Lower Limb Regional

REGIONAL ANATOMYREGIONAL ANATOMY

General introduction Body wall Head and neck Limbs Thoracic cavity Abdominal

cavity Pelvic cavity

解剖学总论运动系统内脏学脉管系统感觉器神经系统内分泌系统

Classification of Human anatomy

systematic anatomyregional anatomy

histologycytology

Microscopic anatomy :

Gross anatomy :


limbsupper limb lower limb

Four major regions

headcraniumface

trunk

backthoraxabdomenpelvis and perineum

neck anterior region of neckposterior region of neck


lower limb

Anterior boundary: fold of groin

Lateral boundary: iliac crest

Posterior boundary: iliac crest,

superior border of the sacrum

Boundaries

Subarea

glutear region, thigh, knee, leg, ankle,foot.


lower limbSurface landmarksiliac crestanterior superior iliac spinetubercle of iliac crestposterior superior iliac spinepubic tubercleischial tuberositygreater trochanterpatellamedial condyle of femurlateral condyle of femur

adductor tuberclemedial condyle of tibialateral condyle of tibiatibial tuberosity medial border of tibiafibular headmedial malleoluslateral malleolus


4. tubercle of iliac crest

6. ischial tuberosity

2. anterior superior iliac spine

1. iliac crest

iliac tuberosity

3.posterior superior iliac spine

5. pubic tubercle


medial condyle

greater trochanter

lateral epicondyle

adductor tubercle medial epicondyle

lateral condyle


patellar ligament


medial condyle

lateral condyle

tibial tuberosity

medial malleolus

lateral malleolus

fibular head


lateral head of gastrocnemius

medial head of gastrocnemius

tendo calcaneus

soleus


Surface markings of blood vessels and nerves

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.


Skin

Superficial fascia

Deep fascia

Muscles, principal blood vessels and principal nerves

Bones and joints

deep fascia

skin

superficial fascia

boneintermuscular septum

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.



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.


great saphenous vein

Cutaneous Veins in the Superficial fascia

In the leg, the saphenous nerve runs in front of the great saphenous vein. .


superficial epigastric veinsuperficial iliac circumflex vein

external pudendal vein

superficial lateral femoral vein superficial medial femoral vein

saphenous nerve


Characteristic of great saphenous vein


It contains about 10 to 15 valves which prevent back flow of the venous

blood. Incompetence of these valves makes the vein dilated and tortuous

leading to varicose vein.

It is connected to the deep veins of the lower limb by perforating veins. T

he perforating veins are also provided with valves which permit flow of blo

od only from the superficial veins to the deep veins. Failure of these valve

s also gives rise to varicose vein.

It is superficial in the front of the medial malleolus. It is the site that used f

or venous puncture or venous cutting.


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 veindorsal venous arch of foot


small saphenous vein

femoral veinfemoral veinpopliteal veinpopliteal vein

great saphenous veingreat saphenous vein

small saphenous veinsmall saphenous vein

dorsal venous arch of foot

dorsal venous arch of foot

国

Superficial fascia


Cutaneous Arteries in the Superficial fascia

Superficial epigastric artery: It pierces the cribriform fascia, runs towards the

umbilicus, and supplies the lower part of the ant

erior abdominal wall. .

Superficial iliac circumflex artery : It pierces the fascia lata lateral to the saphenous o

pening, runs upwards below the inguinal ligament.

External pudendal artery :

It pierces the cribriform fascia, runs medially in f

ront of the spermatic cord, and supplies the ext

ernal genitalia. .


Cutaneous Nerves in the Superficial fascia

Lateral cutaneous nerve of the thigh : It is a branch of the lumbar plexus and emerges in the superficial fascia below the anterior superior iliac spine about 8-10 cm. It supplies the skin on the anterolateral side of the thigh. .

Medial cutaneous nerve of the thigh : It is a branch of the femoral nerve and supplies the skin on the medial side of the lower two-thirds of the thigh, and of the upper one-third of the leg.

Intermediate cutaneous nerve of the thigh : It is a branch of the femoral nerve and pierces the deep fascia at the junction of the upper one-third and middle one-third of the thigh. It supplies a strip of skin on the front of the thigh. .



Posterior femoral cutaneous nerve It is the branch of the sacral plexus and descends d

eep to the deep fascia in the posterior surface of th

e thigh. It pierces the deep fascia superior to the po

pliteal fossa and emerges in the superficial fascia. It

supplies the skin of posterior region of thigh and po

pliteal region.

Saphenous nerve : It is the terminal branch of the femoral nerve and

pierces the deep fascia on the medial side of the k

nee, runs down in front of the great saphenous vei

n, and supplies the skin on the medial side of the l

eg. .



The lateral sural cutaneous nerve is the br

anch of the common peroneal nerve. The medial sural cutaneous nerve is the branch of th

e tibial nerve. These two nerves supplies the skin

on the posterior aspect of the leg and forms the sural nerve at the junction of the upper two-third

s and lower one-third of the leg. The sural nerve

accompanies the small saphenous vein. .


