THE THIGH. 523 



Femoral Artery. The line of the femoral artery is from a point midway 

 between the anterior superior spine and the symphysis pubis (this brings it to the 

 inner side of the middle of Poupart's ligament) to the adductor tubercle at the inner 

 upper part of the internal condyle. Just below Poupart's ligament it gives off four 

 small branches; the superficial external circumflex, superficial epigastric, and superfi- 

 cial and deep external pudic. About 4 cm. ( i ^ in. ) down it gives off the profunda 

 femoris, which is almost as large as the parent trunk. On reaching the edge of the 

 sartorius it passes beneath it to enter Hunter's canal, and at the junction of the mid- 

 dle and lower third of the thigh it pierces the adductor magnus to become the 

 popliteal. At Poupart's ligament the femoral vein lies to the inner side of the 

 artery, but at the apex of the triangle it lies behind it. 



Ligation of the Femoral Artery. In ligating the femoral artery an incision is 

 made in the line given above, and the artery sought for beneath the fascia lata. Lig- 

 atures are not placed high up, on account of the proximity of the deep femoral; 

 lower down at the apex of the triangle is the preferred point. The crural branch of 

 the genitocrural nerve lies on the artery for a short distance below Poupart's ligament; 

 it is small in size. Just to the outer side of the artery, and sometimes touching it, is 



Rectus femoris 

 Vastus internus 



Gracilis and adductor muscles 

 Line of femoral artery 

 Sartorius 

 Scarpa's triangle 

 Adductor tubercle ^. / / / / / /.Saphenous opening 



FIG. 532. Surface anatomy of the thigh. 



the anterior crural nerve, and running down its outer side are the internal cutaneous 

 and internal saphenous branches. The femoral vein, which above was internal to 

 the artery, at the apex of the triangle lies posterior to it (Fig. 534). 



The profunda femoris artery comes off 4 cm. (i^ in.) below Poupart's liga- 

 ment. Its branches are the external (lateral) and internal (medial) circumflex, and 

 four perforating. The last perforating is terminal. The external circumflex passes 

 outward over the iliacus and under the sartorius and rectus and divides into three 

 branches; the ascending branch follows the anterior intertrochanteric line and gives 

 off a branch which enters the joint between the limbs of the iliofemoral or Y liga- 

 ment. The transverse branch goes outward to the upper part of the vastus exter- 

 nus; and the descending branch supplies the muscle lower down. The ascending 

 and transverse branches lie beneath the incision, which is made in operating on the 

 hip-joint anteriorly, and may be cut during the operation. The internal circumflex 

 winds inwardly between the psoas and pectineus, then between the adductor brevis 

 and obturator externus, and then between the adductor magnus and quadratus fem- 

 oris to anastomose with the external circumflex, sciatic, and superior perforating. 



The four perforating arteries wind around close to the bone from within outward 

 and terminate in the hamstring and vastus externus muscles. They perforate the 

 adductor muscles and send large anastomotic branches to one another near the linea 

 aspera. In operations on the femur, when the soft parts are detached from the 

 posterior portion of the bone, the bleeding from these perforating branches is liable 

 to be very free and on account of their depth difficult to control. It is this which 

 renders operations like those for ununited and compound fractures dangerous. 



