DissectionoftheThighPreparation:reviewtheimportantlandmarks,

suchastheinguinalligament,whichseparatestheanteriorthighfromtheanteriorabdominalwall,thepubictubercle,andtheanteriorsuperioriliacspine,tuberosityoftibiaStep1

SkinthethighDissectionoftheThighPreparation:reviewtheimportantlandmarks,suchastheinguinalligament,whichseparatestheanteriorthighfromtheanteriorabdominalwall,thepubictubercle,andtheanteriorsuperioriliacspine,tuberosityoftibiaStep1

SkinthethighDissectionoftheThighStep2DissectthesuperficialfasciaFindandtracethegreatersaphenousveinanditstributaries.Findthelateral

femoralcutaneousnervesandcutaneousbranchesoffemoralnervesYoumaymeetwithsomesuperficialinguinallymphnodesalongtheinguinallig.andtheendofgreatersaphenousveinPreservethesuperficalveinsandcutaneousnerves,thenremovethesuperficialfasciaDissectionoftheThighStep3

DissectthedeepfasciaofthighExposethefascialataanditsthickeningpartlaterally,theiliotibialtract.Identifytheandcleanthesaphenoushiatus

FlipthedeepfasciaDissectionoftheThighStep4

DissecttheanteriorcompartmentofthethighCleanandidentifyanteriorgroupofmusclesofthethighSartorius

Quadricepsfemoris

Rectus

femoris

Vastus

medialis

Vastus

lateralis

Vastus

intermedius

DissectionoftheThighStep5

Dissectthefemoraltriangle

IdentifytheboundaryofthefemoraltriangleDemonstratethefemoralsheathandfemoralcanal.Tracestheupperopeningoffemoralcanal(femoralring)Identifythecontentsinfemoraltriangle,cleanandtracethefemoralN.A.V.anddeepinguinallymphnodesTracethefemoralA.V.andsaphenousnervedownwardintotheadductorcanal(ofHunter)beneaththesartoriusDissectionoftheThighStep6

Dissectthefemoralartery

Recallthatthepectineus,

illiopsoas

andtheirfasciaformthe"floor"ofthefemoraltriangle.Cleanthedeepfemorala.ofthefemoralartery.Acloserviewshowsthemedialfemoralcircumflexarteryandthelateralfemoralcircumflexa.fromthedeepfemorala.Don’tcutDissectionoftheThighStep7

Dissecttheadductorcompartment.Cleanandidentifythemusclesoftheadductorcompartment(Pectineus,Adductorlongus,Adductorbrevis,Adductormagnus,Gracilis)Findtheanteriorandposteriorbranchesoftheobturatornerveoneithersideoftheadductorbrevismuscle

Attempttofindtheanteriorandposteriorbranchesoftheobturatorartery.Don’tcutDissectionoftheThighStep8Dissecttheadductorcanal(ofHunter).IdentifytheboundaryoftheadductorcanalIdentifythecontentsinadductorcanalsaphenousnervefemoralarteryfemoralveinDissectionoftheThighStep9

Demonstrate

theLacunamusculorumandLacunavasorumIdentifytheboundariesandcontentsinLacunamusculorum

IdentifytheboundariesandcontentsinLacunavasorumDon’tcutDissectionoftheLegPreparation:Reviewimportantlandmarkssuchasheadoffibula,neckoffibula,medialandlateralmalleolusStep1

SkinthelegDissectionoftheLegStep2DissectthesuperficialfasciaSearchforthegreatersaphenousveinandtheaccompanyingsaphenousnerveontheanteriomedialside.TraceandcleanthemtothebackoffootFindthesuperficialperonealnerveatthemid-inferior1/3oflegonthelateralside.TracethebranchestothebackoffootPreservethesuperficalveinsandcutaneousnerves,thenremovethesuperficialfasciatoexposethedeepfascia.Step3cleanthedeepfasciaandshapethesuperiorandinferiorextensorretinaculum.Flipthedeepfascia（keeptheretinaculumintact）DissectionoftheLegStep4Dissectthemuscles,nervesandarteriesinanteriorcompartmentoftheleg.Separateandidentifythemusclesoftheanteriorcompartment(tibialisanterior,

extensorhallucis

longus,

extensordigitorum

longus)Cleanandidentifytheanteriortibialartery,anteriortibialveinanddeepperonealnerverunninglateraltotibialisanterior.

