GLUTEAL REGION. 



335 



Fig. 189. Dissection of the Lower Ex- 

 tremity. Posterior View. 



/ . Dissection of 



CLUTEAL RECIOU 



immediately behind it; from the posterior surface of the last piece of the sacrum, 

 the side of the coccyx, and posterior surface of the great sacro-sciatic and 

 posterior sacro-iliac ligaments. The fibres are directed obliquely downwards and 

 outwards ; those forming the upper and larger 

 portion of the muscle (after converging some- 

 what) terminate in a thick tendinous lamina, 

 which passes across the great trochanter, and 

 is inserted into the fascia lata covering the 

 outer side of the thigh, the lower portion of 

 the muscle being inserted into the rough line 

 leading from the great trochanter to the linea 

 aspera, between the Vastus externus and Ad- 

 ductor magnus. 



Three synovial bursse are usually found se- 

 parating the under surface of this muscle from 

 the eminences which it covers. One of these, 

 of large size, and generally multilocular, sepa- 

 rates it from the great trochanter. A second, 

 often wanting, is situated on the tuberosity of 

 the ischium. A third, between the tendon of 

 this muscle and the Vastus externus. 



Relations. By its superficial surface, with 

 a thin fascia, which separates it from cellular 

 membrane, fat, and the integument. By its 

 deep surface, from above downwards, with 

 the ilium, sacrum, coccyx, and great sacro- 

 sciatic ligament, part of the Gluteus medius, 

 Pyriformis, Gemelli, Obturator internus, 

 Quadratus femoris, the tuberosity of the 

 ischium, great trochanter, the origin of the 

 Biceps, Semi-tendinosus, Semi-membranosus, 

 and Adductor magnus muscles. The gluteal 

 vessels and nerve are seen issuing from the 

 pelvis above the Pyriformis muscle, the 

 ischiatic and internal pudic vessels and nerves, 

 and the nerve to the Obturator internus 

 muscle below it. Its upper border is thin, 

 and connected with the Gluteus medius by 

 the fascia lata. Its lower border, free and 

 prominent, forms the fold of the nates, and is 

 directed towards the perineum. 



Dissection. The Gluteus maxiraus should now be divided near its origin by a vertical incision 

 carried from its upper to its lower border : a cellular interval will be exposed, separating it from 

 the Gluteus medius and external Rotator muscles beneath. The upper portion of the muscle 

 should be altogether detached, and the lower portion turned outwards ; the loose areolar tissue 

 filling up the interspace between the trochanter major and tuberosity of the ischium being re- 

 moved, the parts already enumerated as exposed by the removal of this muscle will be seen. 



The Gluteus Medius is a broad, thick, radiated muscle, situated on the outer 

 surface of the pelvis. Its posterior third is covered by the Gluteus maximus ; its 

 anterior two-thirds are covered by the fascia lata, which separates it from the 

 integument. It arises from the outer surface of the ilium, between the superior 

 and middle curved lines, and from the outer lip of that portion of the crest which 

 is between them ; it also arises from the dense fascia covering its anterior part. 

 The fibres converge to a strong flattened tendon, which is inserted into the oblique 

 line which traverses the outer surface of the great trochanter. A synovial bursa 



BA.CK of THICB 



POPLITEAL SPACE 



BACK of LEG 



SOLE if FOOT 



