PRACTICAL CONSIDERATIONS: THE HIP AND THIGH. 643 



triangle. Over all the lower portion of the thigh it is loosely connected by abundant 

 connective tissue with the fascia lata, its attachment being closest along the line of 

 the external intermuscular septum, between the vastus externus and the hamstring 

 muscles. It is coarse externally and thinner over the abductor surfaces. It is easily 

 stripped up by effusions or retracted during operations. 



The superficial fascia in the subinguinal region is in two layers, in the more 

 superficial of which is the subcutaneous fat. The deeper layer is the denser, and on 

 it lie the lymphatic nodes occupying the saphenous opening. It offers, however, in 

 this region, but little resistance to the progress of pus towards the surface, as it is 

 perforated — hence " cribriform fascia" — by the lymph- vessels passing from the super- 

 ficial to the deep set of inguinal nodes, by the superficial epigastric and external 

 pudic vessels, and by the internal saphenous vein to empty into the femoral. 



Lipomata are not infrequent in this fascia, especially on the front, but sometimes 

 on the back of the thigh, and on account of its laxity and of the absence of firm 

 attachments of their capsules, are apt to travel downward by gravity. 



Fig. 613. 



Femoral arten 

 Femoral vein 



Pectineus. 

 upper portion 



Obturator ner\ e 



Internal saphenous vein 



\ I'LCtineus, lower portion 



Adductor longus and brevis, lower portion 

 Ligamentum teres 

 Pectineus, lower portion 



Dissection of thyroid luxation of femur, showing muscles ruptured. 



The deep fascia or fascia lata (page 633), attached above to the lower edge of 

 the great sacro-sciatic ligament, the tuberosity and ramus of the ischium, the crest of 

 the ilium, Poupart's ligament, and the body and ramus of the pubes, and below to 

 the lateral margins of the patella and to the tibia, and continuous posteriorly with the 

 deep fascia of the leg, forms an almost unbroken sheath around the thigh. Its con- 

 tinuity is interrupted only by the saphenous opening (page 635). It is of sufficient 

 strength and density everywhere to influence the course of abscesses and to modify 

 the surface appearance or feel of deep growths. A lipoma beneath the fascia lata may 

 apparently have the density of a malignant growth. A psoas abscess (page 143). 

 after it has followed the muscle under and below Poupart's ligament, usually perfo- 

 rates the sheath and the fascia lata and points external to the vessels at the upper part 

 of the thigh.; but after escaping from the sheath it may be unable to penetrate the 

 fascia, and may be guided by it to the lower third- of the thigh, the knee, or even as 

 low as the leg or ankle. 



The fascia has been torn or wounded, and, as it embraces the subjacent muscles so 

 closely, the latter have bulged through the opening, appearing on the surface of the 

 thigh as rounded elevations varying in size and tension with the position of the limb. 



