THE FKONT OF THE THIGH. 1459 



forming a rounded subcutaneous bony ridge. A line extending from the pubic 

 tubercle horizontally laterally across the front of the thigh crosses the front of the 

 hip-joint at the level of the inferior part of the head of the femur. The cord-like 

 tendon of the adductor longus is readily felt, and a point about 1 in. below the 

 pubic tubercle is selected for performing the operation of subcutaneous tenotomy 

 of the tendon. 



The centre of the fossa ovalis is situated 1J in. distal and lateral to the pubic 

 tubercle ; it overlies the medial (hernial) and intermediate (venous) compartments 

 of the femoral sheath ; behind the lateral border of the opening is the arterial 

 compartment of the sheath ; crossing over the distal border is the termination of 

 the great saphenous vein. A femoral hernia makes its way into the thigh below 

 the proximal edge of the opening. The course of the great saphenous vein in the 

 thigh is indicated by a line extending from the adductor tubercle of the medial 

 epicondyle of the femur to the distal part of the fossa ovalis. 



The horizontal or subinguinal chain of lymph glands can usually be felt along, and 

 a little distal to, the line of the inguinal ligament ; when the glands are inflamed 

 the surgeon should not neglect to examine the buttocks and anus as well as the 

 external genitals. The vertical or femoral chain lies in close relation to the upper 

 end of the great saphenous vein. Deeper glands also are met with deep to the 

 fascia cribrosa, close to the medial side of the femoral vein, and there is generally 

 one in the femoral canal. To clear out the glands in the groin an incision should 

 be made parallel to, and a finger's breadth distal to the whole length of the 

 inguinal ligament. 



To map out the course of the femoral artery, the thigh being slightly flexed and 

 rotated laterally, draw a line from the mid-point between the anterior superior 

 iliac spine and the symphysis pubis to the adductor tubercle at the proximal and 

 posterior part of the medial epicondyle ; rather less than the proximal third of this 

 line corresponds to the femoral artery in the femoral trigone, while rather more 

 than its middle third corresponds to the artery as it lies in the adductor canal. 

 The seat of election for ligature of the vessel is at the apex of the femoral trigone. 

 To compress the femoral, pressure should be made directly backwards against 

 the ilio-pectineal eminence, and not against the head of the femur ; to compress 

 the femoral in the adductor canal, pressure should be made laterally against the 

 medial surface of the shaft of the femur. 



On the lateral aspect of the thigh the fascia lata is thick, aponeurotic, and 

 loosely attached to the vastus lateralis ; hence the tendency of abscesses to travel 

 distally under cover of it towards the knee. The sartorius, which forms the most 

 important muscular landmark of the thigh, may be thrown into prominence by 

 maintaining the thigh unsupported, flexed, and slightly rotated laterally. Observe 

 that in the proximal third of the thigh it forms the lateral boundary of the femoral 

 trigone ; in the middle third it is placed superficial to the adductor canal ; while in 

 the distal third it lies in front of the medial hamstrings. Lateral and adjacent to 

 the proximal part of the sartorius is the prominence -of the tensor fasciae latae, 

 which, as it passes to its insertion, diverges from the sartorius; in the angle 

 between the two the tendon of the rectus femoris may be felt as it overlies the 

 distal part of the anterior aspect of the articular capsule of the hip. 



The medial aspect of the distal half of the shaft of the femur may be conveniently cut down 

 upon through the vastus medialis, where it comes to the surface between the sartorius and rectus 

 muscles ; the incision should be made in the direction of a line extending from a point midway 

 between the medial border of the patella and the adductor tubercle, to the anterior superior 

 iliac spine. 



The front of the hip-joint may be reached through an incision from the anterior superior 

 iliac spine distally, along either the medial or the lateral border of the sartorius ; in the former 

 case the deeper part of the dissection passes between the iliacus and the medial border of the 

 rectus femoris, while in the latter case the joint is reached lateral to the rectus tendon, between 

 it and the anterior borders of the glutseus medius and minimus muscles. The ascending branch of 

 the lateral circumflex artery of the thigh crosses the capsule parallel to, and immediately 

 above, the intertrochanteric line. The ilio-psoas crosses the anterior and the medial part 

 of the capsule ; between the two is a bursa, which frequently communicates with the joint 

 through the thin part of the capsule medial to the ilio-femoral ligament ; it is by way of this 

 communication that a psoas abscess occasionally gives rise to secondary tubercular disease of the 



