; 
id | THE FRONT OF THE THIGH. 1213 
x 
are made by stretching a tape from it to the tip of one or other of the malleoli, care 
being taken that the pelvis is horizontal, and the limbs in corresponding positions. 
The pubic spine is felt under the upper and outer part of the mons Veneris and at 
a corresponding point in the male; between the spine and the symphysis is the 
crest of the pubis, the two crests together forming a rounded subcutaneous bony 
ridge. <A line extending from the pubic spine horizontally outwards across the front 
of the thigh crosses the front of the hip-joint at the level of the lower part of the head 
of the femur. The cord-like tendon of the adductor longus is readily felt, and a 
point about 1 in. below the pubic spine is selected for performing the operation 
of subcutaneous tenotomy of the tendon. 
The centre of the saphenous opening is situated 14 in. below and external 
to the pubic spine; it overlies the inner (hernial) and middle (venous) com- 
partments of the femoral sheath; behind the outer border of the opening is the 
arterial compartment of the sheath; crossing over the lower border is the termina- 
tion of the long saphenous vein. A femoral hernia makes its way into the thigh 
beneath the upper edge of the opening. The course of the long saphenous vein in 
the thigh is indicated | by a line extending from the adductor tubercle of the internal 
vondyle of the femur to the lower part of the saphenous opening. 
The horizontal or inguinal chain of lymphatic glands can usually be felt along, and 
a little below, the line of Poupart’s Lgament; when the glands are inflamed the 
surgeon should not neglect to examine the buttocks and anus as well as the 
external genitals. The vertical or femoral chain lies in close relation to the upper 
end of the long saphenous vein. Deeper glands also are met with beneath the 
cribriform fascia, close to the inner side of the femoral vein, and there is generally 
one in the crural canal. To clear out the glands in the groin an incision should 
be made parallel to, and a finger’s breadth below, the whole length of Poupart’s 
ligament. 
To map out the course of the femoral artery, the thigh beimg slightly flexed and 
rotated outwards, draw a line from the mid-poit between the anterior superior 
iliac spine and the symphysis pubis to the adductor tubercle at the upper and back 
part of the internal condyle; rather less than the upper third of this line corre- 
sponds to the femoral artery in Scarpa’s triangle, while rather more than its middle 
third corresponds to the artery as it les in Hunter’s canal. The seat of election 
for ligature of the vessel is at the apex of Scarpa’s triangle. To compress the 
common femoral, pressure should be made directly backwards against the pubic 
eminence, and not against the head of the femur; to compress the femoral in 
Hunter’s canal, pressure should be made outwards against the inner surface of the 
shaft of the femur. 
On the outer aspect of the thigh the fascia lata is thick, aponeurotic, and 
loosely attached to the vastus externus; hence the tendency of abscesses to travel 
downwards beneath it towards the knee. The sartorius, which forms the most im- 
portant muscular landmark of the thigh, may be thrown into prominence by main- 
taining the thigh unsupported, flexed, and slightly rotated outwards. Observe that 
in the - upper third of the thigh it forms the outer boundary of Scarpa’s triangle ; in 
the middle third it is placed over Hunter’s canal; while in the lower third it 
hes in front of the inner hamstrings. External and adjacent to the upper part of 
the sartorius is the prominénce of the tensor fascie femoris, which, as it descends, 
diverges from the sartorius; in the angle between the two the tendon of the rectus 
may be felt as it overlies the lower part of the anterior aspect of the capsule of the 
hip-joint. 
The inner aspect of the lower half of the shaft of the femur may be conveniently cut down 
upon through the vastus internus, where it comes to the surface between the sartorius and rectus 
muscles ; the incision should be made in the direction of a line extending from a point midway 
between the inner border of the patella and the adductor tubercle, to the anterior superior iliac 
spine. 
The front of the hip-joint may be reached through an incision downwards from the anterior 
superior iliac spine, either along the inner or the outer border of the sartorius; in the former 
case the deeper part of the dissection passes between the iliacus and the inner border of the rectus, 
while in the latter case the joint is reached external to the rectus tendon, between it and the 
anterior borders of the gluteus medius and minimus muscles. The ase ending branch of the 
external circumflex artery crosses the capsule parallel to, and intmediately above, the anterior 
