central tumours. The long saphenous vein was preserved in all cases.
Lymphatic flow through (LyFT) ALT flap: an original solution to reconstruct soft tissue loss with lymphatic leakage or lower limb lymphedema
Published in Journal of Plastic Surgery and Hand Surgery, 2023
David Guillier, Martino Guiotto, Stephane Cherix, Wassim Raffoul, Pietro G. di Summa
However, when the soft tissue defect is associated with disruption of the lymphatic network, flap-only coverage may not be sufficient avoid lymphorrea, wound breakdown, infections and potential secondary lymphoedema. Anatomically, the lymphatic vessels in the lower leg converge in the medial thigh run parallel to the great saphenous vein and continue to the inguinal lymph nodes above the inguinal ligament. The groin lymph-nodal system is divided into superficial and deep planes within the femoral triangle. The superficial lymph node system drains the lymphatic collectors from the lower limb, superficial gluteal region, lower abdominal wall, perineum and external genitalia. The deep inguinal nodes receive some lymphatic flow from the superficial system (minor part) and then drain to the external iliac nodes [4].
De Garengeot hernias. Over a century of experience. A systematic review of the literature and presentation of two cases
Published in Acta Chirurgica Belgica, 2022
Michail Chatzikonstantinou, Mohamed Toeima, Tao Ding, Almas Qazi, Niall Aston
An 89-year-old woman presented with similar history. She was found to have a tender right groin with an irreducible lump. The overlying skin was erythematous with the cellulitis spreading upwards in the abdominal wall. A CT demonstrated fluid collection and free air within the femoral triangle, suggestive of perforated appendix within the femoral hernia (Figure 2). She was taken to theatre for an emergency right groin exploration and repair of a femoral hernia. Given the skin cellulitis a high incision with preperitoneal approach was decided (McEvedy). The external oblique was opened and the rectus sheath was medialised. The femoral ring was approached in the preperitoneal space for confirmation of the suspected pathology. The peritoneum was entered for exploration of the hernia contents. A gangrenous appendix was identified, reduced and excised. Given the tissue inflammation and the nature of the inflamed necrotic appendix, the hernia was not repaired. The patient was kept on intravenous antibiotics post-operatively with close observation of the skin erythema. She recovered well and was discharged 14 days later. She was subsequently readmitted a week following the discharge with groin collection requiring incision and drainage.