1. ANATOMY OF THE FRONT OF THE THIGH
Dr. Mohammed Mahmoud Mosaed

2. Cutaneous Nerves
The lateral cutaneous nerve of the thigh, a branch of the lumbar plexus (L2, 3), enters the thigh behind the lateral end of the inguinal ligament. It divided into anterior and posterior branches, it supplies the skin of the lateral aspect of the thigh and knee. The medial cutaneous nerve of the thigh, a branch of the femoral nerve, supplies the medial aspect of the thigh and joins the patellar plexus. The intermediate cutaneous nerve of the thigh, a branch of the femoral nerve, divides into two branches that supply the anterior aspect of the thigh and joins the patellar plexus. The femoral branch of the genitofemoral nerve, a branch of the lumbar plexus (L1, 2), enters the thigh behind the middle of the inguinal ligament and supplies a small area of skin. The ilioinguinal nerve, a branch of the lumbar plexus (L1), enters the thigh through the superficial inguinal ring. It supplies a small skin area below the medial part of the inguinal ligament.

3. The patellar plexus lies in front of the knee and is formed from the terminal branches of the lateral, intermediate, and medial cutaneous nerves of the thigh and the infrapatellar branch of the saphenous nerve

4. MUSCLES OF THE ANTERIOR COMPARTMENT OF THE THIGH
Pectineus.
Sartorius.
Quadriceps Femoris.

5. Pectineus muscle Origin: Insertion: upper end of linea aspera of femur
Pectineal line of the superior pubic ramus
Insertion: upper end of linea aspera of femur
Action: Flexes and adducts the thigh at the hip joint
Nerve supply: femoral nerve, L3,4

6. SARTORIUS Origin: anterior superior iliac spine
Insertion: Upper part of the medial surface of the shaft of the tibia.
Action: Flexes, abducts, laterally rotates thigh at hip joint;
flexes and medially rotates leg at knee joint
Nerve supply: branches of femoral nerve L2,3

8. QUADRICEPS FEMORIS 1. Rectus Femoris 2. Vastus lateralis
3. Vastus medialis
4. Vastus intermedius

11. 1. Rectus Femoris Origin:
1. Straight head: anterior inferior iliac spine (AIIS)
2. Reflected head: ilium just above the acetabulum
Insertion: Common quadriceps tendon then tibial tuberosity via patellar ligament
Action: Extension of leg at knee joint and flexes thigh at hip joint
Nerve supply: branches of femoral nerve

12. 2. Vastus lateralis Origin: 1. Upper part of inter-trochanteric line
2. Root of greater trochanter
3. Lateral lip of linea aspera
Insertion: Common quadriceps tendon then tibial tuberosity via patellar ligament
Action: Extension of leg at knee joint
Nerve supply: branches of femoral nerve

13. 3. Vastus medialis Origin:
1. Lower part of intertrochanteric line of femur
2. Spiral line
3. Medial lip of linea aspera
4. Upper part of the medial supracondylar line
Insertion: Common quadriceps tendon then tibial tuberosity via patellar ligament
Action: Extension of leg at knee joint; stabilizes patella
Nerve supply: branches of femoral nerve.

14. 4. Vastus intermedius
Origin: anterior and lateral surfaces of the femoral shaft
Insertion: Common quadriceps tendon into patella and tibial tuberosity via patellar ligament
Action: Extension of leg at knee joint
Nerve supply: Branches of femoral nerve

15. Insertion of quadriceps muscle

16. Femoral triangle
The femoral triangle is a triangular depressed area situated in the upper part of the medial aspect of the thigh just below the inguinal ligament

17. Boundaries of the femoral triangle
Lateral boundary is the medial margin of sartorius.
Medial boundary is the medial margin of adductor longus.
The apex is where sartorius overlaps adductor longus.
The base is formed by the inguinal ligament.
The floor is gutter shaped and formed from lateral to medial by:
the iliopsoas tendon which inserted into the lesser trochanter of the femur, the pectineus, and the adductor longus.
The roof is the overlying fascia lata.

