Popliteal fossa Contents and Structure [edit]

Popliteal fossa
Rear view of a person. The location of the popliteal fossa is outlined in blue.
Popliteal fossa of the right leg.
Details
Identifiers
Latin	Popliteal fossa
TA98	A01.2.08.013
TA2	324
F.M.A.	22525 22525, 22525
*Anatomical terminology* [edit in Wikidata]

Popliteal fossae

(sometimes referred to as
the Hough
, [1] or
kneepit
by analogy with the armpit) is a shallow depression located at the back of the knee joint. The bones of the popliteal fossa are the femur and tibia. Like other flexor surfaces of large joints (groin, armpit, cubital fossa, and essentially the front of the neck), this is an area where blood vessels and nerves run relatively superficially and with an increased number of lymph nodes.

Structure [edit]

Borders [edit]

Pit boundaries: [1]

Medial	Side
Management	superior and medial: in semimembranosus & semitendinosus [2]	superior and lateral: biceps femoris muscle [2]
Lower	inferior and medial: medial head of the gastrocnemius muscle [2]	inferior and lateral: lateral head of the gastrocnemius muscle and plantaris muscle [2]

Roof[edit]

When moving from surface structures to deep ones, the roof is formed by:

skin [1]
superficial fascia. [1] It contains the small saphenous vein, the terminal branch of the posterior femoral cutaneous nerve, the posterior division of the medial cutaneous nerve, the lateral sural cutaneous nerve, and the medial sural cutaneous nerve. [1]
popliteal fascia. [12]

Floor[edit]

Gender educated:

popliteal surface of the thigh. [2]
knee joint capsule and oblique popliteal ligament. [2]
strong fascia covering the popliteus muscle. [2]

Contents [edit]

Structures of the popliteal fossa include (from superficial to deep): [1]

tibial nerve
common peroneal nerve (also known as common peroneal nerve) [3]
popliteal vein
popliteal artery, continuation of the femoral artery
small saphenous vein (end) [3]
Popliteal lymph nodes and vessels [3]

It should be noted that the common peroneal nerve also originates at the superior angle of the popliteal fossa. [4]

SKELETAL TRUCTION TECHNIQUE

PREPARATION OF THE POPLICITAL FOSSA,

KNEE JOINT, SHIN, FOOT.

