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.