Question of the Day... Femoral Triangle

This question was taken from the Singapore August 2012 Exam.

Question:
Identify the femoral triangle, femoral vein, and the surrounding structures.

Answer:
Boundaries of the femoral triangle:

• Superior - inguinal ligament
• Medial - medial border of the Adductor Longus
• Lateral - medial border of Sartorius
• Floor (medial to lateral) - Pectineus, Adductor Longus, Iliopsoas
• Roof - Fascia Lata

  Contents (Lateral to medial)

Nerve - Femoral nerve

Artery - Femoral artery

Vein - Femoral Vein

Empty space - allows expansion of Femoral vein during periods where there is expanded intravascular volume

Lymph nodes - Femoral canal - Deep inguinal lymph nodes (node of Cloquet) and associated Lymph nodes

Just a note on the difference between the mid inguinal point and the mid point of the inguinal ligament.

Mid inguinal point = mid point of line drawn from ASIS to pubic symphysis

• This is the landmark for the femoral artery

Midpoint of inguinal ligament = mid point of line drawn from ASIS to pubic tubercle

• This is the landmark for the deep inguinal ring

Question of the Day... Critical Limb Ischaemia

This question is taken from the May Edinburgh 2013 Exam.

Question:
What are the diagnostic criteria for critical limb ischaemia?

Answer:
There are 3 main criteria for critical limb ischaemia.

1. Rest pain
2. Tissue loss
3. Ankle pressure of <50mmHg, ABPI <0.4, or Toe pressure of <30mmHg

Critical limb ischaemia is where the occlusion is no longer acute and the viability of the limb is threatened, requiring immediate management.

It is classically described with the 6 Ps:

Paraesthesia

Pain

Pallor

Pulselessness

Paralysed

Perishingly cold

Management of Critical Limb Ischaemia

In MRCS, the thing that you must remember is everything comes back to 1st principles. So when asked about management, first you talk about confirming the diagnosis (i.e investigations) then you talk about treatment. When talking about treatment, always start with A, B, and C.

A: Airway - intact

B: Ensure Oxygen is given

C: Ensure aggressive fluid resuscitation to avoid Reperfusion Syndrome. Place the patient on cardiac monitoring and monitor Urea and Electrolytes regularly. Consider doing an ABG and Lactate to further monitor acidosis and ischaemia

Management of CLI

In a nutshell!