REGIONAL ANATOMY

Classification of Human anatomy

Gross anatomy :
systematic anatomy
regional anatomy
Microscopic anatomy :
histology
cytology
 Four major regions

cranium
head face
anterior region of neck
neck posterior region of neck
back
thorax
trunk abdomen
pelvis and perineum
upper limb
limbs lower limb
lower limb

Anterior boundary: fold of groin

Lateral boundary: iliac crest
Posterior boundary: iliac crest,
superior border of the sacrum

glutear region, thigh,

knee, leg, ankle,foot.
lower limb
Surface landmarks
iliac crest adductor tubercle
anterior superior iliac spine medial condyle of tibia
tubercle of iliac crest lateral condyle of tibia
posterior superior iliac spine tibial tuberosity
pubic tubercle medial border of tibia
ischial tuberosity fibular head
greater trochanter medial malleolus
patella lateral malleolus
medial condyle of femur
lateral condyle of femur
 3.posterior superior iliac spine

1. iliac crest
2. anterior superior iliac spine

iliac tuberosity

5. pubic tubercle

4. tubercle of iliac crest

6. ischial tuberosity
 greater
trochanter

lateral
epicondyle lateral condyle
medial condyle
adductor tubercle medial epicondyle
patellar ligament
 lateral condyle
fibular head
medial condyle
tibial tuberosity

lateral malleolus
medial malleolus
lateral head of soleus
gastrocnemius

medial head of
gastrocnemius

tendo calcaneus
Femoral artery:
It corresponds to the upper two-
thirds of a line joining two points,
midinguinal point and adduct
tubercle. .
The upper one-third of the line
represents the upper half of the
artery lying in the femoral
triangle.
The middle one-third of the line
represents the lower half of the
artery lying in the adductor canal.
Sciatic nerve :
It is marked by joining the three points.
The first point is at 2.5 cm lateral to the
midpoint between the posterior superior
iliac spine and the ischial tuberosity.
The second point is just medial to the
midpoint between the ischial tuberosity
and the greater trochanter.
The third point is in the midline of the
back of the thigh at the junction of its
upper two-thirds and lower one-third.
Common peroneal nerve
It is marked by joining two points.
The first point is at the upper
angle of the popliteal fossa.
The second point is on the back of
the neck of the fibula.
Layer arrangement of lower limb
skin
superficial fascia
deep fascia
intermuscular septum
bone
Layer arrangement of lower limb
Skin:
The skin of thigh in the region around pubic
symphysis, is studded with hair. The skin over the
lateral and posterior aspects of the thigh are thick and
lesser movable.
The skin over the gluteal region is thick.
The skin over the posterior aspect of leg is thinner and
more freely movable than that over the anterior aspect
of leg.
The skin of the sole is thick for protection, firmly
adherent to the underlying plantar aponeurosis.
Layer arrangement of lower limb
Superficial Fascia:
The superficial fascia of the front of thigh has
two layers, a superficial fatty layer and a deep
membranous layer.
The superficial fasciae of the gluteal region is
heavily laden with fat. It is tough and stringy
over the ischial tuberosity where it forms an
efficient cushion for supporting the body weight
in the sitting posture.
The superficial fascia contains cutaneous veins,
cutaneous arteries, cutaneous nerves, and the
superficial lymph nodes.
Cutaneous Veins in the Superficial fascia
great saphenous
vein
superficial epigastric vein
superficial iliac circumflex vein
external pudendal vein
superficial lateral femoral vein superficial medial femoral vein
great saphenous vein

In the leg, the saphenous

nerve runs in front of the
great saphenous vein. .
saphenous nerve
Cutaneous Veins in the Superficial fascia
Characteristic of great saphenous vein
Cutaneous Veins in the Superficial fascia
Small saphenous
vein

The medial sural cutaneous

nerve accompanies the upper
part of the small saphenous
vein and the sural nerve
accompanies its lower part.

small saphenousvein

sural nerve
 Superficial fascia

superficial vein
dorsal venous arch of foot
great saphenous vein
small saphenous vein

popliteal vein femoral vein

国
small saphenous vein
dorsal venous
arch of foot

great saphenous vein

Cutaneous Arteries in the Superficial fascia

Superficial epigastric artery:

