192 SURGICAL ANATOMY OF 



preference) is to be made, commencing at the middle of 

 Poupart's ligament, and at about an inch above it, to a 

 point just beyond the anterior superior spine of the 

 ilium. The structures divided and the method of divid- 

 ing them are those described in ligature of the common 

 iliac, with this exception, that here they are more apo- 

 neurotic, from being nearer Poupart's ligament ; and the 

 deep epigastric artery is in this instance in danger of 

 division, if the incision be made too near the rectus 

 muscle. 



When the peritoneum and intestines have been pulled 

 away from the point where the ligature is to be applied, 

 it often happens that neither artery nor vein is to be 

 found ; in this case they have followed these structures, 

 and will be discovered lying adherent to the under sur- 

 face of the peritoneal bag, with the ureter, from which 

 they must be cautiously separated. The needle is to be 

 applied from within outwards. 



Collateral Circulation after Ligature of External Iliac : 

 The gluteal anastomoses, with the external circumflex 

 from the profunda femoris ; the ilio-lumbar, with the 

 circumflexa ilii ; the obturator, with the internal circum- 

 flex from the profunda ; the ischiatic, with the perforat- 

 ing and circumflex branches of the profunda ; the inter- 

 nal pudic, with the superficial and deep external pudic, 

 and the internal circumflex from the profunda ; and the 

 deep epigastric with the superior epigastric from the in- 

 ternal mammary. 



SUKGICAL ANATOMY OF THE LUMBAR REGION. 



The lumbar region forms the posterior portion of the 

 abdominal parietes, and is of surgical importance from 

 the application to its anterior aspect of the abdominal 



