Emergence and distribution of the ilioinguinal nerve in the inguinal region: applications to the ilioinguinal anaesthetic block (about 100 dissections)
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Inguinal ligament
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OBJECTIVE Meralgia paresthetica causes dysesthesias and burning in the anterolateral thigh. Surgical treatment includes nerve transection or decompression. Finding the nerve in surgery is very challenging. The author conducted a cadaveric study to better understand the variations in the anatomy of the lateral femoral cutaneous nerve (LFCN). METHODS Twenty embalmed cadavers were used for this study. The author studied the LFCN's relationship to different fascial planes, and the distance from the anterior superior iliac spine (ASIS). RESULTS A complete fascial canal was found to surround the nerve completely in all specimens. The canal starts at the inguinal ligament proximally and follows the nerve beyond its terminal branches. The nerve could be anywhere from 6.5 cm medial to the ASIS to 6 cm lateral to the ASIS. In the latter case, the nerve may lodge in a groove in the iliac crest. Other anatomical variations found were the LFCN arising from the femoral nerve, and a duplicated nerve. A thick nerve was found in 1 case in which it was riding over the ASIS. CONCLUSIONS The variability in the course of the LFCN can create difficulty in surgical exposure. The newly defined LFCN canal renders exposure even more challenging. This calls for high-resolution pre- or intraoperative imaging for better localization of the nerve.
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Femoral nerve
Iliac crest
Inguinal canal
Cadaveric spasm
Reinnervation
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Abstract Lateral femoral cutaneous nerve (LFCN) generally emerges from the pelvis behind the inguinal ligament (IL) to the thigh. Because of its proximity to the anterior superior iliac spine (ASIS) and hip joint, the LFCN is prone to injuries during various procedures. Anatomy of this nerve is highly variable among studies. Moreover, measurement data regarding its branches including the differences between genders and sides are still lacking. This study was, therefore, done to clarify these issues. Eighty‐five thighs from 43 cadavers of both genders were dissected at the inguinal region. Distances from each branch of the LFCN to palpable landmarks: the ASIS, pubic tubercle (PT) and femoral artery (FA) were measured along the IL. Up to four branches of the LFCN were found; however, the single trunk was the most common form (>65%). The common site of this pattern on the IL was within 2 cm medial to the ASIS but could be present at over 6 cm. The distances in case of bifurcation were mostly comparable to those of the single trunk. In contrast, the values varied considerably in the cases with three or more branches (three cases). Regarding side and gender, asymmetry in the branching pattern was found in one fourth of specimens. However, only some minor differences between genders or sides in the measurement data were seen. These findings suggest that asymmetry and multiple branches of the LFCN should be concerned. The measurement data are also useful for localizing the LFCN with higher accuracy. Clin. Anat. 21:769–774, 2008. © 2008 Wiley‐Liss, Inc.
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Injury to the lateral femoral cutaneous nerve (LFCN) is a risk during the operative anterior approach to the hip joint. Although several anatomical studies have described the proximal course of the nerve in relation to the anterior superior iliac spine (ASIS) and the inguinal ligament, the distal course of the LFCN in the proximal aspect of the thigh has not been sufficiently studied. The aim of this cadaveric study was to examine the branching pattern of the nerve, with special consideration to the anterior approach to the hip joint.Twenty-eight cadaveric hemipelves from 18 donors (10 paired and 8 unpaired specimens) were dissected. The LFCN branches were localized proximal to the inguinal ligament and traced distally into the area of the proximal aspect of the thigh. Distribution patterns of the nerve with respect to its relationship to the ASIS and the internervous plane of the anterior approach to the hip joint were recorded.We found 3 different branching patterns of the LFCN: sartorius-type (in 36% of the specimens), characterized by a dominant anterior nerve branch coursing along the lateral border of the sartorius muscle with no, or only a thin, posterior branch; posterior-type (in 32%), characterized by a strong posterior nerve branch; and fan-type (in 32%), characterized by multiple spreading nerve branches of equal thickness. In 50% of the specimens, the LFCN divided into ≥2 branches superior to the inguinal ligament. Sixty-two percent of the LFCN branches entered the proximal aspect of the thigh medial to the ASIS; 27%, above; and 11%, lateral to the ASIS. The LFCN consistently coursed within the deep layer of the subcutaneous fat tissue.Injury to branches of the LFCN cannot be avoided in approximately one-third of surgical dissections that use the anterior approach to the hip joint. To protect the anterior branch of the LFCN, the skin incision should be as lateral as possible. The posterior branch of the LFCN is most vulnerable in the proximal aspect of the anterior approach to the hip joint, where it can be expected to course within the deep layer of the subcutaneous tissue.
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Cadaveric spasm
Sartorius muscle
Obturator nerve
Femoral nerve
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Objective To provide the anatomic data for clinical repair of inguinal hernia(IH).Methods The inguinal structure of 40 adult corpses(30 males,10 females) fixed by formaldehyde was measured with set square,protractor and vernier caliper.Results The average length of inguinal ligament was(12.0±0.5) cm and the width was 0.6 cm.The length of inguinal canal was(4.7±0.6) cm and that of inguinal falx was(2.2±0.8) cm.Four types of inguinal canal were observed in both sides of 40 corpses: the conjoined tendon in 55 sides,conjunction in 12,transversus abdominia aponeurosis in 4 and sarco-aponeurosis in 9.Inferior epigastric artery was abnormal in 9 cases(11.3%).The posterior wall of inguinal canal could be divided into two closely-linked fascias and formed an egg-shaped area of(2.9±0.7) cm in length and(1.4±0.38) cm in width.Conclusion The deep layer of transverse fascia was weaker than superficial layer in these corpses.To strengthen and reconstruct the posterior wall of inguinal canal was the key point in the clinical repair of inguinal hernia(IH).
