THE SURGICAL ANATOMY OF HERNIA. 



Dissection (Fig. 757). For dissection of the parts concerned in inguinal hernia a male 

 subject, free from fat, should always be selected. The body should be placed in the supine posi- 

 tion, the abdomen and pelvis raised by means of blocks placed beneath them, and the lower 

 extremities rotated outward, so as to make the parts as tense as possible. If the abdominal walls 

 are flaccid, the cavity of the abdomen should be inflated by an aperture through the umbilicus. 

 An incision should be made along the middle line from the umbilicus to the symphysis pubis, 

 and continued along the front of the scrotum, and a second incision from the anterior superior 

 spine of the ilium to just below the umbilicus. These incisions should divide the integument, 

 and the triangular-shaped flap included between them should be reflected downward and outward, 

 when the superficial fascia will be exposed. 



The Superficial Fascia of the Abdomen. This, over the greater part of the 

 abdominal wall, consists of a single layer of fascia, which contains a variable 

 amount of fat ; but as it approaches the groin it is easily divisible into two layers, 

 between which are found the superficial vessels and nerves and the superficial 

 inguinal lymphatic glands. 



The superficial layer is thick, areolar in texture, containing adipose tissue in 

 its meshes, the quantity of which varies in different subjects. Below, it passes 

 over Poupart's ligament, and is continuous with the outer layer of the superficial 

 fascia of the thigh. In the male this fascia is continued over the penis and over 

 the outer surface of the cord to the scrotum, where it helps to form the dartos 

 As it passes to the penis and over the cord to the scrotum it changes its character, 

 becoming thin, destitute of adipose tissue, and of a pale reddish color ; and in the 

 scrotum it acquires some involuntary muscular fibres. From the scrotum it may 

 be traced backward, to be continuous with the superficial fascia of the perinseum. 

 In the female this fascia is continued into the labia majora. 



The hypogastric branch of the ilio-hypogastric nerve perforates the aponeurosis 

 of the External oblique muscle about an inch above and a little to the outer side of 

 the external abdominal ring, and is distributed to the integument of the hypogastric 

 region. 



The ilio-inguinal nerve escapes at the external abdominal ring, and is distributed 

 to the integument of the upper and inner part of the thigh, to the scrotum in the 

 male and to the labium in the female. 



The superficial epigastric artery arises from the femoral about half an inch 

 below Poupart's ligament, and, passing through the saphenous opening in the fascia 

 lata, ascends on to the abdomen, in the superficial fascia covering the External 

 oblique muscle, nearly as high as the umbilicus. It distributes branches to the 

 superficial inguinal lymphatic glands, the superficial fascia, and the integument, 

 anastomosing with branches of the deep epigastric and internal mammary arteries. 



The superficial circumflex iliac artery, the smallest of the cutaneous branches, 

 arises close to the preceding, and, piercing the fascia lata, runs outward, parallel 

 with Poupart's ligament, as far as the crest of the ilium, dividing into branches 

 which supply the superficial inguinal lymphatic glands, the superficial fascia, and 

 the integument, anastomosing with the deep circumflex iliac and with the gluteal 

 and external circumflex arteries. 



The superficial external pudic (superior) artery arises from the inner side of 

 the femoral artery close to the preceding vessels, and, after passing through the 

 saphenous opening, courses inward across the spermatic cord, to be distributed to 

 the integument on the lower part of the abdomen, the penis and scrotum in the male, 

 and the labium in the female, anastomosing with branches of the internal pudic. 



The. Superficial Veins. The veins accompanying these superficial vessels are 



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