146 



DISSECTION OF THE THIGH. 



Crural ring- 



situation 

 and form ; 



boundaries. 



Crural 

 septum : 



Femoral 

 hernia : 

 definition 



course ; 



first 

 vertical, 



next 



forwards, 

 and then 

 upwards, 



How it is 

 to be pushed 

 back. 



The crural ring is the upper opening of the crural canal. It is 

 on a level with the base of Gimbernat's ligament, and is larger in 

 the female than in the male. Oval in shape, its greatest measure- 

 ment is from side to side, in which direction it equals about half 

 an inch ; and it is filled by a lymphatic gland. 



The structures around the ring are the superficial and the deep 

 crural arch in front, and the pubis covered by the pectineus muscle 

 behind. Internally is Gimbernat's ligament with the conjoined 

 tendon ; and externally (but within the sheath) is the femoral 

 vein. 



Septum crurale. That part of the subperitoneal fatty layer which 

 is placed over the abdominal entrance to this crural canal has been 

 named crural septum from its position between the thigh and 

 abdomen. The situation of the septum is now visible, but its 

 characters will be ascertained in the dissection of the abdomen. 



FEMORAL HERNIA. In this kind of hernia there is a protrusion 

 of intestine into the thigh beneath Poupart's ligament. And the 

 gut descends in the crural sheath, being placed on the inner side of 

 the vein. 



Course. At first the intestine takes a vertical direction in its 

 progress from the abdomen, and passes through the crural ring, and 

 along the crural canal as far as the saphenous opening. At this 

 spot it changes its course, and is directed forwards to the surface of 

 the thigh, where it becomes elongated transversely ; and should the 

 gut protrude still farther, the tumour ascends on the abdomen, in 

 consequence of the resistance being less in this direction than on 

 the front of the thigh. 



The winding course of the hernia may suggest to the dissector 

 the direction in which attempts should be made to replace the in- 

 testine in the abdominal cavity. With the view of making the 

 bowel retrace its course, it will be necessary, if the protrusion is 

 small, to direct it backwards and upwards ; but if the hernia is 

 large, it must be pressed down first to the saphenous opening, and 

 afterwards backwards and upwards towards the crural canal and 

 ring. 



During the manipulation to return the intestine to its cavity, 

 the thigh is to be raised and rotated inwards, in order that the 

 margin of the saphenous opening and the other structures may be 

 relaxed. 



SCARPA'S TRIANGULAR SPACE. 



Triangular 

 space. 



This hollow is situate on the front of the thigh, and lies beneath 

 the superficial depression seen near Poupart's ligament. 



Dissection (fig. 57, p. 147). The space will appear on remov- 

 ing the fascia lata near Poupart's ligament. The muscular boundaries 

 on the sides may be first dissected, and the muscle on the outer 

 side (sartorius) should be fixed in place with stitches. Afterwards 

 the remains of the crural sheath are to be taken away ; and the 

 femoral vessels are to be followed downwards as far as the sartorius 

 seek nerves, muscle. On the outer side of the vessels clean the divisions of the 



Clean out 

 Scar pa's 

 space. 



Follow 

 vessels, 



