Groin

groin
Border groin area (ABC), inguinal triangle (GDV) and the inguinal period (S).

Groin (ilio-inguinal) is bounded above by a line connecting the front of the upper spine of the iliac bone, bottom - inguinal fold, inside - the outer margin of the rectus abdominis muscle (Fig).
In the inguinal region is the inguinal canal - narrow the gap between the muscles of the anterior abdominal wall, containing in men seed cord, and women - round ligament of the uterus.
The skin of the groin slim, mobile and on the border with thigh forms inguinal fold; in the subcutaneous layer of the groin are superficial hypogastric artery and vein. The aponeurosis of the external oblique muscles of the abdomen and talk between front-upper-awn Ilium and the pubic mound, forms inguinal ligament. For the aponeurosis of the external oblique muscles of the abdomen are internal oblique transverse abdominal muscles. The deep layers of the anterior abdominal wall formed a cross fascia of the abdomen, located medially from the same muscles, preperitoneal fiber and parietal peritoneum. In preperitoneal tissue are lower epigastric artery and vein. The lymphatic vessels of the skin of the groin sent to the superficial inguinal lymph nodes, and from the deep layers - in deep inguinal and iliac lymph nodes. Innervation groin area is iliac-hypogastric, ilio-inguinal and branch sex-femoral nerve.
In the inguinal region often inguinal hernia (see), lymphadenitis, resulting in inflammatory diseases of the lower limbs, organs of small pelvis. Sometimes the cold atechnique, descending from the lumbar spine in tuberculous his defeat, and inguinal metastases in lymph nodes with cancer of the vulva.

Groin (regio inguinalis) - part of the front-side of the abdominal wall, lateral Department Podkrepa (hypogastrium). The border region: lower - inguinal ligament (lig. inguinalis), medial-lateral edge of the rectus abdominis muscle (m. rectus abdominis), top-line segment that connects the front upper iliac spine (Fig. 1).
In the inguinal region is the inguinal canal filling only Nizhnetagilsky her Department; therefore, it is advisable to call this whole area ilio-inguinal (regio ilioinguinalis), highlighting the it Department, called inguinal triangle. The latter is restricted below the inguinal ligament, medial-lateral edge of the rectus abdominis muscle, the top horizontal line, conducted from the border between lateral and middle third of the groin ligament to the lateral edge of the rectus abdominis muscle.
Peculiarities of the inguinal region in men is caused by the lowering of the testis and the changes that happen to the groin in the embryonic period of development. In the muscles of the abdominal wall remains the defect is due to the fact that part of the muscle and tendon fibers went to the formation of the muscles that raise the testicle (m. cremaster) and fascia. This defect is called in topographical anatomy inguinal interval, who first described S. N. Jasinski. The boundaries of the inguinal period: top - bottom edge of the internal oblique (m. obliquus abdominis int.) and transverse abdominal muscles (so transversus abdominis), and below the inguinal ligament, medial-lateral edge straight muscles.
The skin of the groin area is relatively thin and agile, on the border with hip spliced with the aponeurosis of the external oblique muscles, which formed as a result of inguinal fold. Hair in men is more extensive area than in women. In the skin of the scalp contains a lot of sweat and sebaceous glands.
Subcutaneous tissue looks big fat lobules collected in reservoirs. Superficial fascia (fascia superficialis) consists of two sheets, of which surface moves to the thigh, and deep, more durable in comparison with surface, attached to the inguinal ligament. Surface artery represented by branches of femoral artery (a. femoralis): surface epigastric, surface circumflex iliac bone, and outdoor private parts (AA. epigastrica superficialis, circumflexa ilium superficialis and pudenda ext.). They are accompanied by the same name veins flowing into the femoral vein or into the great saphenous vein (v. saphena magna), and in the navel surface epigastric Vienna (v. epigastrica superficialis) anastomosed with vv. thoracoepigas-tricae and thus communication between systems axillary and the femoral vein. Cutaneous nerves are branches podrabinok, iliac-hypogastric and ilio-inguinal nerves (m. subcostalis, iliohypogastricus, ilioinguinalis) (printing. Fig. 1).

groin anatomy
Fig. 1. Right - m. obliquus int. abdominis located on it nerves, left - m. traasversus abdominis with located on the vessels and nerves: 1 - m. rectus abdominis; 2, 4, 22 and 23 - nn. intercostales XI and XII; 3 - m. transversus abdominis; 5 and 24 m. obliquus ext. abdominis; 6 and 21 - m. obliquus int. abdominis; 7 and 20 - a. iliohypogastricus; 8 and 19 - n. ilioinguinalis; 9 - a. circumflexa ilium profunda; 10 - transversalis fascia et fascia spermatica int.; 11 - ductus deferens; 12 - lig. interfoveolare; 13 - falx inguinalis; 14 - m. pyramidalis; 15 - crus mediale (crossed); 16 - lig. reflexum; 17 - m. cremaster; 18 - ramus genitalis n. genitofemoral.

