FASCIA LATA SAPHENOUS OPENING. 833 



(femoral ligament of Hey) ; it overlies, and is adherent to, the sheath of the 

 femoral vessels beneath ; to its edge is attached the cribriform fascia, and it is 

 continuous below with the pubic portion of the fascia lata by a well-defined 

 curved margin. 



The pubic portion of the fascia lata is situated at the inner side of the saphe- 

 nous opening: at the lower margin of this aperture, it is continuous with the 

 iliac portion: traced upwards, it covers the surface of the Pectineus, Adductor 

 Longus, and Gracilis muscles; and passing behind the sheath of the femoral 

 vessels, to which it is closely united, is continuous with the sheath of the Psoas 

 and Iliacus muscles, and is finally lost in the fibrous capsule of the hip-joint. 

 This fascia is attached above to the pectineal line, and internally to the margin 

 of the pubic arch. It may be observed from this description that the iliac 

 portion of the fascia lata passes in front of the femoral vessels, the pubic portion 

 behind them ; an apparent aperture consequently exists between the two, through 

 which the internal saphenous joins the femoral vein. 



The Saphenous Opening is an oval-shaped aperture, measuring about an inch 

 and a half in length, and half an inch in width. It is situated at the upper and 

 inner part of the thigh, below Poupart's ligament, towards the inner side, and 

 is directed obliquely downwards and outwards. 



Its outer margin is of a semilunar form, thin, strong, sharply-defined, and lies 

 on a plane considerably anterior to the inner margin. If this edge is traced 

 upwards, it will be seen to form a curved elongated process or cornu (the 

 superior cornu), or falciform process of Burns, which ascends in front of the 

 femoral vessels, and curving inwards, is attached to Poupart's ligament and to 

 the spine of the pubes and pectineal line, where it is continuous with the pubic 

 portion. 1 If traced downwards, it is found continuous with another curved 

 margin, the concavity of which is directed upwards and inwards; this is the 

 inferior cornu of the saphenous opening, and is blended with the pubic portion 

 of the fascia lata covering the Pectineus muscle. 



The inner boundary of the opening is on a plane posterior to the outer mar- 

 gin, and behind the level of the femoral vessels; it is much less prominent and 

 defined than the outer, from being stretched over the subjacent Pectineus mus- 

 cle. It is through the saphenous opening that a femoral hernia passes after 

 descending along the crural canal. 



If the finger is introduced into the saphenous opening while the limb is 

 moved in different directions, the aperture will be found to be greatly con- 

 stricted on extending the limb, or rotating it outwards, and to be relaxed on 

 flexing the limb and inverting it: hence the necessity of placing the limb in the 

 latter position in employing the taxis for the reduction of a femoral hernia. 



The iliac portion of the fascia lata, together with its falciform process, should now be removed, 

 by detaching it from the lower margin of Poupart's ligament, carefully dissecting it from the 

 subjacent structures, and turning it aside when the sheath of the femoral vessels is exposed 

 descending beneath Poupart's ligament (Fig. 451). 



The Crural Arch, or Pouparfs Ligament, is the lower border of the aponeu- 

 rosis of the External Oblique muscle, which stretches across from the anterior 



1 It is difficult to perceive in the recognized description of these ligaments (Hey's and 

 Burns's), any difference between the two; nor is it clear what structure Mr. Hey really intended 

 to describe. Mr. Gay (on ''Femoral Rupture" p. 16) gives very cogent reasons for thinking 

 that the " deep crural arch" was the structure which Hey had in view. The most recent writer 

 on Femoral Hernia speaks thus while treating of these parts : " The whole upper edge of the 

 iliac fascia lata is commonly called the 'falciform process,' whilst its deeper fibres receive the 

 name of ' Burns's ligament.' Hey's femoral ligament would appear to consist of distinct fibres 

 connected with the inner fold of the iliac fascia, which extend immediately beneath the tendon 

 of the external oblique to the subperitoneal fascia." (CALLENDER, "On the Anatomy of the Parts 

 Concerned -in Femoral Rupture," p. 19, note.) This description of Hey's ligament accords 

 closely with that of the deep crural arch, for the subperitoneal fascia is Mr. Callender's name 

 for the fascia transversalis. Mr. Callender goes on to say, "The upper border of this (saphe- 

 nous) opening thus receives, by an unfortunate complication, the names of 'Falciform process,' 

 ' Femoral ligament,' ' Burns's or Hey's ligament.' The various divisions of the iliac fascia lata 

 depend in great measure upon the skill of the dissector, and are, in my opinion, artificial." 

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