PUNCTURE OF THE KNEE JOINT,

SKELETAL TRUCTION TECHNIQUE

GOAL: TO REMEMBER TOPOGRAPH - ANATOMICAL RELATIONSHIPS OF MUSCLES,

CELLULAR SPACES, FASCIA, VASCULAR NERVE BANDS

LOWER LIMB. MASTER THE PUNCTURE OF THE KNEE AND ANKLE JOINTS AND THE TECHNIQUE OF APPLYING SKELETAL TRUCTION

POPLITEL FOSSA AREA
1. Borders: superior and lateral - biceps femoris tendon; above and medially - the tendons of the semimembranosus and semitendinosus muscles; below and laterally - the lateral head of the gastrocnemius muscle, the plantaris muscle; below and medially - the medial head of the gastrocnemius muscle; in front - the popliteal area of the femur, the bursa of the knee joint, the popliteal ligament and muscle;
2. Contents: a) popliteal artery with collateral branches; b) popliteal vein with tributaries; c) sciatic nerve, then tibial and common peroneal nerves, cutaneous nerves of the leg; d) lymph nodes;	relative position of elements (lateral à medial and posterior à anterior): common peroneal nerve, lateral cutaneous nerve of the calf, medial cutaneous nerve of the calf, tibial nerve, artery, vein; the artery lies on the popliteal area, is connected to the joint capsule, and is often damaged by a supracondylar fracture of the femur;
3. Ways of spread of purulent processes from the popliteal fossa:
a) in the anterior thigh	through the adductor muscle channel;
b) in the back of the thigh	along the course of the sciatic nerve;
c) in the anterior bed of the tibia	along the anterior tibial artery;
d) in the posterior bed of the tibia;	through the Gruber-Pirogov Canal;
JOBER'S POSTUME
1. Boundaries:
a) in front - the tendon of the adductor magnus muscle	represents the internal part of the popliteal fossa; used as access to the popliteal artery;
b) behind - the tendons of the semi-membranosus, tender and semitendinosus muscles;
c) from above - the sartorius muscle;
d) from below - the internal head of the gastrocnemius muscle, the internal condyle of the femur;
2. Lymphatic drainage:
a) into the superficial lymph nodes;	under the own popliteal fascia;
b) to the middle lymph nodes;	along the popliteal vessels;
c) into deep lymph nodes;	on the capsule of the knee joint;
phlegmon of the popliteal fossa is often classified as adenophlegmon, which occurs during purulent gonitis and purulent processes of the lower leg and foot;
KNEE-JOINT
1. Formation of the patella, femur and tibia	the joint is rotationally block-shaped, incongruent;
2. Joint ligaments:
a) patellar ligament;	tendon of the 4th head of the thigh muscle;
b) lateral tibial ligament	prevents lateral movements in the joint;
c) lateral fibular ligament;	prevents lateral movements in the joint;
d) oblique and arcuate popliteal ligaments;
e) anterior and posterior cruciate ligaments;	prevent anterior and posterior movements in the joint;
3. Menisci of the joint:	cartilaginous formations that create joint congruence;
a) medial (internal);	shape in the form of the letter "C";
b) lateral (outer);	shape in the form of the letter "O";
4. Inversions of the knee joint:	protrusion of the synovial membrane
a) anterior superior medial and lateral;	joints, creating mechanical protection for the joint; these are places of possibility
b) anterior lower medial and lateral;	accumulations of pathological fluid (serous, purulent exudate, blood);
c) posterior superior medial and lateral;
d) posterior lower medial and lateral;
e) anterior-superior inversion;	communicates with the suprapatellar synovial bursa in 85%;
5. Synovial bursae of the joint:
a) subcutaneous infrapatellar;	does not communicate with the joint cavity
b) deep infrapatellar;	separated by a fatty lump (lying under the patellar ligament itself) with no communication with the joint cavity
c) subcutaneous prepatellar;	lies between the superficial and lata fascia of the thigh, does not communicate with the joint cavity;
d) subfascial prepatellar;	lies between the fascia lata and the tendon of the 4th chapter muscle, does not communicate with the joint cavity;
e) subtendinous prepatellar;	lies between the tendon of the 4th head of the muscle and the periosteum, does not communicate with the joint cavity;
e) suprapatellar	lies under the tendon of the 4th head of the muscle, communicating with the joint cavity;
6. Blood supply to the joint:	collateral circulation
a) branches of the femoral artery;	joint has a leading role in
b) branches of the deep femoral artery;	cases of injury to the popliteal artery
c) branches of the popliteal artery;	and circulatory disorders in the lower leg and foot;
d) branches of the tibial artery;
SHIN AREA
1. Borders: at the top - a line passing through the tibial tuberosity; below is a line passing over the base of both ankles;
2. Layer-by-layer structure of the anterior surface of the tibia:
a) skin;	the skin in front is tightly adjacent to the tibia
b) subcutaneous - fatty tissue;	lies between the sheets of fascia
c) superficial fascia of the leg;	great saphenous vein
d) own fascia of the leg;	forms three intermuscular septa
d) anterior muscle group;
f) anterior vascular-nervous bundle;	consists of the anterior tibial artery, two veins, deep peroneal nerve;