Fig. 1. The border areas, the inguinal triangle and the inguinal period: ABC - groin; DEC - inguinal triangle; F - inguinal period.

Discharge lymphatic vessels of the skin are sent to the superficial inguinal lymph nodes.
Own fascia with the appearance of a thin plate is attached to the inguinal ligament. These fascial sheets prevent the lowering of inguinal hernia on the thigh. The external oblique muscle of the abdomen (m. obliquus abdominis ext.) with the top down and from the outside in, within the groin area does not contain muscle fibers. Below the line connecting the front top of the iliac spine with the navel (linea spinoumbilicalis), is the aponeurosis of the muscles, which have a characteristic pearlescent. Longitudinal fibers of the aponeurosis of the lateral overlap in education which, in addition to the aponeurosis, participate elements of romanovoi plates and the fascia own belly. Between the fibers aponeurosis there are longitudinal slit, the number and length of which is extremely varied, as the severity of transversal fibers. Y. A. Yartsev explains the differences in the structure of the aponeurosis of the external oblique muscles (Fig. 2 and printing. Fig. 2)contributing to unequal its strength.




Fig. 2. On the right is the aponeurosis of the external oblique muscles of the abdomen and through the nerves, to the left of surface vessels and nerves: 1 - rami cutanei lat. abdominales nn. intercostales XI and XII; 2 - ramus cutaneus lat. n. iliohypogastrici; 3 - a. et v. circumflexae ilium superficiales; 4 - a. et v. epigastricae superficiales, n. iliohypogastricus; 5 - funiculus spermaticus, a. et v. pudendae ext.; 6 - crus mediale (drawn up); 7 - lig. reflexum; 8 - ductus deferens and surrounding blood vessels; 9 - ramus genitalis n. genitofemoralis; 10 - n. ilioinguinalis; 11 - lig. inguinale; 12 - m. obliquus ext. abdominis and the aponeurosis.

Fig. 2. Differences in the structure of the aponeurosis of the external oblique muscles of the abdomen (Yartsevo).

