Approximately 1 cm lateral to the palpable femoral artery, make a longitudinal skin incision on the proximal thigh distal to the inguinal region. After transecting the subcutaneous tissue, incise the femoral fascia longitudinally medial to the sartorius muscle. Open the fascia of the adductor canal at the caudal edge of the incision, expose the superficial femoral artery, and encircle it with a vessel loop. Divide and suture-ligate between Overholt forceps the lymph collectors crossing beneath the inguinal ligament. Encircle the common femoral artery and the deep femoral artery.
Repeat the same manoeuvre to expose the femoral bifurcation in the left groin.
Tips:
1. Access lateral to the femoral artery spares the lymph collectors and permits subsequent offset layered closure to promote reliable wound healing.
2. The superficial femoral artery serves as a landmark for dissecting proximally lateral to it. This allows the deep femoral artery and the common femoral artery to be located easily and also avoids the risk of injury to the veins running medially.
3. Suture ligation of the lymph collectors helps, to a large extent, to prevent subsequent lymphatic cysts and fistulae. Postoperative lymph collection in the groin not infrequently paves the way for deep wound infection with fatal consequences.
4. Circumflex femoral artery: at times, this artery lies hidden and can cause profuse back-bleeding if it is not clamped off.
