PARTS CONCERNED IN FEMORAL HERNIA. 559 



stitched together to keep moist the subjacent parts; and the saphenous 

 opening is to be learnt. 



The saphoneous opening in the fascia lata (fig. 193, jQ is a narrow semi- 

 lunar slit, which is situate rather to the inner side of the middle line of the 

 thigh. It measures about a third of an inch in width, and one inch and a 

 half in length. Its upper extremity (superior cornu) is at Pou part's liga- 

 ment; and its lower extremity (inferior cornu) is distant from that struc- 

 ture about one inch and a half, and presents a well-defined margin. 



The inner part of the opening is posterior to the level of the femoral 

 vessels, and is flattened over the subjacent muscle (pectineus) ; but it is 

 marked below by a thin and sharp border. 



The outer boundary is much stronger, and has a semilunar border when 

 detached, whose concavity is turned downwards and inwards. This edge 

 is named from its shape falciform margin of the saphenous opening (falci- 

 form process of Burns) ; it is superficial to the femoral vessels, and is con- 

 nected by fibrous bands to the crural sheath, and to the deeper layer of 

 the superficial fascia. Traced upwards, the outer edge blends with the 

 base of Gimbernat's ligament (part of Poupart) : the upper end of this 

 border, where it is internal to the subjacent femoral vein, has been named 

 the femoral ligament. 



The rigidity of the margin of the opening is much influenced by the 

 position of the limb; for with the finger beneath the upper part of the 

 falciform border, whilst the thigh is moved in different directions, this 

 band will be perceived to be most unyielding when the limb is extended 

 and rotated out, and most relaxed when the thigh is bent and turned in 

 the opposite direction. 



Through the lower part of the opening the saphenous vein is transmit- 

 ted : and through the upper part, close to the falciform edge, a femoral 

 hernia projects. Lymphatics and one or two superficial vessels also pass 



through it. 



PARTS CONCERNED IN FEMORAL HERNIA. 



To obtain a knowledge of the hernial protrusion in the thigh, the dis- 

 sector has to study the undermentioned parts, viz., the crural arch and 

 Gimbernat's ligament, the crural sheath with its crural canal and ring, 

 together with a partition (septum crurale) between the thigh and the 

 abdomen. 



Dissection (fig. 194). To examine Poupart's ligament and a loose 

 membranous sheath around the femoral vessels, the piece of the fascia lata 

 outside the saphenous opening is to be reflected inwards by the following 

 incisions: One cut is to be begun near the edge of the falciform border, 

 and to be carried outwards for one inch and a half, parallel and close to 

 Poupart's ligament. Another is to be directed obliquely downwards and 

 inwards from the termination of the first, to a little below the inferior 

 cornu of the opening. When the fascia marked out by those incisions has 

 been raised and turned inwards, and the fat removed, the tube on the ves- 

 sels (crural sheath) will be brought into view as it descends beneath Pou- 

 part's ligament. 



With the handle of the scalpel the crural sheath is to be separated 

 carefully from the fascia lata beneath, from Poupart's ligament in front, 

 and from Gimbernat's ligament on the inner side. 



Pouparfs ligament (fig. 194, ), or the crural arch, is the firm band of 



