Technical aspects of treating aortic aneurysms
Peter A. Schneider in Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
On the day of the procedure, the skin of the femoral areas is extensively prepared. Ultrasound is used to identify the best place along the length of the artery to perform the percutaneous access. The inguinal ligament may be marked along its course for anatomic definition from pubic tubercle to anterior-superior iliac spine. If there is extensive common femoral disease, and the decision is to proceed with percutaneous access, it is usually best to enter the artery with the needle proximal to the common femoral artery disease. Ultrasound is used to avoid calcific areas of the artery wall. A short skin incision is made, usually just large enough to accommodate the intended sheath (Figure 28.1). A Kelly clamp can be used to dilate the tissues a little along the intended pathway of the needle. This is performed under ultrasound.
General surgery
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan in Essential Notes for Medical and Surgical Finals, 2021
The inguinal canal extends from the deep inguinal ring (midpoint of the inguinal ligament) to the superficial ring (at the pubic tubercle). The boundaries include: Anterior wall: external oblique aponeurosis + fi bres of internal oblique laterallyRoof: fi bres of internal obliqueFloor: inguinal ligamentPosterior wall: fascia transversalis + conjoint tendon medially The contents of the inguinal canal include the spermatic cord + ilio-inguinal nerve.
Abdominal wall, hernia and umbilicus
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Diagnostic error is common and often leads to delay in diagnosis and treatment. The hernia appears below and lateral to the pubic tubercle and lies in the upper leg rather than in the lower abdomen. Inadequate exposure of this area during routine examination leads to failure to detect the hernia. The hernia often rapidly becomes irreducible and loses any cough impulse due to the tightness of the neck. It may only be 1–2 cm in size and can easily be mistaken for a lymph node. As it increases in size, it is reflected superiorly and becomes difficult to distinguish from a medial direct hernia, which arises only a few centimetres above the femoral canal. A direct inguinal hernia leaves the abdominal cavity just above the inguinal ligament and a femoral hernia just below (Figure60.21).
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.
Anatomical course of the lateral femoral cutaneous nerve with special reference to the direct anterior approach to total hip arthroplasty
Published in Modern Rheumatology, 2020
Masahiko Sugano, Junichi Nakamura, Shigeo Hagiwara, Takane Suzuki, Takayuki Nakajima, Sumihisa Orita, Tsutomu Akazawa, Yawara Eguchi, Yohei Kawasaki, Seiji Ohtori
The following dissection protocol was applied. Each cadaver was first placed on a dissection table in a supine position. Along the inguinal ligament, an incision was made from the anterior superior iliac spine (ASIS) to the pubic tubercle, followed by longitudinal dissection of the center of the anterior thigh from the center of the inguinal ligament. The LFCN and its branches were identified by their origin from the pelvis at the level of the inguinal ligament. All nerve branches of the LFCN were carefully traced distally in the subcutaneous tissue of the proximal aspect of the thigh. The following distances of Ropars et al. [12] were measured using a ruler (Figure 1). (a) The distance from the midpoint of the ASIS to the LFCN at the level of the inguinal ligament. When the nerve divided proximally to the inguinal ligament into two main femoral and gluteal branches their distance from the ASIS was measured. Whether each nerve passed through or under the inguinal ligament was recorded. (b) The distance from the midpoint of the ASIS to the points where the LFCN branches crossed the anterior margin of the TFL was recorded and the distance from the ASIS to this point was measured. (c) The distance from the lateral epicondyle of the femur to the lateral malleolus of the ankle (lower leg length) was measured.
Surgical options for meralgia paresthetica: long-term outcomes in 13 cases
Published in British Journal of Neurosurgery, 2019
Zeki Serdar Ataizi, Kemal Ertilav, Serdar Ercan
Meralgia paresthetica (MP) is an entrapment neuropathy of the lateral femoral cutaneous nerve (LFCN). It causes burning, coldness, pain, tingling, sensory loss, or local hair loss in the distribution of the lateral femoral cutaneous nerve. Meralgia paresthetica, also known as Bernhardt-Roth, was first described by Hager in 1885.1 The LFNC arises from the L2 and L3 spinal nerve roots. It travels downward lateral to the psoas muscle and then crosses the iliacus muscle. It divides into the anterior and posterior branches by entering the thigh below, through or above the inguinal ligament. Its anterior branch penetrates to the fascia lata approximately 10 cm inferior to the anterior superior iliac spine (ASIS) and carries sensation from the anterior and lateral sides of the thigh. The smaller posterior branch innervates the skin of the lateral aspect of the leg from the greater trochanter to the mid-thigh.2–5
Related Knowledge Centers
- Anterior Superior Iliac Spine
- Fascia Lata
- Inguinal Canal
- Inguinal Hernia
- Psoas Major Muscle
- Pubic Tubercle
- Aponeurosis
- Ilium
- Pubis
- Abdominal External Oblique Muscle