1204 



SURGICAL ANATOMY OF THE PERINEUM. 



the lower layer. The dorsal nerve of the penis is also contained within the two 

 layers, accompanying the dorsal artery along the ischio-pubic ramus, and with it 

 piercing the anterior layer and the suspensory ligament to be distributed to the 

 penis. 



The Accelerator urinae and Erector penis should now be removed, when the deep perineal 

 fascia will be exposed, stretching across the front part of the outlet of the pelvis. The urethra 

 is seen perforating its centre just behind the bulb, and on each side is the crus penis, connecting 

 the corpus cavernosum with the rami of the ischium and os pubis. 



The deep perineal fascia (triangular ligament), which has already been described 

 (see page 463), consists of two layers, the inferior or superficial layer of which, 

 sometimes called the anterior layer of the triangular ligament, is now exposed. It 

 is united to the superior or deep layer behind, but is separated in front by a sub- 

 fascial space, in which are contained certain structures. 



The superficial layer of the deep perineal fascia consists of a strong fibrous 

 membrane, the fibres of which are disposed transversely, which stretches across 



GREAT SACRO- 

 SCIATIC LIGAMENT 



Superficial perineal artery. 

 Superficial perineal nerve. 

 Internal pudic nerve. 

 Internal pudic artery. 



FIG. 768. The superficial muscles and vessels of the perinseum. 



from one ischio-pubic ramus to the other and completely fills in the pubic arch ; 

 it is attached in front to the subpubic ligament, except just in the centre, where a 

 small interspace is left for the dorsal vein of the penis. In the erect position of 

 the body it is almost horizontal. It is perforated by the urethra in the middle 

 line, and on each side by the ducts of Cowper's glands. It is pierced also by the 

 dorsal artery of the penis close to the base of the ligament ; by the artery to the 

 corpus cavernosum more anteriorly and in the opposite direction, close to the lateral 

 margin of the ligament ; and by the artery to the bulb also from above downward 

 in front of the opening for Cowper's duct. The dorsal nerve of the penis also 

 passes through the ligament in company with the artery of the same name. The 

 crura penis are exposed, lying superficial to this ligament. They will be seen to 

 be attached by blunt-pointed processes to the rami of the os pubis and ischium, in 

 front of the tuberosities, and passing forward and inward, joining to form the body 

 of the penis. In the middle line is the bulb and corpus spongiosum, exposed by 

 the removal of the Accelerator urinse muscle. 



