642 THE ARTERIES. 



PLAN OF THE RELATIONS OF THE ANTERIOR TIBIAL ARTERY. 



In front. 



Integument, superficial and deep fasciae. 

 Anterior tibial nerve. 



Tibialis anticus (overlaps it in the upper part of the leg). 

 Extensor longus digitorum ) / n , ^ , i- 1,1 v 

 Extensor proprius hallucis \ (overla P xt sll g htl y)- 

 Anterior annular ligament. 



Inner side. ^ ^\ Outer side. 



Tibialis anticus. / Anterior \ Anterior tibial nerve. 



Extensor proprius hallucis ( Tibiai Extensor longus digitorum. 



(crosses it at its lower V / Extensor proprius hallucis. 



part). </ 



Behind. 



Interosseous membrane. 

 Tibia. 

 Anterior ligament of ankle-joint. 



Peculiarities in Size. This vessel may be diminished in size, may be deficient to a greatei 

 or less extent, or may be entirely wanting, its place being supplied by perforating branches from 

 the posterior tibial or by the anterior division of the peroneal artery. 



Course. The artery occasionally deviates in its course toward the fibular side of the leg, 

 regaining its usual position beneath the annular ligament at the front of the ankle. In two 

 instances the vessel has been found to approach the surface in the middle of the leg, being 

 covered merely by the integument and fascia below that point. 



Surface Marking. A line drawn from the inner side of the head of the fibula to midway 

 between the two malleoli will mark the course of the artery, the point where the artery comes 

 in front of the interosseous membrane being in this line, one and a quarter inches below the 

 level of the head of the fibula. 



Surgical Anatomy. The anterior tibial artery may be tied in the upper or lower part 

 of the leg. In the upper part the operation is attended with great difficulty, on account of the 

 depth of the vessel from the surface. An incision about four inches in length, should be made 

 through the integument, midway between the spine of the tibia and the outer margin of the 

 fibula, the fascia and intermuscular septum between the Tibialis anticus and Extensor longus 

 digitorum being divided to the same extent. The foot must be flexed to relax these muscles, 

 and they must be separated from each other by the finger. The artery is then exposed deeply 

 seated, lying upon the interosseous membrane, the nerve lying externally, and one of the venae 

 comites on either side ; these must be separated from the artery before the aneurism needle is 

 passed round it. 



To tie the vessel in the lower third of the leg above the ankle-joint an incision about three 

 inches in length should be made through the integument between the tendons of the Tibialis 

 anticus and Extensor proprius hallucis muscles, the deep fascia being divided to the same extent. 

 The tendon on either side should be held aside, when the vessel will be seen lying upon the 

 tibia, with the nerve superficial to it and one of the venae comites on either side. 



The branches of the anterior tibial artery are the 



Posterior Recurrent Tibial. Muscular. 



Superior Fibular. Internal Malleolar. 



Anterior Recurrent Tibial. External Malleolar. 



The posterior recurrent tibial is not a constant branch, and is given off from 

 the anterior tibial before that vessel passes through the interosseous space. It 

 ascends beneath the Popliteus muscle, which it supplies, and anastomoses with the 

 lower articular branches of the popliteal artery, giving off an offset to the 

 superior tibio-fibular joint. 



The superior fibular is sometimes given off from the anterior tibial, sometimes 

 from the posterior tibial. It passes outward, round the neck of the fibula, through 

 the Soleus, which it supplies, and ends in the substance of the Peroneus longus 

 muscle. 



The anterior recurrent tibial branch arises from the anterior tibial as soon as 

 that vessel has passed through the interosseous space ; it ascends in the Tibialis 

 anticus muscle, and ramifies on the front and sides of the knee-joint, anastomos- 

 ing with the articular branches of the popliteal and with the anastomotica magna. 



The muscular branches are numerous : they are distributed to the muscles 



