THE LEG. 265 



tella, are to be removed according to circumstances ; but 

 in the instance of performing the operation on children, 

 it is of great importance to avoid removing the entire 

 epiphyses, as there would then be no further growth in 

 the limb. 



Structures Divided in Excision of the Knee-joint. In- 

 tegument and aponeurosis, patellar plexus of nerves, bursa 

 patellae, ligamentum patellae, anterior part of capsular 

 ligament, synovial membrane, crucial ligaments, lateral 

 ligaments, articular vessels, and articular extremities of 

 femur and tibia. The popliteal vessels are separated 

 from the opened joint by the posterior ligament and 

 poplitens muscle. 



SURGICAL ANATOMY OF THE LEG. 



The surgical region of the leg commences just below 

 the knee, and extends to an imaginary line drawn round 

 the lower part of the limb, just above the malleoli. 



Surface Markings. Anteriorly is the crest of the tibia, 

 internal to which is the flat plane surface of the shaft of 

 the bone, which being subcutaneous throughout permits 

 of ready examination, and external to it is the mass of 

 the tibialis anticus, and extensors of the toes. Externally 

 are the peronei, separated by a well-marked groove cor- 

 responding to the interspace between them and the ex- 

 ternal edge of the soleus. Posteriorly is the swell of the 

 calf, due to the gastrocenemius and soleus, the division 

 between the two heads of the former being marked by a 

 furrow continuous with the lower portion of the popli- 

 teal space. As the muscular fibres cease, the tendo- 

 Achillis becomes more evident. 



The leg can be readily divided into two regions, an 