Don’tcutDissectionoftheLegStep5

Dissectthemuscles,nervesandarteriesinlateralcompartmentofthelegSeparateandidentifythemusclesofthelateralcompartment(peroneus

longus,peroneus

brevis

)FindthecommonperonealnerveneartheneckoffibulaandtracethesuperficialperonealnerverunningdownwardsbetweenthemusclesDissectionofthedorsumoffeetStep1SkinthefeetStep2DissectthesuperficialfasciaTracethegreatandsmallsaphenousveintothedorsalvenousarchoffoot

Cleansaphenousn.accompanyingGSVandsural

n.(lateraldorsalcutaneousn.offoot)accompanyingSSVTracesuperficialperonealnervesanditsbranches(medialandintermmediatedorsalcutaneousnerveoffoot)SearchfortheendofdeepperonealnerveneartheinterdigitalcleftofthebigandsecondtoesDissectionofthedorsumoffeetStep3

Cleanthedeepfascia

Shapethesuperiorandinferiorextensorretinaculum

Flipthedeepfascia（keeptheretinaculumintact）Step4Cleanandidentifythetendonsofextensorhallucis

longus,extensordigitorum

longusIdentifytheextensordigitorum/hallucis

brevisTracethedeepperonealnerveTracethe

dorsalis

pedisarteryandveinYoumustidentifyfollowstructures！MusclesPsoas

Iliacus

髂腰肌Tensorfaciae

latae

闊筋膜張肌Sartorius縫匠肌Quadricepsfemoris

股四頭肌Rectusfemoris

股直肌Vastus

medialis

股內側肌Vastus

lateralis

股外側肌Vastus

intermedius

股中間肌Patellarligament髕韌帶Pectineus

恥骨肌Adductorlongus

長收肌Adductorbrevis

短收肌Adductormagnus

大收肌Gracilis

股薄肌Tibialisanterior脛骨前肌Extensorhallucis

longus

拇長伸肌Extensordigitorum

longus

趾長伸肌Peroneus

longus

腓骨長肌

Peroneus

brevis

腓骨短肌

VesselsGreatsaphenousv.大隱靜脈Femorala.股動脈Deepfemorala.股深動脈Anteriortibiala.脛前動脈Dorsala.offoot足背動脈Nervesfemoraln.股神經Saphenousn.隱神經Obturatorn.閉孔神經Deepperonealn.腓深神經Superficialperonealn.腓淺神經ReviewDescribetheboundariesandcontentsofthelacunavasorumandlacunamusculorum

Describetheboundariesandcontentsofthefemoraltriangleandadductorcanal.Brieflydescribetheinnervationofthemuscleswhichevertandinvertthefoot.

Apatientisstabbedinthethighjustbelowthemiddleoftheinguinalligament.Whatstructuresmaybedamaged?Whatwillbetheeffectofthetraumatothemajornervehere.ReviewDescribethebeginnings,courseandendingsofgreatandsmallsaphenousveins.Describethemainarterialtreeofthelowerlimb.Namethreesiteswhereperipheralpulsemaybepalpated.Describetheorigin,courseanddistributionofthefemoralnerve,

superficialperonealnerveanddeepperonealnerves.