20. Contents of femoral triangle
The femoral sheath contains the femoral vessels.
The femoral nerve which lies lateral to the artery and outside the femoral sheath
The triangle also contains fat and lymph nodes

23. Adductor (subsartorial) Canal
The adductor canal is an intermuscular cleft situated on the medial aspect of the middle third of the thigh.
It begins at the apex of the femoral triangle and ends below at the opening in the adductor magnus.
Boundaries
The anteromedial wall is formed by the sartorius muscle and fascia.
The posterior wall is formed by the adductor longus and magnus.
The lateral wall is formed by the vastus medialis.
Contents
the terminal part of the femoral artery, the femoral vein, the deep lymph vessels, the saphenous nerve, the nerve to the vastus medialis, and the terminal part of the obturator nerve.

26. Femoral Nerve
The femoral nerve is the largest branch of the lumbar plexus (L2, 3, and 4).
It emerges from the lateral border of the psoas muscle within the abdomen and passes downward in the interval between the psoas and iliacus.
It lies behind the fascia iliaca and enters the thigh lateral to the femoral sheath, behind the inguinal ligament.
About 1.5 in. (4 cm) below the inguinal ligament, it terminates by dividing into anterior and posterior divisions. The femoral nerve supplies all the muscles of the anterior compartment of the thigh .
Note that the femoral nerve does not enter the thigh within the femoral sheath.

27. Branches Anterior Division
The anterior division gives off two cutaneous and two muscular branches.
The cutaneous branches are: the medial cutaneous nerve of the thigh and the intermediate cutaneous nerves that supply the skin of the medial and anterior surfaces of the thigh
The muscular branches supply the sartorius and the pectineus.
Posterior Division
The posterior division gives off:
Muscular branches to the quadriceps muscle. The muscular branch of the rectus femoris also supplies the hip joint; the branches to the three vasti muscles also supply the knee joint.
Cutaneous branch: The saphenous nerve runs downward and medially and crosses the femoral artery from its lateral to its medial side . It emerges on the medial side of the knee between the tendons of sartorius and gracilis . It then runs down the medial side of the leg in company with the great saphenous vein. It passes in front of the medial malleolus and along the medial border of the foot, where it terminates in the region of the ball of the big toe.

29. Femoral artery
Origin: The femoral artery is a continuation of the external iliac artery It begins behind the inguinal ligament, midway between the anterior superior iliac spine and the pubic symphysis (midinguinal point( It descends almost vertically toward the adductor tubercle The femoral artery is the main arterial supply to the lower limb Termination: it ends at the opening in the adductor magnus muscle by entering the popliteal space as the popliteal artery

31. Branches of the femoral artery
The superficial circumflex iliac artery is a small branch that runs up to the region of the anterior superior iliac spine .
The superficial epigastric artery is a small branch that crosses the inguinal ligament and runs to the region of the umbilicus.
The superficial external pudendal artery is a small branch that runs medially to supply the skin of the scrotum (or labium majus).
The deep external pudendal artery runs medially and supplies the skin of the scrotum (or labium majus).
The profunda femoris artery (deep femoral artery) is a large and important branch that arises from the lateral side of the femoral artery about 1.5 in. (4 cm) below the inguinal ligament. It passes medially behind the femoral vessels and enters the medial compartment of the thigh. It ends by becoming the fourth perforating artery.
Branches of profunda femoris artery:
Medial circumflex femoral artery
Lateral circumflex femoral artery
Three perforating arteries

35. Femoral vein
Beginning: at the adductor opening as the continuation of the popliteal vein.
Termination: posterior to the inguinal ligament as the external iliac vein.
Course: The vein is posterolateral to the femoral artery in the distal adductor canal. At the apex of the femoral triangle, the vein lies posterior to the artery. At the base of the triangle the vein lies medial to the artery.
The vein occupies the middle compartment of the femoral sheath, between the femoral artery and femoral canal; fat in the canal permits expansion of the vein. There are usually four or five valves in the femoral vein
Tributaries:
1. The muscular tributaries.
2. The profunda femoris vein
3. The great saphenous vein which enters the vein anteriorly.
4. Lateral and medial circumflex femoral veins are usually tributaries of the femoral vein.