ILIAC FOSSA (EXTRA-PERITONEAL). 191 



fascia, which is to be carefully pinched up, nicked, and 

 a director insinuated between it and the peritoneum. It 

 is then to be divided to the length of the incision in the 

 muscles (the deep circumflex iliac artery will stand a 

 chance of being cut). The peritoneal bag and its con- 

 tents are to be then pulled away towards the middle 

 line, when the vessel will be seen just beyond the sacro- 

 iliac synchondrosis. The needle is to be passed from 

 within outwards. 



The collateral circulation would be maintained by the 

 inosculation of the lateral sacral and middle sacral, epi- 

 gastric and internal mammary, aortic intercostals and 

 lumbar, the ilio-lumbar and last lumbar, the obturator, 

 with its fellow of the opposite side, and the epigastric, 

 gluteal, and sacral, hsemorrhoidal of the internal iliac, 

 with the superior hsemorrhoidal of the inferior mesen- 

 teric and the vesical of the opposite sides, and the uterine 

 and ovarian in the female. 



The External Iliac Artery. The course of this vessel 

 would be indicated on the surface of the body by a line 

 extending from either side of the umbilicus to the centre 

 of Poupart's ligament. It commences at the bifurcation 

 of the common iliac, and extends to the crural arch, 

 where it becomes common femoral. 



Its relations are, in front, intestines and peritoneum, 

 a considerable quantity of loose areolar tissue, the sper- 

 matic vessels, the genito-crural nerve (near Poupart's 

 ligament), the circumflexa ilii vein, and a chain of lym- 

 phatics ; externally, the psoas muscle, and fascia iliaca ; 

 internally, the external iliac vein, vas deferens, and lym- 

 phatics ; behind, the external iliac vein and psoas magnus 

 muscle. 



Ligature of External Iliac. An incision (curved for 



