39 



APPLIED ANATOMY. 



Femoral Hernia. Femoral hernia is always acquired and descends through 

 the femoral canal beneath Poupart's ligament to make its appearance at the saphe- 

 nous opening on the thigh. Beneath the inner end of Poupart' s ligament is the 

 iliopectineal line of the horizontal ramus of the pubic bone. The two form an angle 

 with the spine of the pubis as its apex. Gimbernat's ligament is the prolongation of 

 Poupart's ligament from the spine of the pubis for about 2 cm. (^ in.) out on the 

 iliopectineal line. From the iliopectineal line the pectineus muscle proceeds down- 

 ward and outward beneath Poupart's ligament to below and behind the lesser tro- 

 chanter of the femur. Farther out beneath Poupart's ligament run the femoral vein 

 and artery, the latter being to the outer side of the vein. Between the femoral vein 

 and Gimbernat's ligament is left a space i to 2 cm. ( -f to -f in.) wide. This space 

 is called \h& femoral canal. It is through this canal or opening that femoral hernia 

 descends. The femoral sheath is the continuation downward of the transversalis 

 fascia which is prolonged from the interior of the pelvis over the femoral artery and 

 vein and between the vein and Gimbernat's ligament so as to form three compart- 

 ments. The outer contains the femoral artery, the middle the femoral vein, and the 

 inner is the femoral canal. The femoral canal is from i to 2 cm. ( f to -| in. ) long 



External cutaneous nerve 



Iliacus muscle 



Anterior crural nerve 



Crural branch of genitocrural nerve 



Femoral artery 



Femoral vein 

 Femoral canal 

 Gimbernat's ligament 

 Spine of pubis 



-Pectineus muscle 



Psoas muscle 



FIG. 403. The crural arch and the structures which pass beneath it. 



and runs from the abdominal side of Poupart's ligament to the upper edge of the 

 saphenous opening and lies between the femoral vein and Gimbernat's ligament. 

 Its lower extremity is closed by the meeting of its sides. Above, or superficial to 

 it, is Poupart's ligament, and beneath it is the horizontal ramus of the pubis and 

 pectineal fascia covering the pectineus muscle. It is filled with loose connective 

 tissue, fat, and lymphatics, and sometimes contains a lymphatic node, forming 

 all together what has been called the septum crurale. It will thus be seen that the 

 septum crurale is continuous with the subperitoneal fatty tissue (Fig. 403) . 



Coverings of a Femoral Hernia. When a femoral hernia descends, the 

 intestine pushes in front of it the peritoneum, septum crurale (subperitoneal tissue), 

 and the femoral sheath (transversalis fascia) and makes its appearance at the saphe- 

 nous opening. The cribriform fascia closing the saphenous opening gives it a cover- 

 ing, and also the subcutaneous tissue and skin above. 



Saphenous Opening. This has its centre 4 cm. ( i y z in. ) below and to the outer 

 side of the spine of the pubis. Its margin blends above with Poupart's ligament to pro- 

 ceed to the spine of the pubis. Its outer and upper edge is marked, forming the falci- 

 form process or ligament (of Burns). The upper inner portion of the falciform process 

 is attached to the iliopectineal line and spine of the pubis and, blending with Poupart's 

 ligament above, is called Gimbernat's ligament (tig amentum lacunare) (Fig. 404). 



