FASCIA OF LOWER LIMB

The subcutaneous tissue

(superfi cial fascia) lies deep
to the skin and consists of
loose connective tissue that
contains a variable amount
of fat, cutaneous nerves,
superficial veins (great and
small saphenous veins and
their tributaries),lymphatic
vessels, and lymph nodes.
The subcutaneous tissue of the hip and thigh is
continuous with that of the inferior part of the
anterolateral abdominal wall and buttocks.
At the knee, the subcutaneous tissue loses its
fat and blends with the deep fascia, but fat is
again present distal to the knee in the
subcutaneous tissue of the leg.
The deep fascia of the
lower limb is especially
strong, investing the limb
like an elastic stocking This
fascia limits outward
expansion of contracting
muscles, making muscular
contraction more effi cient
in compressing veins to
push blood toward the
heart.
The deep fascia of the thigh is called fascia lata (L.
lata, broad). Superiorly, the fascia lata attaches to
and is continuous with:
The inguinal ligament, pubic arch, body of pubis,
and pubic tubercle anteriorly.
The membranous layer of subcutaneous tissue
(Scarpa fascia) of the inferior abdominal wall also
attaches to the fascia lata approximately a fi
nger’s breadth inferior to the inguinal ligament.
The iliac crest laterally and posteriorly.
The sacrum, coccyx, sacrotuberous ligament,
and ischial tuberosity/ischiopubic ramus
posteriorly and medially.
Inferiorly, the fascia lata attaches to and is
continuous with:
Exposed parts of bones around the knee.
The deep fascia of the leg inferior to the knee.
 iliotibial tract
The fascia lata is substantial because it encloses the
large thigh muscles, especially laterally, where it is
thickened and strengthened by additional reinforcing
longitudinal fi bers to form the iliotibial tract
This broad band of fi bers is the shared aponeurosis
of the tensor fasciae latae and gluteus maximus
muscles. The iliotibial tract extends from the iliac
tubercle to the anterolateral tubercle of the tibia
(Gerdy tubercle).
 intermuscular septum
The thigh muscles are separated into three
compartments—anterior, medial, and posterior.
The walls of these com partments are formed by
the fascia lata and three fascial inter muscular
septa that arise from its deep aspect and attach
to the linea aspera of the femur
The lateral intermuscular
septum is especially strong;
the other two septa are
relatively weak. The lateral
intermuscular septum
extends deeply from the
iliotibial tract to the lateral
lip of the linea aspera and
lateral supracondylar line of
the femur. This septum
offers an internervous plane
(plane between nerves) to
surgeons needing wide
exposure of the femur.
 saphenous opening
The saphenous opening in the fascia lata is
a gap or hiatus in the fascia lata inferior to the
medial part of the inguinal ligament,
approximately 4 cm inferolateral to the pubic
tubercle. .
The saphenous opening is usually approximately
3.75 cm in length and 2.5 cm in breadth, and its
longaxis is vertical.
Its medial margin is smooth but its superior,
lateral, and inferior margins form a sharp
crescentic edge, the falciform margin. The
falciform margin is joined at its medial margin by
fi brofatty tissue, the cribriform fascia (L.
cribrum,a sieve).
This sieve-like fascia is a localized membranous
layer of subcutaneous tissue that spreads over
the saphenous opening,closing it.
The connective tissue is pierced by numerous openings
(thus its name) for the passage of efferent lymphatic
vessels from the superfi cial inguinal lymph nodes, and
by the great saphenous vein and its tributaries. .
After passing through the saphenous opening and
cribriform fascia, the great saphenous vein enters the
femoral vein
The lymphatic vessels enter the deep inguinal lymph
nodes
The deep fascia of the leg,
or crural fascia (L. crus,
leg), attaches to the
anterior and medial
borders of the tibia, where
it is continuous with its
periosteum.
The deep fascia of the leg
is thick in the proximal part
of the anterior aspect of
the leg, where it forms part
of the proximal
attachments of the
underlying muscles.
Although thinner distally, the deep fascia of the
leg forms thickened bands both superior and
anterior to the ankle joint, the extensor
retinacula
Anterior and posterior intermuscular septa pass from
the deep surface of the lateral deep fascia of the leg and
attach to the corresponding margins of the fi bula.
The interosseous membrane and intermuscular septa
divide the leg into three compartments: anterior (dorsifl
exor), lateral (fi bular), and posterior (plantarfl exor)
The posterior compartment is further subdivided by the
transverse intermuscular septum, separating superfi cial
and deep plantarfl exor muscles.