596 /4 MANUAL OF ANATOMY 



Front Ol the Thigh. — The dissector should make himself thoroughly familiar 

 with the landmarks of the front of the thigh and of the knee. The first 

 dissection should be limited to the upper 4 inches in connection with the parts 

 involved in femoral her-nia. For tlus purpose three incisions are required 

 for the removal of the skin, as follows : one along the line of the groin from 

 the anterior superior iliac spine to the pubic angle, a second extending from 

 the pubic angle vertically downwards along the inner side of the thigh for 

 4 inches, and a third extending from the lower end of the second incision 

 transversely across the front of the thigh as far as its outer aspect. 



It is to be desired that the subsequent dissection, which has to do with the 

 superficial fascia and cutaneous vessels, should be undertaken in concert with 

 the dissector of the abdomen. The superficial fascia in this region should be 

 shown to be divisible into a subcutaneous fatty layer and a deep thin mem- 

 branous layer, which correspond with Camper's and Scarpa's fasciae of the 

 lower part of the anterior abdominal wall. In order to reflect the subcu- 

 taneous layer, a transverse incision should be carefully made across the thigh, 

 the depth of this incision coinciding internally with the long saphenous vein, 

 which lies between the two layers of the superficial fascia. Another incision 

 should be made vertically upwards on the inner side of the thigh, and extending 

 only through the subcutaneous layer. Acting simultaneously with the 

 dissector of the abdomen, the dissector of the thigh can now reflect outwards 

 the subcutaneous layer, and both dissectors will see that it is continuous over 

 Poupart's ligament with Camper's fascia of the anterior abdominal wall. 

 Care should be taken not to disturb the lymphatic glands of this region. 

 The inguinal glands (including the pubic glands) and the superficial femoral 

 or saphenous glands are next to be dissected. The former will be found 

 lying with their long axes obHque just below Poupart's Ugament, and the latter 

 with their long axes vertical along the terminal part of the long saphenous 

 vein. 



The cutaneous arteries of the groin, with their corresponding veins, are 

 to be dissected, namely, the superficial epigastric, superficial circumflex 

 iliac, and superior external pudic. The inferior external pudic, being beneath 

 the fascia lata, is not to be dissected at present. The terminal part of the 

 long saphenous vein should be shown, up to the level of the saphenous 

 opening, and the following tributaries should be displayed joining it, namely, 

 the external femoral cutaneous or anterior saphenous from the front of the 

 thigh, the internal femoral cutaneous or posterior saphenous from the inner 

 and back parts of the thigh, and the cutaneous veins of the groin, namely, 

 the superficial epigastric, superficial circumflex iliac, and superior and inferior 

 external pudic. 



The deep layer of the superficial fascia is next to be raised towards 

 Poupart's ligament. It lies immediately beneath the long saphenous vein, 

 and upon the deep fascia or fascia lata. When raised towards the groin 

 it will be seen to cover the saphenous opening, and thereafter to be firmly 

 bound down to the fascia lata about ^ inch below Poupart's ligament. The 

 portion of it which covers the saphenous opening should be carefully studied. 

 It is called the cribriform fascia, and it should be shown to be closely attached 

 to the outer border of the saphenous opening, but only loosely to the inner 

 part. It will be obvious that a hernia in passing through the saphenous 

 opening must receive a covering from the cribriform fascia. 



The following nerves should now be dissected, namely, (i) branches of 

 the inguinal nerve (so-called ilio-inguinal), which will be found on the inner 

 aspect of the thigh; (2) the femoral branch of the genito-femoral, appearing 

 immediately external to the femoral artery just below Poupart's hgament, 

 after having pierced the outer part of the femoral sheath ; and (3) the external 

 cutaneous nerve, which will be found emerging beneath the outer end of 

 Poupart's ligament. 



The fascia lata is next to be cleaned, and the saphenous opening exposed, 

 which should be carefully dissected. The best starting-point is the in- 

 ferior cornu, which will readily come into view by raising the long saphenous 

 vein. The cribriform fascia, is to be carefully removed, and the various 