g) tibia and fibula, interosseous membrane
3. Layer-by-layer structure of the posterior surface of the leg:
a) skin;
b) subcutaneous - fatty tissue;
c) superficial fascia of the leg;
d) own fascia of the leg (superficial layer);	between the leaves lies the small saphenous vein and the sural nerve;
e) superficial layer of the muscles of the posterior bed of the leg;	soleus, gastrocnemius (lateral and medial) muscles;
f) own fascia of the leg (deep layer);
g) cellular space of the posterior bed of the tibia;	contains the posterior vascular-nerve bundle;
h) deep layer of muscles of the posterior bed of the leg;	tibialis posterior, flexor digitorum longus, flexor pollicis longus;
i) posterior interosseous vascular-nerve bundle;
j) tibia and fibula, interosseous membrane
4. Fascial - muscle beds:	forms its own fascia of the leg, giving spurs to the tibia;
a) front;	contains muscles - extensors of the foot;
b) rear;	contains muscles - flexors of the foot;
c) lateral;	contains muscles - pronators of the foot;
5. Vascular-nerve bundles:
a) anterior: anterior tibial artery and two veins, deep branch of the peroneal nerve;	located in the anterior fascial-muscular bed of the leg; relative position of elements (medially à laterally): vein, artery, vein, nerve;
b) posterior: posterior tibial artery and two veins, tibial nerve;	located in the posterior fascial-muscular bed of the leg; relative position of elements (medially à laterally): vein,
artery, vein, nerve; the elements lie in the Gruber-Pirogov channel;
c) lateral: peroneal artery and vein, superficial branch of the peroneal nerve;	located in the lateral fascial-muscular bed of the leg; relative position of elements (medial à lateral): vein, artery, nerve; the first two elements lie in the lower muscular-fibular canal; the nerve lies in the superior muscular-fibular canal;
Ways of spread of purulent contents from the posterior bed of the leg: a) into the tissue of the popliteal fossa; b) into the tissue of the anterior bed of the leg; c) into the tissue of the lateral bed of the tibia; d) into the tissue of the middle bed of the foot (through the medial malleolar canal);
ANKLE AREA
1. Borders: at the top - a plane drawn over the bases of both ankles; below and in front - a plane connecting the lateral and medial ankles, the dorsum and plantar surfaces of the foot;
2. Layer structure:
a) skin;
b) subcutaneous - fatty tissue;	absent in the ankle area;
c) superficial fascia;	between c) and d) pass: 1) in front - branches of the superficial peroneal nerve; 2) medially (in front of the medial malleolus) - great saphenous vein, saphenous nerve; 3) laterally (behind the lateral malleolus) - small saphenous vein, sural nerve;
d) own fascia;	thickening, it forms fibrous channels for tendons;
e) muscle tendons, deep vessels and nerves;
e) joint capsule;
g) joint;
3. Departments of the region:
a) front;	between the front ankles; contains three synovial sheaths of the foot extensors, the anterior vascular-nervous bundle, synovial sheaths with the joint cavity and do not communicate with each other;
relative position of elements (medial à lateral): tibialis anterior muscle, extensor pollicis longus, anterior tibial vessels, deep peroneal nerve, extensor digitorum longus;
b) rear;	corresponds to the Achilles tendon; contains one tendon sheath and tendon bursa of the calcaneus (Achilles); does not communicate with the joint cavity;
c) medial;	between the medial malleolus and the Achilles tendon; contains three synovial sheaths of the flexor tendons of the foot and fingers, the posterior vascular-nerve bundle; lie in the medial malleolar canal; the synovial sheaths do not communicate with the joint cavity; relative position of elements (front à back and top à down): tibialis posterior muscle, flexor digitorum longus, posterior
tibial vessels, tibial nerve, flexor pollicis longus;
d) lateral;	between the lateral malleolus and the Achilles tendon; contains two synovial sheaths of the pronator tendons of the foot, the peroneal artery; the tendons lie in the lateral malleolar canal; do not communicate with the joint cavity; relative position of the elements (front à back and top à bottom): peroneus brevis muscle, peroneus longus muscle, peroneal artery;
4. Joint capsule:
attachment 2.5 cm higher	the joint cavity in 20% communicates with
apex of the outer malleolus;	cavity of the subtalar space; may have a connection with the synovial sheath of the flexor pollicis longus;
5. Joint ligaments:
a) external;
b) internal;
FOOT AREA
Dorsum of the foot
1. Layer structure:
a) skin;
b) subcutaneous - fatty tissue;
c) superficial fascia;	contains dorsal cutaneous nerves of the foot, veins
d) own fascia of the dorsum of the foot (superficial leaf);	continuation of the own fascia of the leg; fascia forms bags,
d) own fascia of the dorsum of the foot (deep layer);	including tendons of long and short muscles - extensor fingers, blood vessels and nerve; a deep layer covers the metatarsal bones and dorsal interosseous muscles;
e) bones of the foot (tarsal and metatarsal);
2. Vessels and nerves area:
