BRANCHES OF THE FEMORAL. 441 



been cautiously divided, and the Sartorius exposed, this muscle must be drawn outwards, in order 

 to fully expose the sheath of the vessels. The finger being introduced into the wound, and the 

 pulsation of the artery felt, the sheath should be divided over it to a sufficient extent to allow of 

 the introduction of the ligature, but no further ; otherwise the nutrition of the coats of the vessel 

 may be interfered with, or muscular branches which arise from the vessel at irregular intervals 

 may be divided. In this part of the operation, a small nerve which crosses the sheath should 

 be avoided. The aneurism needle must be carefully introduced and kept close to the artery, to 

 avoid the femoral vein, which lies behind the vessel in this part of its course. 



To expose the artery in the middle of the thigh, an incision should be made through the integu- 

 ment, between three and four inches in length, over the inner margin of the Sartorius, taking care 

 to avoid the internal saphenous vein, the situation of which may be previously known by com- 

 pressing it higher up in the thigh. The fascia lata having been divided, and the Sartorius muscle 

 exposed, it should be drawn outwards, when the strong fascia which is stretched across from the 

 Adductors to the Vastus internus, will be exposed, and must be freely divided ; the sheath of the 

 vessels is now seen, and must be opened, and the artery secured by passing the aneurism needle 

 between the vein and artery, in the direction from within outwards. The femoral vein in this 

 situation lies on the outer side of the artery, the long saphenous nerve on its anterior and outer 

 side. 



It has been seen that the femoral artery occasionally divides into two trunks, below the origin 

 of the profunda. If, in the operation for tying the femoral, two vessels are met with, the surgeon 

 should alternately compress each, in order to ascertain which vessel is connected with the aneu- 

 rismal tumor, or with the bleeding from the wound, and that one only tied which controls it. If, 

 however, it is necessary to compress both vessels before the circulation in the tumor is controlled, 

 both should be tied, as it would be probable that they had become reunited, as is mentioned above. 



Collateral Circulation. The principal agents in carrying on the collateral circulation after 

 ligature of the femoral artery are, according to .Sir A. Cooper, as follows :' 



" The arteria profunda formed the new channel for the blood." " The first artery sent off 

 passed down close to the back of the thigh bone, and entered the two superior articular branches 

 of the popliteal artery." 



" The second new large vessel arising from the profunda at the same part with the former, 

 passed down by the inner side of the Biceps muscle, to an artery of the popliteal which was dis- 

 tributed to the Gastrocnemius muscle; whilst a third artery dividing into several branches passed 

 down with the sciatic nerve behind the knee-joint, and some of its branches united themselves 

 with the inferior articular arteries of the popliteal, with some recurrent branches of those arteries, 

 with arteries passing to the Gastrocnemii, and, lastly, with the origin of the anterior and posterior 

 tibial arteries." 



" It appears then that it is those branches of the profunda which accompany the sciatic nerve, 

 that are the principal supporters of the new circulation." 



Branches. The branches of the femoral artery are the 



Superficial epigastric. 

 Superficial circumflex iliac. 

 Superficial external pudic. 

 Deep external pudic. 



{External circumflex. 

 Internal circumflex. 

 Three perforating. 

 Muscular. 

 Anastomotica magna. 



The superficial epigastric 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 inguinal 

 glands, the superficial fascia and integument, anastomosing with branches of the 

 deep epigastric and internal mammary arteries. 



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

 close to the preceding, and, piercing the fascia lata, runs outwards, parallel with 

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

 supply the integument of the groin, the superficial fascia, and inguinal glands- 

 anastomosing with the circumflex iliac, and with the gluteal and external circum 

 flex arteries. 



1 Medtco-Chiruryical Transactions, vol. ii. 1811. 