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Backgrouns: Femoral nerve is used for nerve block in several surgeries. The knowledge of femoral nerve in thigh is important for anatomist, anesthetics, and surgeons to prevent iatrogenic femoral nerve palsy. We dissected 25 human cadavers to study the anatomy of femoral nerve. We dissected the femoral nerve bilaterally in Anatomy Department of Smt N H L Municipal Medical College, and recorded the branching pattern of femoral nerve with digital photography.
Objective: To highlight the variation in branching pattern of the femoral nerve.
Materials and Methods: We measured the distance from the anterior superior iliac spine (ASIS) to the pubic symphysis bilaterally on each cadaver as an anatomical landmark. We located the femoral nerve through transverse incisions from the ASIS to the pubic symphysis and incisions originating from the midpoint between the ASIS and the pubic symphysis extending longitudinally to the patella. We chose the inguinal ligament as a proximal limitation for dissection of the femoral nerve in the thigh. The distance from the inguinal ligament to the first branching point of the femoral nerve was measured. We traced and dissected all femoral nerve branches to the insertion points.
Result: The mean medial–lateral distance from the ASIS to the pubic symphysis was 14.50 ± 1.34 cm (range 13–16). We found the femoral nerve near the midpoint, 46± 5% from the ASIS. We did not measure in cadaver specimen 5 since bony landmarks were difficult to palpate because of excessive adipose tissue. The distance from the inguinal ligament to the first branching point of the femoral nerve was 1.50 ± 0.47 cm (range 1–2cm).
Conclusion: The anatomy and morphology we observed remained consistent with the established literature, suggesting that our chosen specimens did not differ from the standard population and that we may consider the results representative of the general population.
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Many nerves of the lumbar plexus provide sensation to the thigh, including the lateral femoral cutaneous nerve (LFCN). The lateral femoral cutaneous nerve is usually derived from the dorsal branches of the L2 and L3 ventral rami. It appears from under the lateral border of the psoas major and travels towards the notch on the anterior superior iliac spine (ASIS), exiting the lesser pelvis by passing under the inguinal ligament. The lateral femoral cutaneous nerve branches into anterior and posterior divisions and provides sensation to the anterolateral and lateral thigh, respectively. The pathology associated with the lateral femoral cutaneous nerve is meralgia paresthetica, also known as Bernhardt-Roth syndrome, which is characterized by loss of sensation on the anterolateral and lateral thigh and has numerous etiologies, including obesity, diabetes, and tight clothing.
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Femoral nerve
Obturator nerve
Cutaneous nerve
Lumbar plexus
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The objective of the present study was to define the location of the most lateral superficial inguinal node lying along the inguinal ligament, through an embryological and anatomotopographical study, in order to rationalize the lateral extension of the groin lymphadenectomy in vulvar cancer.Sections of the upper portion of the femoral triangle belonging to three human fetuses, whose crown-rump (CR) length ranged from 70 to 310 mm, corresponding to a developmental age of 11 and 35 weeks, were studied. In addition, for an objective topographical evaluation of the disposition of the superficial inguinal lymph nodes, adult cadavers photographs of dissected Scarpa's triangle, reported in anatomical atlases, were analyzed.Both the embryological investigation and the anatomotopographical evaluation on cadavers photographs demonstrate that the most lateral superficial inguinal lymph node does not rise above the medial margin of the sartorius muscle, nor far lateral to the point where the superficial circumflex iliac vessels cross the inguinal ligament.On the basis of the present study, the authors believe that the superficial circumflex iliac vessels could represent the lateral surgical landmark, easily detectable, at which the inguinal lymphadenectomy should cease. Therefore, there is no need to extend the lateral excision to the anterior superior iliac spine. Finally, leaving the fatty tissue laterally to these vessels, some lymphatic channels could be preserved, decreasing the incidence and the entity of wound seroma and lymphedema.
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Groin
Inguinal canal
Lymphadenectomy
Levator ani
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Gabrielle Falloppio first discovered the inguinal ligament (or Poupart ligament) in 1562, which was further described by Francois Poupart, the famous French anatomist. The ‘tendinous’ anatomy of the inguinal ligament, stretching from the anterior superior iliac spine (ASIS) to the pubic tubercle (PT) with its grooved superior surface, was later discussed in detail by Cunningham. It forms by the folding of the inferior extent of the external oblique aponeurosis. The importance of the inguinal ligament in surgery stems from the fact that it is an important landmark and integral component of groin hernia repair and inguinal disruption (sportsman groin). Among the most commonly performed surgeries in the world is inguinal hernia repair, done on more than 20 million people per annum. The lifetime occurrence of groin hernia which includes visceral or adipose tissue protrusions through the inguinal or femoral canal is 27 to 43% in men and 3 to 6% in women. Inguinal hernias are almost always symptomatic, and surgery being the only cure. Acquiring detailed knowledge of inguinal anatomy is essential for surgeons operating on groin hernias.
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Groin
Inguinal canal
Aponeurosis
Round Ligament
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