a) saphenous nerve (medially);
b) deep peroneal nerve (anterior);	on the dorsum of the foot the first interdigital space is innervated;
c) superficial peroneal nerve (anterior and lateral);	on the dorsum of the foot form the dorsal saphenous nerves;
d) sural nerve;
e) venous plexus of the dorsum of the foot;	lies subcutaneously, forms the small and large saphenous veins;
e) dorsal vessels of the foot: an artery and two veins;	continuation of the anterior vascular bundle of the leg, forms the metatarsal and digital vessels; forms an anastomosis with the lateral artery of the sole in the area of the first interdigital space;
Plantar surface of the foot
1. Layer-by-layer structure (middle fascial-muscular bed from bottom to top):
a) skin;	inactive, thick, dense;
b) subcutaneous - fatty tissue;	well developed, penetrated by fibrous vertical bundles going to the plantar aponeurosis;
c) plantar aponeurosis;	in the area of the metatarsal heads it forms commissural openings;
d) flexor digitorum brevis;
e) deep fascia of the sole;	under the fascia on the quadratus muscle lies the lateral vascular-nerve bundle of the sole;
f) quadratus plantae muscle and tendon of the long flexor digitorum with lumbrical muscles;	the quadratus muscle is woven into the tendon of the long flexor digitorum;
g) muscle that adducts the first toe;
h) interosseous fascia of the sole;	lies on the interosseous muscles of the sole; between the deep fascia of the sole and the interosseous fascia of the sole there is a private median cellular space;
2. Fascial - muscular beds of the foot:
a) medial;	isolated, contains the muscles of the first toe (separated by a vertical septum extending from the aponeurosis);
b) average;	contains its own medial cellular space; proximally passes into the plantar canal;
c) lateral;	isolated, contains the muscles of the fifth toe (separated by a vertical septum extending from the aponeurosis);
d) deep;	contains interosseous muscles (enclosed between the interosseous fascia of the sole and the long ligament of the sole);
3. Sole channels:
a) plantar;	communicates distally with the midfoot;
b) heel;	enclosed between the calcaneus and the beginning of the abductor pollicis muscle;
c) ankle;	communicates with the posterior deep bed of the tibia;
4. Vascular-nerve bundles:
a) medial: plantar vein, artery, nerve;	corresponds to the medial intermuscular septum; relative position of elements (medial à lateral): vein, artery, nerve;
b) lateral: plantar vein, artery, nerve;	corresponds to the lateral intermus - the cervical septum, proximally crosses the plantar canal; relative position of elements (medial à lateral): nerve, artery, vein; the artery is powerful, forms the metatarsal and digital arteries; has a connection with the artery of the dorsum of the foot in the first interdigital space;
Along the vascular-nerve bundles and muscle tendons, purulent processes from the subcutaneous fatty tissue may spread:
a) into the subgaleal tissue (through the commissural openings);
b) into the middle bed of the foot, calcaneal, ankle canals and further into the deep posterior bed of the lower leg (along the lateral and posterior vascular-nerve bundles of the foot and lower leg); c) on the dorsum of the foot (along the plantar branch of the dorsal artery of the foot in the first interdigital space);
d) on the lateral and dorsal surfaces of the fingers (along the tendons of the lumbrical muscles);
the primary portal when infection spreads from the subcutaneous tissue to the middle bed of the foot, calcaneal, ankle canals and further to the deep posterior bed of the leg, to the back of the foot, to the lateral and dorsal surfaces of the fingers are the commissural openings;
5. Foot joints:
a) ankle;	between the talus and tibia;
b) subtalar;	between the talus and calcaneus;
c) talus - calcaneal - navicular;	connected by a strong interosseous calcaneal-talar ligament;
d) calcaneal-cuboid;	c) ig) form a single line - the chopar (transverse) joint; strengthened by the bifurcation ligament: calcaneal-cuboid and calcaneal-scaphoid portions - the key of the joint; the joint is used when performing disarticulation;
d) talus-scaphoid;
e) wedge-shaped - scaphoid;
g) tarsus - metatarsal;	between the fifth metatarsal, three cuneiform and cuboid bones - the Lisfranc joint;
h) wedge-shaped - cuboid;	strengthened by the medial interosseous sphenoid-metatarsal ligament (medial sphenoid bone - II metatarsal bone - key of the joint); the joint is used when performing disarticulation;
6. Arches:
a) external (cargo);	consists of the calcaneus, cuboid and IV - V metatarsal bones; fulcrum points: calcaneal tubercle, heads of IV-V metatarsal bones;
b) internal (spring);	consists of the talus, navicular, three wedge-shaped, and I-III metatarsal bones; fulcrum: upper part of the heel
bones, heads of I-III metatarsal bones;
c) transverse (front);	formed by metatarsal bones; strengthened by the transverse head of the adductor hallucis muscle;
d) transverse (posterior);	formed by tarsal bones; strengthened by the tendons of the tibialis posterior and peroneus longus muscles;

