The borders and layers of the lower limb`s regions
The upper limb is separated from the trunk by: the inguinal ligament anterosuperiorly, the iliac crest posterosuperiorly and a line connecting posterior superior iliac spine with the IV lumbar spinous process.
The lower limb can be divided into following regions:
Borders: superior – iliac crest; inferior – gluteal skin fold; external – the line connecting the anterior superior iliac spine with the greater trochanter.
The subgluteal space.
It is between the superficial layer of the gluteal fascia covering the posterior side of the gluteus maximus and deep layer of the gluteal fascia covering the gluteus medius. The space connects with deep fat of the posterior femoral region; with the pelvic fat through foramen infrapiriforme; with fat in ischiorectal fossa through the lesser sciatic foramen; with the medial femoral compartment. The space contains the vessels and nerves passing through foramen infrapiriforme and suprapiriforme (see the table “Topography of limbs’).
The deep subgluteal space is closed because the gluteus medius and minimus lie in common fascial sheath.
Borders: anterosuperior – the inguinal ligament; posterorsuperior – gluteal skin fold; inferior – the line passing about 3 cm above the patella. The femoral region is divided into anterior and posterior by the lines connecting the femoral epicondyles with the anterior superior iliac spine (externally) and pubic symphysis (internally).
Layers of anterior femoral region:
Subcutaneous tissue contains superficial branches of the femoral artery with accompanying veins and inguinal lymph nodes. Superficial layer of the fascia lata is continuous with the inguinal ligament; the deep one gives the iliopectineal arch separating lacuna vasorum and lacuna musculorum. The inner part of the superficial layer of the fascia lata over the femoral vessels is called fascia cribrosa. It is pierced by vessels. If we remove the fascia cribrosa we can see the opening called saphenous hiatus with a thick border called the falciform margin. The saphenous hiatus contains the last part of the long saphenous vein which drains into the femoral vein.
The fascia lata sends three intermuscular septa (medial,lateral and posterior) to attach to the femur. The septa separate femoral muscle compartments. The fascia lata forms separate sheaths for the sartorius, tensor fasciae latae and gracilis, and for the femoral vessels and nerve.
The anterior femoral region contains the lacuna vasorum and musculorum, femoral triangle and adductor canal. The detailed information about them see in the table “Topography of limbs”.
Layers of posterior femoral region:
In the lower third of the posterior femoral region, the adductor canal opens. The upper part of the sciatic nerve passes between the fascia lata and biceps femoris; the lower part is between the biceps femoris and semimembranosus.
Borders: superior — the line passing horizontally about 3 cm above the patella; inferior — the line passing horizontally about 3 cm below the patella.
The knee region is divided into anterior and posterior by the vertical lines passing through the femoral epicondyles..
Layers of anterior knee region:
Subcutaneous tissue contains medially the long saphenous vein with the saphenous nerve; laterally the short saphenous vein.
Layers of posterior knee region:
Borders: superior – the line passing horizontally about 3 cm below the patella; inferior – the line passing through the bases of the malleoli.
The crural region is divided into anterior and posterior by the lines connecting the femoral condyles with the malleoli.
Layers of anterior crural region:
The subcutaneous tissue contains the long and short saphenous veins and its tributaries, and also cutaneous sural nerves. The crural fascia gives anterior and posterior intermuscular septa which are attached to the fibula and separate the leg into three muscle compartments: anterior; lateral and posterior. The anterior compartment contains the anterior tibial vessels and deep peroneal nerve; the lateral compartment contains the peroneal vessels and superficial peroneal nerve.
The anterior crural region contains the superior musculoperoneal canal (see the table “Topography of limbs”).
Layers of posterior crural region:
The posterior compartment contains the posterior tibial vessels and tibial nerve.
The posterior crural region contains the inferior musculoperoneal canal and cruropopliteal canal (see the table “Topography of limbs”).
Borders: superior – the line passing through the bases of the malleoli; inferior – the line passing horizontally and connecting the malleoli anteriorly and the line passing through the sole and connecting the malleoli.
The talocrural region is divided into anterior, posterior, medial and lateral.
Layers of anterior talocrural region:
In subcutaneous tissue, the long saphenous vein passes in front of the medial malleolus and the branches of the superficial peroneal nerve between the malleoli.
Under the extensor retinacula there are three canals containing the tendons of the anterior crural muscles enclosed in synovial sheaths: medial canal contains the tendon of the tibialis anterior; lateral canal contains the tendon of the extensor digitorum longus; middle canal contains the tendon of the extensor hallucis longus and anterior tibial vessels and deep peroneal nerve.
Layers of posterior talocrural region:
Layers of lateral talocrural region:
In subcutaneous tissue behind the lateral malleolus there are the short saphenous vein and its tributaries and sural nerve.
Layers of medial talocrural region:
Borders: superiorly, the line passing through the apices of the malleoli.
The region of the foot is divided into dorsal and plantar regions.
Layers of the dorsal region of the foot:
Subcutaneous fat of the dorsal side contains a venous network which gives rise to the long and short saphenous veins, and the cutaneous branches of the superficial and deep peroneal nerves.
Layers of the plantar region of the foot:
There are medial and lateral plantar grooves in the sole (see the table «Topography of limbs»)
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