Superficial Lymph Nodes in the Superficial fascia

Superficial inguinal lymph nodes:

Arrangement is T-shaped.

A lower vertical group is placed along both sides

of the terminal part of the great saphenous vein.

A upper horizontal group is placed below of the i

nguinal ligament.

They drain the skin and fascia of the lower limb; t

he perineum and trunk below the umbilical plane.

Efferents from all nodes terminate in the deep ing

uinal nodes. A few may pass directly to the exter

nal iliac nodes.


Superficial Lymph Nodes in the Superficial fascia

Popliteal Lymph Nodes:

These nodes lie near the termination of the small saphenous v

ein, deep to the deep fascia.

They receive afferents from:

the territory of the small saphenous vein th

e deep parts of the leg the

knee joint.

Their efferents terminate in the deep inguinal nodes.


Deep fascia

Deep fascia of the thigh ( fascia lata )

It is thickened laterally where it forms a 5 cm wide band call

ed the iliotibial tract which can stabilizes the knee joint and

become the main support of the knee against gravity.

It is a tough fibrous sheath that envelops the whole of the thigh like a sleeve.

The intermuscular septa of the thigh include lateral, medial, and posterior intermuscular septa and divide the thigh into three compartments.

Saphenous Opening (saphenous hiatus) is an oval opening

in the fascia lata.The centre of the opening is 4 cm below a

nd 4 cm lateral to the pubic tubercle. The opening has a sha

rp crescentic lateral margin called the falciform margin and

is closed a very thin membrane called cribriform fascia.


Deep fascia

Deep fascia of the gluteal region : Above and in front of the gluteus maximus:

thick, dense , opaque and pearly white

over the gluteus maximus:

thin and dense

to split and enclose the gluteus maximu

Deep fascia of the leg: It forms the intermuscular septa to separate the m

uscles of leg into three groups

Around the ankle, It is thickened to form bands cal

led retinacula. The retinacula have function to reta

in tendons in place.


Deep fascia

Deep fascia of the foot:

The deep fascia covering the sole is thic

k in the center and thin at the side. The t

hicked center part is known as the planta

r aponeurosis, which is triangular in shap

e. . .

The functions of the plantar aponeurosis

are to fix the skin of the sole; to protect d

eeper structures; to help in maintaining t

he longitudinal arches of the foot; and to

give origin to muscles.


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.



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.



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.



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.



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

posterior group

iliopsoastensor fasciae latae

gluteus maximusgluteus mediusgluteus minimuspiriformis

psoas major

iliacus

psoas majortensor fasciae latae

gluteus minimus

gluteus maximus

gluteus medius

piriformis

obturator internus

quadratus femoris



Muscles of the lower limb:

Muscles of the Thigh

sartoriusquadriceps femoris

gracilis, pectineusadductor longusadductor brevisadductor magnus

anterior group

medial group

posterior group

biceps femorissemitendinosussemimembranosus

sartorius

rectus femoris

vastus lateralis

vastus medialis

iliotibial tract

tensor fasciae latae

patellar ligament




vastus intermedius.

vastus lateralis

vastus medialis



anterior group

medial group

posterior group






pectineus

adductor longus

gracilis




anterior group

medial group

posterior group





pectineus

adductor brevis

gracilis

adductor magnus

adductor longus



anterior group

medial group

posterior group






semitendinosus

biceps femoris

semimembranosus



anterior group

medial group

posterior group





Muscles of the lower limb: Muscles of the leg:

tibialis anterior

extensor digitorum longus

extensor hallucislongusdeep layer:

gastrocnemiussoleus

anterior group

lateral group peroneus longusperoneus brevis

tibialis anteriorextensor hallucis longusextensor digitorum longus

superficial layer:

flexor hallucis longustibialis posteriorflexor digitorum longus

posterior group




tibialis anterior

extensor digitorumlongus

extensor hallucis longus

deep layer:

gastrocnemiussoleus

anterior group



superficial layer:


posterior group




peroneus longus

peroneus brevis

deep layer:

gastrocnemiussoleus

anterior group



superficial layer:


posterior group




lateral head of gastrocnemius

medial head of gastrocnemius

deep layer:

gastrocnemiussoleus

anterior group



superficial layer:


posterior group




tendo calcaneus

soleus

deep layer:

gastrocnemiussoleus

anterior group



superficial layer:


posterior group




tibialis posterior

flexor digitorum longus

flexor hallucis longus

deep layer:

gastrocnemiussoleus

anterior group



superficial layer:


posterior group


　

femoral artery

popliteal artery

anterior tibial artery posterior tibial artery

lateral plantar artery

medial plantar artery

blood vessels and nervesarteries

dorsal artery of foot


femoral nerve

saphenous nerve

sciatic nerve

tibial nerve

common peroneal nerve

superficial peroneal nerve

deep peroneal nerve

blood vessels and nervesnerves


　

Lacuna musculorumLacuna vasorumFemoral triangleFemoral sheath Femoral canal Femoral ringAdductor canalSpace deep to gluteus maximusPosterior space of thighPopliteal fossaPosterior space of legMalleolar canal

Regional structures


　

lacuna musculorum

Lacuna musculorumBoundaries

anterior: inguinal ligamentposterior: iliummedial: iliopectineal arch

Contents

iliopsoasfemoral nerve

Communicating

Superiorly:fascial inferior cavityInferiorlu:femoral triangle


　

lacuna vasorum

Lacuna vasorumBoundaries

anterior: inguinal ligamentposterior: pectineal ligamentLateral: iliopectineal archmedial: lacunar ligament

Contentfemoral sheathfemoral vesselsfemoral canal

Communicating

Superiorly: posterior space of peritoneumInferiorlu: femoral triangle


　

Femoral triangle

Position: It is a triangular depression on the fron

t of the upper one-third of the thigh immediate

ly below the inguinal ligament.