OPERATIONS.

Knee joint puncture
1. Indications - presence of pathological fluid in the joint (blood, infected exudate), administration of medicinal drugs;
2. Pain relief: local anesthesia;	anesthesia is carried out according to the rule: novocaine in front of the needle;
3. Puncture points: a) at the lateral edge of the base of the patella; b) at the lateral edge of the middle of the patella; c) at the medial edge of the middle of the patella;	puncture the upper and middle inversions;
4. Insert the needle perpendicular to the axis of the thigh under the tendon stretch of the 4th head of the muscle;
5. Change the direction of the needle inward and move it deeper;
6. Remove pathological fluid from the joint cavity; administer a medicinal drug;
7. Remove the needle;
ACTION ALGORITHM	NOTES
Application of skeletal traction	performed when it is impossible to simultaneously reposition the fragments and hold them with a plaster cast, or as preoperative preparation;
1. Indications - closed fractures of long tibial bones, dislocations, conditions after arthroplasty;
2. Localization of insertion of a pin or clamp - femoral condyles, tibial tuberosity, calcaneal tubercle, olecranon process of the humerus; supramalleolar region;
Insertion of a clamp for hip fractures
1. Place the limb on a Beler splint, inject a 0.5% solution of novocaine 10 - 15 ml to the periosteum on both sides;	at the points of insertion of the tip of the clamp (above the condyles of the femur);
2. Pull the hook up in the places where the tip of the clamp is inserted, make short (0.5 cm) tissue incisions to the bone;
3. Insert the sharp ends of the terminal into the cuts and hammer in to a depth of 1 - 2 cm;
4. Secure the terminal arcs with a screw and check the reliability of fastening by pulling;
5. Attach a cord or thin cable to the arc of the terminal, hang the corresponding load from it through the block;
Insertion of pins for hip fractures
1. Place the limb on a Beler splint;
2. Inject 10 - 15 ml of 0.5% novocaine solution into the soft tissues up to the periosteum on each side;	above the medial and lateral epicondyles of the femur;
3. Press the CYTO drill pad tightly to the skin from the side of the medial epicondyle, pierce the skin with a needle, guide the needle to the bone;	strictly perpendicular to the axis of the thigh along a horizontal line; (intersection point) of a horizontal line drawn 3 cm above the patella and 2 cm dorsal to the medial border of the patella
4. Drill the bone without pressing;	Intermittent operation of the electric drill;
5. Make a cut in the skin above the protrusion of the needle;
6. Fasten and tighten the needle well in a CITO-type bracket;
7. Attach a cord or cable to the bracket and bring the corresponding load to it through the block onto the load hanger;

CONTROL QUESTIONS

List the inversions of the knee joint.

List the ligaments of the knee joint.

List the synovial bursae of the knee joint.

Name the boundaries of the popliteal fossa.

The meaning of
the gill's
fossa.

List the fascial and muscular beds of the lower leg.

List the vascular-nerve bundles of the lower leg.

8. Gruberov

channel, its walls, contents.

How are the channels for the tendons in the ankle joint formed?

10.

List the fascial spaces of the plantar surface of the foot.

11.

List the connections between the popliteal fossa fiber and neighboring areas.

12.

List the connections between the fiber of the deep posterior bed of the tibia and the neighboring ones

regions.

13.

