VEINS OF THE LOWER EXTREMITY. 



615 





the leg, and communicates with the deep veins on the dorsum of the foot and 

 behind the outer malleolus. Before it perforates the deep fascia it gives off 



a communicating branch, which 



v passes upward and inward to join 



1 the internal saphenous vein. This 



vein has a variable number of 

 valves, from three to nine (Gay), 

 one of which is always found near 

 its termination in the popliteal 

 vein. The external saphenous 

 nerve lies close beside this vein. 



Surgical Anatomy. The saphena 

 veins are of considerable surgical import- 

 ance, since a varicose condition of these 

 vessels is more frequently met with than 

 of those in other parts of the body, except 

 perhaps the spermatic and haemorrhoidal 

 veins. The course of the internal 

 saphenous is in front of the tip of the 

 malleolus, over the subcutaneous surface 

 of the lower end of the tibia, and then 

 along the internal border of this bone 

 to the back part of the internal condyle of 

 the femur, \yhence it follows the course 

 of the Sartorius muscle, and is represented 

 on the surface by a line drawn from the 

 posterior border of the Sartorius on a 

 level witb the internal condyle to the 

 saphenous opening. The short saphenous 

 lies behind the external malleolus, and 

 from this follows the middle line of the 

 calf to just below the ham. It is not 

 generally so apparent beneath the skin as 

 the internal saphenous. Both these veins 

 in the leg are accompanied by nerves, the 

 internal saphenous being joined by its 

 companion nerve just below tbe level of 

 the knee-joint. No doubt much of the 

 pain of varicose veins in the leg is due to 

 this fact. On the Continent the internal 

 saphenous vein as it rests on the tibia 

 just above the malleolus is sometimes 

 selected for venesection. 



FIG. 335. External 

 or short saphenous 

 vein. 



The Deep Veins of the Lower 



Extremity accompany the arteries and their branches, 

 and are called the vence comites of those vessels. 



The external and internal plantar veins unite to form 

 the posterior tibial. They accompany the posterior 

 tibial artery and are joined by the peroneal veins. 



The anterior tibial veins are formed by a con- 

 tinuation upward of the venae comites of the dorsalis 

 pedis artery. They pass between the tibia and fibula, 

 through the large oval aperture above the interosse- 

 ous membrane, and form, by their junction with the 

 posterior tibial, the popliteal vein. 



The valves in the deep veins are very numerous. 



The Popliteal Vein is formed by the junction of the 



FIG. 334. The internal or long ,>., nnmitp nf flip antprinr anrl nnrprinv Hhial VPO 

 saphenous vein and its branches, venae ( 



sels ; it ascends through the popliteal space to the 



tendinous aperture in the Adductor magnus, where it becomes the femoral vein. 

 In the lower part of its course it is placed internal to the artery ; between the 