Superficial iliac circumflex

artery :

External pudendal artery :

 Cutaneous Nerves in the Superficial fascia
Lateral cutaneous nerve of
the thigh :

Medial cutaneous nerve of

the thigh :

Intermediate cutaneous nerve of

the thigh :
 Cutaneous Nerves in the Superficial fascia

Saphenous nerve :

Posterior femoral cutaneous

nerve
Cutaneous Nerves in the Superficial fascia

lateral sural cutaneous nerve

medial sural cutaneous nervesural
nerve
Superficial Lymph Nodes in the Superficial fascia
Superficial inguinal lymph
nodes:
Superficial Lymph Nodes in the Superficial fascia

Popliteal Lymph Nodes:

Deep fascia
Deep fascia of the thigh
( fascia lata )
Deep fascia
Deep fascia of the gluteal
region :

Deep fascia of the leg:

Deep fascia
Deep fascia of the
foot:
Dissection (First time)
1.Dissect the skin: According to the
picture 1 to draw the lines on the
cadaver, and then make the skin
incisions along these lines. That means
to make a vertical incision along the
medial side of the lower limb, and its
distal end reaches to the inferior margin
of the medial malleolus; to make one
oblique incision from the anterior
superior iliac spine to the pubic
tubercle; to make two horizontal
incisions at the levels of keen and
ankle. Reflect the skin laterally,
exposing the superficial fascia.
Dissection (First time)
1.Dissect the skin: According to the picture 1 to draw the lines on the
cadaver, and then make the skin incisions along these lines. That means to
make a vertical incision along the medial side of the lower limb, and its
distal end reaches to the inferior margin of the medial malleolus; to make
one oblique incision from the anterior superior iliac spine to the pubic
tubercle; to make two horizontal incisions at the levels of keen and ankle.
Reflect the skin laterally, exposing the superficial fascia.
2. Examine the surface landmarkings of the lower limb, such as iliac crest,
anterior superior iliac spine, tubercle of iliac crest, posterior superior iliac
spine, pubic tubercle, ischial tuberosity, greater trochanter, patella, medial
condyle of femur, lateral condyle of femur, adductor tubercle, medial
condyle of tibia, lateral condyle of tibia, tibial tuberosity, fibular head,
medial malleolus, lateral malleolus, tendo calcaneus and calcaneal
tuberosity.
Dissection (First time)
3. Examine the important structures in the superficial fascia: (1) try to find
the superficial inguinal lymph nodes below the inguinal ligament and along
the upmost part of the great saphenous vein; (2) identify the great saphenous
vein (you can begin to find it posterior to the medial femoral condyle or in
front of the medial malleolus ) and its five tributaries at its upper part before
piercing the cribriform fascia;. Review its course and characteristics; (3)
find out the cutaneous nerves on the anterior surface of the thigh: the lateral
cutaneous nerve pierces the fascia lata below the anterior inferior iliac spine
about 8 to 10 centimeter and emerges in the superficial fascia; the
intermediate cutaneous nerve of the thigh pierces the fascia lata at the
junction of the upper one-third and middle one-third of the thigh; the medial
cutaneous nerve of the thigh pierces the fascia lata on the medial side of the
thigh at the junction of the middle one-third and the lower one-third of the
thigh; (4) identify the saphenous nerve and its companion, great saphenous
vein, in the medial surface of the leg.
Dissection (First time)
4. Save the structures you have found in the superficial fasia, remove the
superficial fascia, and then begin to examine the deep fascia and its forming
structures: (1) The iliotibial tract situates in the lateral part of the thigh; (2)
The saphenous opening, an oval opening, locates inferior and lateral to the
pubic tubercle; (3) The falciform margin is a sharp crescentic lateral margin
of the saphenoud opening; (4) Around the ankle, the deep fascia is
thickened to form bands called retinacula.
5. Place the cadaver in the prone position, incise and reflect the skin
according to the picture 2.
6. Try to find the posterior femoral cutaneous nerve. It descends deep to the
deep fascia in the posterior surface of the thigh and pierces the deep fascia
superior to the popliteal fossa and then emerges in the superficial fascia.
Dissection (First time)
7. In the posterior surface of the leg, identify the small saphenous vein
along the midline and its accompanies, the sural nerve and the medial
sural cutaneous nerve. Find out the lateral sural cutaneous nerve.
8. Save the structures you have found in the superficial fascia, and then
remove the superficial fascia to expose the deep fascia.
9. The deep fascia above and in front of the gluteus maximus , i.e over
the gluteus medius, is thick, dense , opaque and pearly white; over the
gluteus maximus is thin and dense.
 Muscles and principal blood vessels and principal nerves
Muscles of the lower limb:
Muscles of pelvic girdle:
anterior group iliopsoas
tensor fasciae latae
gluteus maximus
posterior group gluteus medius psoas major
gluteus minimus iliacus
piriformis
psoas major
tensor fasciae
latae
gluteus maximus
gluteus medius
gluteus minimus
piriformis
obturator internus
quadratus femoris
 Muscles and principal blood vessels and principal nerves
Muscles of the lower limb:
Muscles of the Thigh