List the communications between the fiber of the midfoot and adjacent areas.

14.

Lisfranc
joint and its key formed by?

SITUATIONAL TASKS

TASK No. 1 After a knee joint injury, a patient developed bursitis, complicated by gonitis (inflammation of the knee joint). Name the bursae located in the area of the knee joint. How did the infection from the bursa get into the joint cavity? List the inversions of the knee joint. Indicate the puncture points of the knee joint.

TASK No. 2: The patient has tuberculosis of the knee joint. Indicate the incisions for opening the knee joint, the stages of the operation of resection of the knee joint according to Textor and Kornev. Specify the source of the expected bleeding during this operation.

TASK No. 3: A patient with phlegmon of the popliteal fossa was admitted to the surgical department. Indicate possible ways of spread of pus from the popliteal fossa. Name the topography of the neurovascular bundle of the popliteal fossa and the incisions for phlegmon in this area.

TASK No. 4: A patient with an extensive wound in the knee joint was admitted to the surgical department. When examining the patient's foot in the position of maximum flexion and internal rotation. Indicate the location and which nerve is damaged in this injury?

TASK N 5: A patient with phlegmon of the anterior bed of the leg was admitted to the surgical clinic. Name the fascial-muscular sheaths of the lower leg, their vascular-nerve bundles. Specify the operational approaches for opening the phlegmon of the anterior fascial sheath of the leg.

TASK No. 6: A patient was admitted to the surgical department with phlegmon of the posterior fascial-muscular sheath of the leg. Name the muscles and vascular-nervous formations of the posterior fascial-muscular sheath of the leg, the routes of spread of pus and the incisions for this pathology.

TASK No. 7: A patient with phlegmon of the plantar surface of the foot was admitted to the surgical department. The examination revealed that the purulent process was localized in the medial bed of the foot. Name the fascial-muscular beds of the plantar surface of the foot, the vascular-nerve bundles of the sole of the foot and the paths of spread of pus. Specify the Delorme cuts.

TASK No. 8: Phlegmon of the midfoot was complicated by the flow of pus onto the dorsum of the foot and into the heel canal. Indicate the possible route of spread of purulent leakage and incisions for purulent processes of the sole of the foot (DeLorme incisions).

STANDARD ANSWERS

TASK No. 1 In the area of the knee joint there are bursae: patellar, prepatellar (subcutaneous, subfascial, subtendinous), subpatellar (superficial, deep). The suprapatellar bursa in 85% communicates with the anterior superior synovial volvulus, therefore, infection from the bursa could enter the joint cavity. The articular capsule of the knee joint forms 9 inversions of the synovial membrane: superior - middle, anterior - superior (external, internal), anterior - inferior (external, internal), posterior - superior (external, internal), posterior - inferior (external, internal). Puncture points: outside - at the upper edge of the patella and at the middle of the patella on the outer and inner surfaces.

TASK No. 2 Parapatellar incisions according to Textor. Stages of resection of the knee joint: 1. horseshoe-shaped incision (according to Textor) from the medial to lateral epicondyles through the tibial tuberosity with dissection of the soft tissues and the patellar ligament; 2. separating the flap upward and crossing the joint ligaments; 3. removal of the articular surface of the patella, and if it is damaged, removal of the bone completely; 4. removal of the joint capsule; 5. sawing of the articular surfaces of the femur and tibia at the level of the condyles; 6. bringing together and fixing the ends of the bones with sutures. Laying the patella and fixing it at the level of the line of contact of the 2 bones; 7. suturing your own patellar ligaments; 8.stitches on the skin, plaster cast. Resection of the knee joint according to Kornev is carried out without opening the cavity of the knee joint. With this operation, damage to the popliteal artery, which is fixed behind the knee joint capsule, is possible.