Strong aponeurosis, which is characterized by well marked cross-fiber and the absence of gaps may bear up to 9 kg and is found in 1/4 observations.
Weak aponeurosis with a significant number of slots and by a small number of transversal fibers maintains loading up to 3.3 kg and is found in 1/3 of cases. These data are important to assess the different ways plastics in the inguinal graineterie.
The most important from the practical point of view the formation of the aponeurosis of the external oblique muscles is inguinal ligament (lig. inguinale), otherwise called papatowai, or fallopian; it stretched between the front top of the iliac spine and the pubic mound. Some authors consider it as a complex tendon-fascial elements.
Due to the aponeurosis of the external oblique muscles are formed also lacunar (lig. lacunare) and zavorozhennaya (lig. reflexum) ligaments. Its lower edge of the gap link continues in Grebeshkova ligament (lig. pectineale).
Deeper than the aponeurosis of the external oblique muscle is the internal oblique, stroke fiber which is opposite to the direction of the external oblique: they go from the bottom up and from the outside in. Between the two oblique muscles, that is, in the first intra-muscular layer, are iliac-hypogastric and ilio-inguinal nerves. From the internal oblique muscle, as well as from the anterior wall of the vagina rectus and about 25% of cases from the transverse abdominal muscles depart muscle fibers that form the muscle that raises the testicle.
Deeper internal oblique muscle is transverse muscle of the abdomen (m. transversus abdominis), and between them, i.e. in the second intra-muscular layer, vessels and nerves pass: podreberie the same vessels, thin lumbar arteries and veins, branches iliac-hypogastric and ilio-inguinal nerves (main trunks of these nerves penetrate into the first intermuscular layer), deep artery, the envelope of the Ilium (a. circumflexa ilium profunda).
The deepest layers groin area formed by transverse fascia (transversalis fascia), preperitoneal fiber (tela subserosa peritonei parietalis) and parietal peritoneum. Cross fascia connects to the inguinal ligament, and on the median line is attached to the upper edge of the symphysis.
Preperitoneal fiber separates the peritoneum from cross fascia.
In this layer are lower epigastric artery (a. epigastrica inf.) and deep artery, the envelope of the Ilium (a. circumflexa ilium prof.) - branches of the external iliac artery. At the level of a navel. epigastrica inf. anastomosed with finite upper branches epigastric artery (a. epigastrica sup.) - from the internal thoracic artery - a. thoracica int. From the initial part of the lower epigastric artery artery leaves the muscles that raise the testicle (a. cremasterica). Discharge lymphatic vessels and muscles of the aponeurosis groin area goes along the bottom and deep epigastric circumflex iliac bone arteries and are directed mainly to external iliac lymph nodes located on the external iliac artery. Between the lymphatic vessels of all layers in the groin are anastomoses.
Parietal peritoneum (peritoneum parietale) forms in the groin area a number of folds and hollows (see the Abdominal wall). It does not extend to the inguinal ligament approximately on 1 see
Located within the groin area, immediately above the inner half of papatowai ligaments, inguinal canal (canalis inguinalis) represents the gap between the muscles of the anterior abdominal wall. It occurs in men in the movement of the egg in the uterine life and contains a seed cord (funiculus spermaticus); women in this gap is round ligament of the uterus. The direction of the channel oblique: top to bottom, inside and outside rear to front. The length of the channel in men 4-5 cm; for women it a few millimeters long, but compared to male narrower.
There are four wall of the inguinal canal (front, back, top, and bottom) and two holes, or ring (surface and deep). The front wall is the aponeurosis of the external oblique muscles of the abdomen, back - cross fascia, the upper and the lower edges of the internal oblique transverse abdominal muscles, the lower trough formed curved backwards and upwards fibers inguinal ligament. According to P. A. Kupriyanov, N. I. Kukudzhanova and other specified the structure of the front and top of the wall of the inguinal canal seen in people suffering from an inguinal hernia, healthy front wall is formed not only by the aponeurosis of the external oblique muscles, but fibers internal oblique, and the upper wall - bottom edge only transverse abdominal muscles (Fig. 3).
If to open inguinal canal and slipping seed cord, it will be detected above the crotch period, the bottom of which forms a cross fascia, component at the same time, the rear wall of the inguinal canal. This wall with the medial side strengthens the crotch sickle, or the United tendon (falx inguinalis, s. tendo conjunctivus) of the internal oblique transverse abdominal muscles, which are closely associated with the outer margin of the direct muscle residuals - inguinal, lacunar, Grebeshkova. On the outside of the bottom of the inguinal period of fortified Mihalkovo ligament (lig. interfoveolare), located between the inner and outer mahovymi dimples.
People suffering from an inguinal hernia, the ratio between the muscles that make up the wall of the inguinal canal, is changing. The bottom edge of the internal oblique muscle they departs up and together with transverse muscle forms the upper wall of the channel. The front wall is formed only by the aponeurosis of the external oblique muscles of the abdomen. At considerable height of the inguinal period (more than 3 cm) creates conditions for rygeomrade. If the internal oblique muscle (most of all elements of the anterior abdominal wall opposing intra-abdominal pressure) is located above the spermatic cord, then the back wall of the inguinal canal at a relaxed aponeurosis of the external oblique muscles cannot long survive intra-abdominal pressure (P. A. Kupriyanov).
The outlet of the inguinal canal is superficial mahovoe ring (anulus inguinalis superficialis), formerly the outer, or subcutaneous. It is the length of the fibers of the aponeurosis of the external oblique muscles of the abdomen, forming two legs, with the top (or medial - crus mediale) is attached to the upper edge of the symphysis, and the lower (or lateral - crus laterale) - to the pubic mound. Sometimes there is also a third, deep (rear), leg - lig. reflexum. Both feet to the top formed by them interval crossed fibers going cross and arched (Minskoye fiber - fibrae intercrurales) and turns the gap in the ring. The sizes of rings for men: base width - 1-1,2 cm, the distance from the base to the apex (height) - 2.5 cm; it usually passes in healthy men, a tip of the index finger. Women dimensions superficial inguinal ring about 2 times less than men. At the level of the surface of the inguinal rings projected medial inguinal hole.
Inlet of the inguinal canal is the deepest (internal) mahovoe ring (anulus inguinalis profundus). It is funnel-shaped protrusion cross fascia, which is formed in the process of embryonic development of the elements of the spermatic cord. Due to the cross-fascia form the common shell spermatic cord and testis.
Deep mahovoe ring has in men and women is about the same diameter (1-1,5 cm), with most of it are filled with fatty lump. Deep ring lies on 1-1,5 cm above the middle of papatowai ligaments and about 5 cm above and outward from the surface of the ring. At the level of deep inguinal rings projected lateral inguinal hole. Nizhnetagilsky Department deep rings fortified Mihalkovo ligament and fibers iliac-pubic strand, verhalatorsky Department deprived strengthen its formations.
On top of the spermatic cord and its membranes is the muscle that raises the testicle with the fascia and poverhnostnye last - fascia spermatica ext., formed mainly due to romanovoi plates and the fascia own belly. To seed cord (women and to the round ligament of the uterus) within the inguinal canal is adjacent top ilio-inguinal nerve, bottom - branch inguinal femoral nerve (ramus genitalis n. genitofemoralis).
Pathology. The most common pathological processes are congenital and acquired hernias (see) and inflammation of the lymph nodes (see Lymphadenitis).

Fig. 3. The scheme of the structure of the inguinal canal in healthy men (left) and in patients with inguinal hernia (right) on the sagittal section (on Kupriyanov): 1 - transverse muscle of the abdomen; 2 - cross the fascia; 3 - inguinal ligament; 4 - seed cord; 5 - internal oblique muscle of the abdomen; 6 - the aponeurosis of the external oblique muscles of the abdomen.