Boundaries:

lateral: medial border of sartorius

medial: medial border of the adductor l

ongus base: inguinal ligament

roof : skin, superficial fas

cia, deep fascia floor: adductor lon

gus, pectineus, iliopsoas and their fasciae


　

Femoral triangle

Communicating:

superiorly: lacuna musculorum

lacuna vasorum

inferiorly: adductor canal

Contents: (from laterally to medially)

femoral nerve,

femoral artery,

femoral vein,

femoral canal

femoral sheath


femoral a.

external iliac a.

Femoral artery

superficial branches

superficial epigastric a.

superficial iliac circumflex a.

external pudendal a.

deep branches

deep femoral a. deep external pudendal a. muscular branches


femoral artery

deep femoral artery

medial femora circumflex artery

lateral femoral circumflex artery

external iliac arterysuperficial iliac circumflex artery

superficial epigastric artery

Femoral artery

superficial branchessuperficial epigastric a.

superficial iliac circumflex a.

external pudendal a.

deep branchesdeep femoral a.

deep external pudendal a.

muscular branches


Femoral artery

deep femoral artery medial femoral circumflex a.

lateral femoral circumflex a.

three perforating arteries

deep femoral a.femoral a. medial femoral circumflex a.

lateral femoral circumflex a.

external iliac a.

perforating a.


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

posterior division

muscular branch: rectus femoris branch

three vasti branch

cutaneous branch: saphenous nerve

anterior division

muscular branch: sartorius branch

cutaneous branch: medial cutaneous nerves

intermediate cutaneous 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 fiv

e in number, and lie medial to the upper part of the f

emoral vein. These nodes receive afferents from (a)

the superficial inguinal lymph nodes; (b) the poplite

al lymph nodes; (c) glans penis or clitoris; and (d) th

e 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


　

Femoral canal

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

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

Femoral ring


　

Adductor canal

Posotion: on the medial side of the middle one-third of the thighShape: triangular on cross-sectionBoundaries: anterior wall: vastus medialis medial wall : a strong fibrous membrane posterior wall: adductor longus, adductor magnus Content: saphenous nerve, femoral artery , femoral veinCommunicating: superiorly: femoral triangleInferioe: popliteal fossa

adductor canal


　

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.


　

Posotion: deep to gluteus maximusContent: 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 cavityanterioinferiorly: below the hip jointinferiorly: posterior space of thighmedialinferiorly: ischiorectal fossa

Space deep to gluteus maximus


　

suprapiriform foramen:superior gluteal artery, vein and nerve

gluteus minimus

gluteus maximus

gluteus medius

piriformis

obturator internus

quadratus femoris

The piriformis divides the greater sciatic foramen into two parts: suprapiriform foramen and infrapiriform foramen. .

infrapiriform foramen:saiatic nerve.posterior femoral cutaneous nerve;inferior gluteal artery, vein and nerve;internal pudendal artery, vein and pudendal nerve;


　sciatic nerve

Posterior space of thigh

Position:

between the posterior

group muscles of the thigh

Content:

sciatic nerve

Communicating:

superiorly: space deep to

gluteus maximus

Inferiorly: popliteal fossa


　

Popliteal fossa

Boundaries: superolaterally: biceps femoris

superomedially: semitendinosus ,

semimembranosus

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

tibial nerve


popliteal vein

popliteal artery

Position: a diamond-shaped depression lying behind the knee joint.


　

tibial nerve


popliteal vein

popliteal artery

Popliteal fossaContents and arrangement:

2.crossing the fossa obliquely from the superior angle to the lateral angle, along the medial border of the biceps femoris: common peroneal nerve

Communicating: superiorly: popliteal fossa inferiorly: malleolar canal

1.on the midline of the popliteal fossa,from the superficial to deep: tibial nerve, popliteal vein and popliteal artery

3.popliteal lymph nodes and fat

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

Communicating:

superiorly: popliteal fossa

inferiorly: malleolar canal

Position: between the superficial and

deep layer muscles of the

posterior group of leg.

tibial nerve

posteriortibial arteryfibular artery

Contents:

posterior tibial artery, veins and tibial nerve

fibular artery and veins


　

Malleolar canal

Constitution:

flexor retinaculum and calcaneustibial nerve


popliteal vein

popliteal artery

Position: inferior to the medial malleolus

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.



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.



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.

Lower Limb Regional

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