TASK No. 3 Paths of spread of pus from the popliteal fossa: 1. up - to the back of the thigh along the sciatic nerve; 2. to the anterior surface of the thigh through the femoral-popliteal canal along the popliteal vessels; 3. into the deep fascial space of the leg along the tibial nerve and posterior tibial vessels; 4. in the anterior extensor bed along the anterior tibial artery and the common peroneal nerve; 5. along the tendon of the 2nd head of the thigh muscle on the outer side of the knee joint and the lower third of the thigh; 6. along the popliteus muscle into the space between the soleus and gastrocnemius muscles; 7. between the deep layer of fascia and the soleus muscle; 8. Under the superficial layer of the own fascia; Topography of the vascular-nerve bundle from back to front: tibial nerve, popliteal vein and popliteal artery (NEVA). The incision is vertical away from the middle of the popliteal fossa or S-shaped.

TASK No. 4 The wound is located below and laterally in the popliteal fossa. The common peroneal nerve is damaged.

TASK No. 5 Fascial - muscle sheaths of the lower leg: anterior (extensors), posterior (flexors), lateral (pronators). Vascular-nerve bundles of fascial beds: anterior - deep peroneal nerve, anterior tibial artery and vein; posterior - tibial nerve, posterior tibial artery and vein; lateral - peroneal artery and vein, superficial peroneal nerve. The incision takes into account the projection of the anterior tibial artery - from the middle of the distance between the head of the fibula and the tibial tuberosity (proximally) to the middle of the distance between the ankles on the dorsum of the foot (distally).

TASK No. 6 The posterior fascial-muscular sheath of the lower leg is represented by: the superficial layer - the gastrocnemius, soleus, and plantaris muscles. Deep layer - popliteus, flexor digitorum longus, posterior - tibialis, flexor pollicis longus. Vascular-nerve bundle: tibial nerve, posterior tibial artery and vein. Paths of spread of pus: up - through the popliteal - gastrocnemius canal into the popliteal fossa, down - along the vascular-nervous bundle through the intra-malleolar, calcaneal canals to the plantar surface of the foot, into the anterior bed - through the anterior interosseous foramen. An incision is made in the middle third 1-2 cm from the medial edge of the tibia. In the lower third - away from the projection line of the posterior vascular-nerve bundle (proximally - the middle of the popliteal fossa, distally - the middle of the distance between the Achilles tendon and the medial malleolus).

TASK No. 7 There are 3 beds on the foot: medial, lateral, median. Vascular-nerve bundles: laterally - external plantar nerve, artery, vein. medially - internal plantar nerve, artery, vein. Ways of spread of pus: 1. under the skin on the sole; 2. along the lumbrical muscles into the interdigital spaces of the dorsum of the foot and toes; 3. along the intra-malleolar canal into the deep muscle bed of the leg; 4. on the dorsum of the foot along the deep plantar branch of the artery arising from the dorsum of the foot; 5. melting of intermuscular septa and the appearance of deep diffuse phlegmon of the foot; 6. Tenosynovitis of the first finger with signs of purulent arthritis of the ankle joint. Delorme incisions: medial - the middle third of the line connecting the point between the middle and inner third of the width of the heel with the first interdigital space; lateral - the middle third of the line connecting the middle of the heel with the third interdigital space.

TASK No. 8 On the dorsum of the foot along the lumbrical muscles and deep arterial branches of the plantar branches extending from the dorsal artery of the foot. Into the posterior bed of the leg through the calcaneal and intramalleolar canals along the tibial nerve and the posterior tibial artery and vein. Delorme incisions: medial - the middle third of the line connecting the point between the middle and inner third of the width of the heel with the first interdigital space; lateral - the middle third of the line connecting the middle of the heel with the third interdigital space.

Links[edit]

^ abcdef Bakenmaier III C; Bleckner L (2008). "Chapter 20: Popliteal Nerve Block". Military Advanced Guide to Regional Anesthesia and Analgesia
. Rockville, MD: Veterans Advocacy and Pain Initiative (DVPMI). Archived from the original (PDF) on February 20, 2016. Retrieved June 8, 2011.
^ abcdefgh Nichols, Jennifer S.; Ashford, Robert W. (April 1, 2013). "Surgical anatomy and pathology of the popliteal fossa". Orthopedics and Trauma
.
27
(2): 113–117. DOI: 10.1016/j.mporth.2013.02.011. ISSN 1877-1327.
^ abc Moore's Clinically Oriented Anatomy, 6th edition
https://teachmeanatomy.info/lower-limb/areas/popliteal-fossa/