246 SURGICAL ANATOMY OF THE 



knife, if a point midway between the anterior superior 

 spinous process of the ilium and the trochanter major be 

 taken for entering the instrument, and its point be in- 

 sinuated onwards towards the capsule, transfixing it, and 

 directed downwards, forwards, and inwards, to a point 

 just in front of the tuberosity of the ischium ; the knife 

 is then to cut the anterior flap from the front of the thigh, 

 and an assistant is to help the operator by rotating the 

 limb forcibly outivards, so as to bring the globular head 

 of the femur and its attached ligamentum teres towards 

 the surface ; the ligament and capsule being divided, the 

 assistant rotates the limb inwards, at the same time draw- 

 ing it towards himself, so that the operator's knife, after 

 cutting through the posterior portion of the capsule, may 

 clear the trochanter major, and fashion the hinder flap. 



Structures Divided in Amputation through the Hip-joint 

 by the Antero-posterior Flaps. In the anterior, integu- 

 ment, fasciae, and superficial vessels, sartorius, anterior 

 crural nerve, femoral vessels, rectus, tensor fasciae, ilia- 

 cus and psoas, portion of gracilis, adductor longus, ad- 

 ductor brevis, pectineus, and profunda vessels, and part 

 of obturator externus and glutei, with superior gluteal 

 and external circumflex vessels and nerves, capsular lig- 

 ament, and ligamentum teres. In the posterior, part of 

 the gracilis, adductor longus and brevis, and the adduc- 

 tor magnus and pectineus, internal circumflex artery, 

 obturator nerve, quadratus femoris, part of obturator ex- 

 ternus, obturator internus and gemelli, the hamstring 

 muscles, sciatic vessels and nerves, part of glutens mini- 

 mus and medius, and the gluteus maximus, with its ves- 

 sels, and the integuments of the buttock. 



Excision of the Hip-joint. The joint may be exposed 

 either by a straight, curved, or T-incision, according to 



