THE LEG. 269 



nerves. The most posterior contains the gastrocnemius 

 and soleus, uniting to form the tendo-Achillis, and the 

 plantaris, with a good deal of fat and bursal tissue. 

 The second, anterior to the former, contains the flexor 

 longus digitorum internally, the flexor longus pollicis 

 externally, and tibialis posticus muscles between them, 

 closely united by intermuscular septa. The posterior 

 tibial vessels on the tibial side, having the posterior 

 tibial nerve external to them, and the peroneal vessels 

 on the fibula, lying at first beneath the intermuscular 

 aponeuroses, next between the flexor longus pollicis and 

 tibialis posticus, and lower down the limb, between the 

 tibialis posticus and the fibula. 



The posterior tibial artery would rarely require liga- 

 ture in its upper third, unless for injury, in which case 

 the wound should be enlarged, and the bleeding point 

 secured ; but if, however, the vessel be divided by a 

 punctured wound from the front of the leg, or in the 

 case of traumatic aneurism of the vessel, low down, it is 

 necessary to place a ligature upon it in this situation. 



Ligature of the Posterior Tibial Artery in the Upper 

 Third. This vessel is reached most scientifically by an 

 incision made along the posterior border of the subcuta- 

 neous surface of the tibia, about four inches in length, 

 dividing the integument and aponeurosis, taking care to 

 avoid the internal saphena vein and nerve. The inner 

 border of the gastrocnemius is to be drawn aside ; when 

 the tibial head of the soleus is reached, its fibres are to 

 be divided, until the intermuscular septum (the position 

 of which is variable) is come upon. This is next to be 

 cut through, and the fibres of this muscle divided until 

 freedom of access is obtained. The cut edges of the 

 soleus are to be separated, the smooth intermuscular apo- 



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