sartorius
anterior group quadriceps femoris tensor fasciae latae

gracilis, pectineus
sartorius
medial group adductor longus
adductor brevis rectus femoris
adductor magnus
posterior group biceps femoris vastus lateralis
semitendinosus
semimembranosus vastus medialis
iliotibial tract

patellar ligament
 Muscles and principal blood vessels and principal nerves
Muscles of the lower limb:
Muscles of the Thigh

sartorius
anterior group quadriceps femoris
gracilis, pectineus
medial group adductor longus
adductor brevis
adductor magnus vastus intermedius.

posterior group biceps femoris vastus lateralis

semitendinosus
semimembranosus vastus medialis
 Muscles and principal blood vessels and principal nerves
Muscles of the lower limb:
Muscles of the Thigh

sartorius
anterior group quadriceps femoris
pectineus
gracilis, pectineus
medial group adductor longus adductor longus
adductor brevis
adductor magnus gracilis
posterior group biceps femoris
semitendinosus
semimembranosus
 Muscles and principal blood vessels and principal nerves
Muscles of the lower limb:
Muscles of the Thigh

sartorius
anterior group quadriceps femoris
pectineus
gracilis, pectineus adductor brevis
medial group adductor longus
adductor brevis adductor magnus
adductor magnus adductor longus
posterior group biceps femoris gracilis
semitendinosus
semimembranosus
 Muscles and principal blood vessels and principal nerves
Muscles of the lower limb:
Muscles of the Thigh

sartorius
anterior group quadriceps femoris
gracilis, pectineus
medial group adductor longus
adductor brevis
semitendinosus
adductor magnus
posterior group biceps femoris semimembranosus
semitendinosus biceps femoris
semimembranosus
Muscles and principal blood vessels and principal nerves
Muscles of the lower limb:
Muscles of the leg:
tibialis anterior
anterior group extensor hallucis longus
extensor digitorum longus
peroneus longus tibialis anterior
lateral group
peroneus brevis extensor digitorum
longus
superficial layer:
gastrocnemius
soleus extensor hallucis
posterior group deep layer: longus
flexor hallucis longus
tibialis posterior
flexor digitorum longus
Muscles and principal blood vessels and principal nerves
Muscles of the lower limb:
Muscles of the leg:

tibialis anterior
anterior group extensor hallucis longus
extensor digitorum longus
tibialis anterior
lateral group peroneus longus
peroneus brevis extensor digitorum
longus
superficial layer:
gastrocnemius extensor hallucis long
soleus
posterior group deep layer:
flexor hallucis longus
tibialis posterior
flexor digitorum longus
Muscles and principal blood vessels and principal nerves
Muscles of the lower limb:
Muscles of the leg:

tibialis anterior
anterior group extensor hallucis longus
extensor digitorum longus
lateral group peroneus longus peroneus longus
peroneus brevis
superficial layer: peroneus brevis
gastrocnemius
soleus
posterior group deep layer:
flexor hallucis longus
tibialis posterior
flexor digitorum longus
Muscles and principal blood vessels and principal nerves
Muscles of the lower limb:
Muscles of the leg:
tibialis anterior
anterior group extensor hallucis longus
extensor digitorum longus
lateral head of
lateral group peroneus longus gastrocnemius
peroneus brevis
medial head of
gastrocnemius
superficial layer:
gastrocnemius
soleus
posterior group deep layer:
flexor hallucis longus
tibialis posterior
flexor digitorum longus
Muscles and principal blood vessels and principal nerves
Muscles of the lower limb:
Muscles of the leg:

