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venous drainage and Lymphatics of lower limb

venous drainage and Lymphatics of lower limb. DR.QUDSIA SULTANA. Veins of lower limb. Superficial veins Great saphenous vein Small saphenous vein Deep veins Venae comitantes Perforating veins Communicating veins. Superficial: Great (long) saphenous vein Short (small) saphenous vein

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venous drainage and Lymphatics of lower limb

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  1. venous drainage and Lymphatics of lower limb DR.QUDSIA SULTANA

  2. Veins of lower limb • Superficial veins • Great saphenous vein • Small saphenous vein • Deep veins • Venae comitantes • Perforating veins • Communicating veins

  3. Superficial: Great (long) saphenous vein Short (small) saphenous vein Many tributaries of the above veins Deep veins: accompany arteries Anterior tibial Posterior tibial Popliteal Femoral Plantar arch and its tributaries Veins of the lower limb

  4. Deep veins Anterior tibial vein: Veins accompanying dorsal metatarsal arteries end in the dorsal venous arch (arcuate artery) Venous arch continues as the anterior tibial vein Finally joins with the posterior tibial vein to form popliteal vein

  5. Deep veins Posterior tibial vein: Plantar metatarsal veins join to for plantar arch (continues as lateral plantar vein) This will join the medial plantar vein and continue as posterior tibial vein This vein is joined by the peroneal or fibular vein

  6. Deep veins Posterior tibial vein combines with the anterior tibial vein and continues as popliteal vein These veins receive many tributaries corresponding to the branches of the arteries of same name

  7. Femoral vein Continuation of the popliteal vein Receives profunda femoris vein and its tributaries Many muscular veins form other tributaries of this vein Continues as external iliac vein

  8. Factors Responsible for Venous Return from Lower Limb • General factors : • Negative intra thoracic pressure( Recumbent position ). • The pulsations of accompanying arteries. • The valves allows the blood to flow in upward direction only. • The deep veins lie in the tight fascial compartment. ( upright position).

  9. Local factors: • Venous : Veins of lower limb are more muscular. Greater number of valves • Muscular : When the limb is active, muscular contraction compresses the deep veins and drives the blood in them upwards. • Fascial: Tight sleeve of deep fascia makes the muscular compression of the veins much more effective by limiting outward bulging of the muscles.

  10. Superficial Veins • Lie in superficial fascia. • Drain into deep veins at their termination. • Connected to deep veins through perforating veins. Superficial Veins are: • Dorsal Venous arch. • Great or long saphenous vein. • Small saphenous vein

  11. Dorsal Venous Arch

  12. Great Saphenous Vein • Longest Vein of the body .

  13. Great saphenous vein • Longest vein • Continuation of medial end of dorsal venous arch • Front of medial malleolus • A fingers breadth behind the medial border of tibia • One hands breadth posterior to patella

  14. Pierces cribriform fascia of Saphenous opening to drain into femoral vein

  15. Medial femoral cutaneous nerve • Structures accompanying • In thigh Medial femoral cutaneous nerve. • At knee Saphenous branch of descending genicular artery. • In leg and foot Saphenous nerve Saphenous nerve

  16. Valves in the Great Saphenous vein 10 -20 valves . Saphenofemoral valve is functionally important.

  17. Superficial circumflex iliac vein Superficial epigastric V Superficial external pudendal V Femoral V Posteromedial vein Antero lateral vein Great Saphenous V Saphenous nerve Anterior leg vein Medial malleolus Dorsal venous arch Posterior arch vein Tributaries • Posterior arch vein • Anterior leg vein • Anterolateral vein • Postero- medial vein • Superficial epigastric • Superficial circumflex iliac • Superficial external pudendal • Deep external pudendal

  18. Thoracoepigastric vein :

  19. Two types : • Direct • Indirect

  20. Indirect Perforators:Pass from: superficial veins muscular veins deep veins. • Direct Perforators:Pass from superficial veins deep veins. • constant in number and site

  21. Musculovenous Pump • Soleus is regarded as the peripheral heart.

  22. Perforating veins • Mid- Hunter: • Hunters Canal, connects Femoral with Great Saphenous Vein. • Knee: • Connects post tibial With Great Saphenous Vein. • Ankle: • Medial ankle – 3, Connects post tibial With GSV • Lateral ankle -1, Communicates the SSV with peroneal vein

  23. Perforating veins or Perforators

  24. Small saphenous vein Popliteal vein • Continuation of lateral end of dorsal venous arch • Lateral to tendo calcaneous • Sural nerve on lateral side • Dips into popliteal fossa • Drains into popliteal vein Small saphenous vein

  25. Bifurcates to drain into : • Great saphenous vein • Popliteal vein

  26. Applied anatomy

  27. Applied aspects Varicosities: • Thrombosis of deep veins • Increased intra abdominal pressure • Incompetency of valves • Incompetency of sapheno-femoral valve • Incompetency of valves in perforating veins

  28. 4 layered compression bandage technique. Increases venous return. Helps in healing of venous ulcers within 8 weeks .

  29. Tests to know the site of incompetence • BRODIE TRENDELENBURG TEST: -for sapheno femoral valve first empty the veins---sapheno femoral junction is compressed with the thumb --- patient is asked to stand up---pressure released --- varices fill from above---- sapheno femoral valve incompetency--- positive test to test the communicating system--- pressure is maintained—gradual filling of veins

  30. Elevate the patients limb & empty the L.L. veins Apply the tourniquet below the saphenous opening 2 3 The site of incompetent perforator is suspected by a palpable fascial defect, multiple tourniquet & confirmed by Duplex As the patient stands, the V.V. fill rapidly from above. This means that the incompetent connection between the deep & superficial system is NOT the sap-fem junction (which is controlled by the tourniquet), but it is below it. 5 4 Tourniquet Test Localize the site of saphenous opening: 4cm below & lateral to the pubic tubercle 1

  31. Varicose ulcers

  32. Venous cut down

  33. Accessible and muscular

  34. Lymphatic drainage of lower limb

  35. Horizontal group Vertical Group Superficial inguinal lymph nodes • Upper (Horizontal) • Lateral group • Medial group • Lower (Vertical)

  36. Deep inguinal lymph nodes • 1-3 • Medial side of femoral vein • Afferents • deep lymph vessels accompanying the femoral vessels • Glans penis or glans clitoridis • Few from superficial inguinal nodes

  37. LYMPHATIC DRAINAGE OF LOWER LIMB Popliteal lymph nodes: • They lie in popliteal fossa • They receive lymph from: • knee joint • Deep lymph vessels from leg along anterior & posterior tibial arteries • Some superficial lymph vessels from leg & foot along small saphenous vein • Their efferents drain into deep inguinal lymph nodes

  38. Applied anatomy • Lymphedema- Filaria • Enlargement of lymph nodes • Syphilitic lesions

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