THE THIGH. 



5 2 7 



Superficial 



Lymphatics of the Groin. The lymphatic nodes of the groin are frequently 

 the seat of infection necessitating operative measures. They are superficial and deep. 

 For clinical purposes there is no better division of the superficial nodes than into an 

 oblique set along Pourjart's ligament and a longitudinal set along the blood-vessels 

 (Fig. 536). 



While as a general rule it may be stated that the nodes drain the region they 

 are nearest to, this is frequently not the case. Therefore it is not always possible to 

 infer the source of the infection from the location of the infected lymph node. The 

 nodes of the groin drain the lower anterior half of the 

 abdomen, the genitalia, lower limb, and the anal, gluteal, 

 and lumbar regions. 



They vary from 10 to 20 in number, and their 

 efferent vessels either pass through the femoral canal to 

 the nodes inside of the abdomen, or may terminate in 

 the deep lymphatic nodes of the femoral canal. 



The deep lymphatics consist of one to three nodes 

 in the femoral canal internal to the femoral vessels. 

 They are not constant, and one which is sometimes 

 found at the upper end of the femoral canal is known 

 as the gland or node of Cloquet. They receive the deep 

 lymphatics of the thigh, as well as sometimes a commu- 

 nication from the superficial lymphatics. They rarely 

 become the seat of infection, but if inflamed may be 

 mistaken for strangulated femoral hernia. 



Excision of Inguinal Nodes. The inguinal 

 nodes frequently become inflamed and swollen (bubo) 

 from infection transmitted from the parts which they 

 drain. For this they are frequently excised. The 

 superficial nodes are located on the fascia lata around 

 the saphenous opening, and at that point are intimately 

 associated with and surround the veins. On this ac- 

 count it is easy to wound the veins, and the hemor- 

 rhage may be so free and so hard to control as to en- 

 danger the life of the patient. I know of one such 

 fatal case. This accident is to be avoided by freeing 

 the edge of the mass below the saphenous opening 

 and isolating the long saphenous vein, which is then 

 followed up and exposed at its entrance into the femoral 

 vein. The diseased mass is then to be dissected loose 

 from each side, away from the vein, and removed. The 

 femoral vein itself at this point is superficial, and if the 

 saphenous opening is cleaned out it will of necessity 

 be exposed. 



The other veins emptying into the femoral at the 

 saphenous opening above the long saphenous the su- 

 perficial circumflex iliac, epigastric, and external pudic 

 are usually too small and easily secured to cause trouble. 



Sciatic Nerve. The sciatic nerve in its descent 

 crosses a line joining the tuberosity of the ischium and 

 greater trochanter at the junction of its inner and middle thirds. It then descends 

 toward the middle of the popliteal space. It divides into the internal and external 

 popliteal nerves at about the middle of the thigh (Fig. 537). Rarely it divides 

 lower down, but more frequently higher up. It is said that it will bear a weight 

 of 183 Ibs., but Symington {Lancet, 1878 Treves) has pointed out that it will tear 

 out from its spinal attachment before this limit is reached. In exposing it the incision 

 should be made high up at the gluteal fold, to the outer side of the tuberosity of the 

 ischium. At this point it lies to the outer side of the biceps and on the adductor 

 magnus; a little lower down it disappears beneath the biceps, and, if the incision 

 is made here, the muscle must be displaced and it may only be found with difficulty. 



FIG. 536. Superficial lymphatic 

 vessels of lower limb; semidiagram- 

 matic. (Based on figures of Sappey.) 