tibialis anterior
anterior group extensor hallucis longus
extensor digitorum longus soleus
lateral group peroneus longus
peroneus brevis
superficial layer:
gastrocnemius
soleus
posterior group deep layer:
flexor hallucis longus
tibialis posterior tendo calcaneus
flexor digitorum longus
Muscles and principal blood vessels and principal nerves
Muscles of the lower limb:
Muscles of the leg:

tibialis anterior
anterior group extensor hallucis longus
extensor digitorum longus tibialis posterior

lateral group peroneus longus

flexor digitorum
peroneus brevis longus
superficial layer: flexor hallucis longus
gastrocnemius
soleus
posterior group deep layer:
flexor hallucis longus
tibialis posterior
flexor digitorum longus
blood vessels and nerves
arteries

femoral artery

popliteal artery
　

anterior tibial artery posterior tibial artery

dorsal artery of foot

medial plantar artery

lateral plantar artery

blood vessels and nerves
nerves
femoral nerve
saphenous nerve
sciatic nerve
tibial nerve
common peroneal nerve
superficial peroneal nerve

deep peroneal nerve

Regional structures
Lacuna musculorum
Lacuna vasorum
Femoral triangle
　 Femoral sheath Femoral canal Femoral ring
Adductor canal
Space deep to gluteus maximus
Posterior space of thigh
Popliteal fossa
Posterior space of leg
Malleolar canal
Lacuna musculorum
Boundaries
anterior: inguinal ligament
posterior: ilium
medial: iliopectineal arch
　
Contents
iliopsoas
femoral nerve
Communicating
Superiorly:fascial inferior cavity lacuna musculorum

Inferiorlu:femoral triangle
Lacuna vasorum
Boundaries
anterior: inguinal ligament
posterior: pectineal ligament
Lateral: iliopectineal arch
medial:
　 lacunar ligament
Content
femoral sheath
femoral vessels
femoral canal
lacuna vasorum
Communicating
Superiorly: posterior space of peritoneum
Inferiorlu: femoral triangle
Femoral triangle

Position:It is a triangular depression on the front

of the upper one-third of the thigh
immediately below the inguinal ligament.

　
Boundaries:
lateral: medial border of sartorius
medial: medial border of the adductor
longus base: inguinal ligament
roof : skin, superficial
fascia, deep fascia floor: adductor
longus, their fasciae
pectineus, iliopsoas and
Femoral triangle
Communicating:
superiorly: lacuna musculorum
lacuna vasorum
inferiorly: adductor canal
　
Contents: (from laterally to medially)
femoral nerve,
femoral artery,
femoral vein, femoral sheath

femoral canal
Femoral artery

superficial branches external

iliac a.
superficial epigastric a.
superficial iliac circumflex a. femoral a.
external pudendal a.

deep branches
deep femoral a.
deep external pudendal a.
muscular branches
 external iliac artery
superficial iliac circumflex artery
superficial epigastric artery
deep femoral artery
lateral femoral circumflex artery
femoral artery
medial femora circumflex artery

Femoral artery
superficial branches
superficial epigastric a.
superficial iliac circumflex a. deep branches
external pudendal a. deep femoral a.
deep external pudendal a.
muscular branches
 external iliac a.
femoral a.
deep femoral a. medial femoral circumflex a.
lateral femoral circumflex a.

perforating a.

Femoral artery
deep femoral artery
medial femoral circumflex a.
lateral femoral circumflex a.
three perforating arteries
femoral artery
Pulsations of the femoral artery can be felt at the
midinguinal point. A bilateral absence or feebleness of
the femoral pulse may result from coarctation or
narrowing of the aorta, or thrombosis .
It can be compressed at the midinguinal point against the
head of the femur or against the superior ramus of the
pubis to control bleeding from the distal part of the limb.
Since the femoral artery is quite superficial in the
femoral triangle, it can be easily exposed for ligation or
for passing a cannula or a thick needle.
Femoral vein
It locates medially to the femoral artery at
the base of the femoral triangle, but
posteromedially to the artery at the apex.