DissectionoftheGluteusPreparationpalpateimportantlandmarkssuchasthesacrum,ischial

tuberosity,andgreatertrochanterofthefemur

Step1SkinthebuttocksStep2

Dissectthesuperficialfascia：searchforsuperior,

medialandinferiorcluneal

cutaneousnerves，preserveanycutaneousnervesyoumayfindinsuperficialfasciathenremovethefasciaStep3observetheglutealfasciaDissectionoftheGluteusStep3DissecttheGluteus

Isolateandreflectthegluteusmaximusfromitsiliacorigin(isolatetheinferiorgluteala.andn.wheretheyenterthegluteusmaximus,thencutabuttonhole.Palpatethestrongsacrotuberousligamentandcarefullyremovethegluteusmaximuslaterally，Donotcutthisligament)DissectionoftheGluteusStep4DissecttheGluteusFreeand

Identifypiriformisgluteusmedius

gluteus

minimus

obturator

internusquadratus

femoris.DissectionoftheGluteusStep5DissectthebloodvesselsandnervespassingthroughthesuprapiriformforamenCleanandidentifysuperiorglutealn.superiorgluteala.superiorglutealv.

PayattentiontotheirrelationshipDissectionoftheGluteusStep6DissectthebloodvesselsandnervespassingthroughtheinfrapiriformforamenCleanandidentifysciaticn.posteriorfemoralcutaneousn.inferiorglutealn.,a.v.,internalpudendal

a.v.,pudendaln.

PayattentiontotheirrelationshipDissectionoftheGluteusStep7Dissectthebloodvesselsandnervespassingthroughthelessersciaticforamen

Cleanandidentifyinternalpudendalv.a.pudendaln.

(tendonof)obturator

internusPayattentiontotheirrelationshipDissectionofthePosteriorThighandPopliteal

FossaStep1

skinthethighandpopliteal

fossaStep2dissectthesuperficialfasciaClearnandidentifytheposteriorfemoralcutaneousn.

andupperendofsmallsaphenousvein.Preservethesuperficalveinsandcutaneousnerves,thenremovethesuperficialfasciaStep3FlipthedeepfasciaDissectionofthePosteriorThighandpopliteal

fossaStep4

DissecttheposteriorosseofascialcompartmentofthethighSeparateandidentifythesemitendinosus,semimembranosusandthebicepsfemoris.

Identifythesciaticnerveandtraceitdownwardstoitsbranches(tibialnerveandcommonperonealnerve).DissectionofthePosteriorThighandpopliteal

fossaStep5

Dissectthepopliteal

fossa

Identifythebounderiesofpopliteal

fossa（diamond-shaped）Clearnandidentifythecontentsinpopliteal

fossa

tibialnervecommonperonealnervepoplitealveinpoplitealarteryanditsbranchespopliteallymphnodeDissectionofthePosteriorLeg

Step1

skinthelegStep2dissectthesuperficialfascia

Clearnandidentifythe

smallsaphenousvein,medialandlateral

sural

cutaneousnerves,suralnervePreservethesuperficalveinsandcutaneousnerves,thenremovethesuperficialfasciaStep3FlipthedeepfasciaDissectionofthePosteriorLegStep4dissecttheposteriorosseofascialcompartmentoflegCleanandidentifythethe

gastrocnemius

andcutitslateralandmedialheadstoexposethesoleusandplantaris.Alsotendo

calcaneus.（superficiallayerofmuscles）Placeyourforcepsbeneaththemedialheadofthesoleusmuscleandreflectorcutit(preservethetendineousarchofsoleusintact)toexposethetibialn.,posteriortibiala.andmusclesofthedeeplayerDissectionofthePosteriorLegStep5dissectthebloodvesselandnerveCleanandidentifythetibialn.,posteriortibiala.betweenthesuperficialanddeeplayersofmuscle,Tracethemdownwardintothemalleolarcanal

DissectionofthePosteriorLegStep6dissectthedeeplayerofmusclesCleanandidentifythemusclesofthedeeplayerFlexordigitorum

longusTibialisposteriorFlexorhallucis

longus

Dissectionofthemalleolarcanal

Step1

exposeandshapetheflexorretinaculumbetweenthemedialsurfaceofcalcaneusandmedialmalleolusStep2

cleanandidentifythestructurespassingthroughthemalleolarcanalTendonoftibialisposteriorTendonofflexordigitirum

longusPosteriortibiala.v.andTibialn.Tendonofflexorhallucis

longusYoumustide