It is commonly used for intravenous

infusions in infants and in patients with
peripheral circulatory failure. .
Stab wounds at the apex of the femoral
triangle may cut all the large vessels of the
lower limb because the femoral artery and
vein, and the profunda femoris artery and
vein are arranged in one line from before
backwards at this site.
Femoral nerve
anterior division
muscular branch: sartorius branch
cutaneous branch: medial cutaneous nerves
intermediate cutaneous nerve
posterior division
muscular branch: rectus femoris branch
three vasti branch
cutaneous branch: saphenous nerve
The hip joint is supplied by the nerve to the rectus femoris.
The knee joint is supplied by the nerves to the three vasti.
Femoral nerve
In the thigh, it lies in the groove
between the iliacus and the psoas major,
outside the femoral sheath, and lateral to
the femoral artery. .
It not only supply the hip joint, but also
the knee joint. Therefore, diseases of the
hip may produce referred pain in the
knee and also in the cutaneous area
innervated by its branch.
Deep inguinal lymph nodes:

The deep inguinal lymph nodes are about four to

five in number, and lie medial to the upper part of
the femoral vein. These nodes receive afferents from
(a) the superficial inguinal lymph nodes; (b) the
popliteal lymph nodes; (c) glans penis or clitoris;
and (d) the deep lymphatics of the lower limb.
 femoral sheath
Femoral sheath
It is a funnel-shaped sleeve of
fascia enclosing the upper 3 to 4
cm of the femoral vessels.
The anterior wall of the sheath is
　
formed by the transverse fascia;
and the posterior wall is formed by the iliac fascia. Inferiorly,
the sheath merges with connective tissue around the femoral
vessels.
It is divided into the following three compartments by septa.
The lateral compartment contains the femoral artery. The
intermediate compartment contains the femoral vein. The
medial compartment is known as the femoral canal.
Femoral canal femoral ring
Posotion: medial compartment of the
femoral sheath
Shape: It is conical in shape and about
1.5 cm long.
Content: a lymph node, areolar tissue
　
Communicating:
superiorly: abdominal cavity
Femoral ring femoral canal

The upper end of the femoral canal is called the femoral ring.
Boundaries:
anterior : inguinal ligament medial: lacunar ligament
posterior: pectineus and its covering fascia
lateral: septum separating it from the femoral vein
Adductor canal
Posotion: on the medial side of the middle
one-third of the thigh
Shape: triangular on cross-section
Boundaries:
　 wall: vastus medialis
anterior
medial wall : a strong fibrous membrane
posterior wall: adductor longus, adductor
magnus adductor
canal
Content: saphenous nerve, femoral artery ,
femoral vein
Communicating:
superiorly: femoral triangle
Inferioe: popliteal fossa
Adductor canal
The femoral artery enters the canal at the apex of the
femoral triangle. Within the canal it gives off
muscular branches and a descending genicular
branch. .
The
　 femoral vein lies posterior to the femoral artery
in the upper part, and lateral to the artery in the
lower part of the canal.
The saphenous nerve leaves the canal with the
saphenous artery by piercing the the fibrous
membrane. .
The femoral artery is exposed in the adductor canal
for various surgical procedures.
Space deep to gluteus maximus
Posotion: deep to gluteus maximus
Content:
superior gluteal artery, vein and nerve;
saiatic nerve.
posterior
　 femoral cutaneous nerve;
inferior gluteal artery, vein and nerve;
internal pudendal artery, vein and pudendal
nerve;
Communicating:
deeply: pubic cavity
anterioinferiorly: below the hip joint
inferiorly: posterior space of thigh
medialinferiorly: ischiorectal fossa
 gluteus maximus
gluteus medius The piriformis divides the
gluteus minimus greater sciatic foramen into
piriformis
two parts: suprapiriform
obturator internus
foramen and infrapiriform
quadratus femoris
　 foramen. .
suprapiriform foramen:
superior gluteal artery, vein and nerve
infrapiriform foramen:
saiatic nerve.
posterior femoral cutaneous nerve;
inferior gluteal artery, vein and nerve;
internal pudendal artery, vein and pudendal nerve;
 Posterior space of thigh

Position:
between the posterior
group muscles of the thigh sciatic nerve
　
Content:
sciatic nerve
Communicating:
superiorly: space deep to
gluteus maximus
Inferiorly: popliteal fossa
Popliteal fossa
Position:a diamond-shaped depression lying behind the knee joint.
Boundaries:
common peroneal nerve
superolaterally: biceps femoris
tibial nerve
superomedially: semitendinosus , popliteal artery
popliteal
　 semimembranosus vein

inferolaterally: lateral head of gastrocnemius

inferomedially: medial head of gastrocnemius
roof: deep fascia of popliteal fascia
floor : popliteal surface of the femur , capsule
of the knee joint, popliteal fascia covering the
popliteal muscle
Popliteal fossa
Contents and arrangement:
1.on the midline of the popliteal fossa,from the superficial to deep:
tibial nerve, popliteal vein and popliteal artery
2.crossing the fossa obliquely from the superior angle to the
lateral
　 angle, along the medial border of the biceps femoris:
common peroneal nerve
common peroneal nerve
3.popliteal lymph nodes and fat
tibial nerve
Communicating: popliteal
artery popliteal
superiorly: popliteal fossa vein
inferiorly: malleolar canal
The common peroneal nerve can be palpated
against the posteriolateral side of the neck of
the fibula. It may be injured in this area.
Posterior space of leg
Position:between the superficial and
deep layer muscles of the posterior
posterior group of leg. tibial
artery
fibular artery
　
Contents: tibial nerve

posterior tibial artery, veins and tibial nerve

fibular artery and veins
Communicating:
superiorly: popliteal fossa
inferiorly: malleolar canal
Malleolar canal
Position:inferior to the medial malleolus
Constitution: common peroneal nerve
flexor retinaculum and calcaneus
tibial nerve
popliteal artery
　 popliteal
vein
Contents: from anterior to posterior

tendon of tibialis posterior

tendon of flexor digitorum longus
posterior tibial artery
posterior tibial veins
tibial nerve
flexor pollicis longus
Dissection (Second time)
1. Reflect the deep fascia.
2. Examine the muscles located in the anterior surface and medial surface of
the thigh, make certain the boundaries of the femoral triangle, and then
identify its contents e.g., from laterally to medially, they are femoral nerve,
femoral artery and femoral vein.
On lifting the middle one-third of sartorius, a part of deep fascia stretches
between vastus medialis and adductor muscles is exposed. On longitudinal
division of this strongfascia, the adductor canal is visualised. Dissect its
contents. From superficial to profundal, they are saphenous nerve, femoral
artery, and femoral vein. Find out and examine the femoral artery and its
branched.
3. Examine the muscles located in the anterior surface and lateral surface of
the leg, try to find out the anterior tibial artery and its accompanies anterior
tibial veins; deep peroneal nerve; superficial peroneal nerve.
Dissection (Second time)
4. Place the cadaver in the prone position, and reflect the deep fascia.
5. Reflect the gluteus maximus to examine the underlying structures.
For this, first identify the lower border of the gluteus maximus; then
insert a forceps on the deep surface of gluteus maximus; finally cut it
from below upwards lateral to its origin 1 centimeter. Reflect gluteus
maximus lateroinferiorly. Piriformis is the key muscle of the gluteal
region, define its superior and inferior margins; blood vessels and
nerves which pass through the suprapiriform foramen and
infrapiriform foramen.
6. Examine the posterior group muscles of thigh, define the posterior
space of the thigh and find out the sciatic verve.
Dissection (Second time)
7.Examine the boundaries of the popliteal fossa, remove the fat
and then dissect the popliteal artery and its branches, the popliteal
vein and its tributaries, the tibial nerve and its branches; the
common peroneal nerve and its branches.
8. Examine the posterior group muscles of leg; cut off the lateral
head of gastrocnemius and the medial head of gastrocnemius and
then reflect them laterally; observe the soleus. Cut off the soleus
and expose the posterior space of leg; try to find out the posterior
tibial artery, veins and tibial nerve on the midline, find out the
fibular artery, veins laterally.
9. Posterior to the medial malleolus, cut off the flexor retinaculum
and expose the malleolar canal. From anteriorly to posteriorly,
identify the tendon of tibialis posterior, tendon of flexor digitorum
longus, posterior tibial artery, posterior tibial veins, tibial nerve,
and flexor pollicis longus.