1044 



THE SURGICAL ANATOMY OF HERNIA. 



The aponeurosis of the External oblique should be removed by dividing it across in the same 

 direction as the external incisions, and reflecting it downward and outward : great care is requisite 

 in separating it from the aponeurosis of the muscle beneath. The lower part of the Internal 

 oblique and the Cremaster are then exposed, together with the inguinal canal, which contains 

 the spermatic cord (Fig. 580). The mode of insertion of Poupart's and Gimbernat's ligaments 

 into the os pubis should also be examined. 



Poupart's ligament, or the crural arch, is the lower border of the aponeurosis 

 of the External oblique muscle, which extends from the anterior superior spine of 

 the ilium to the spine of the os pubis. From this latter point it is reflected 

 outward to be attached to the pectineal line for about half an inch, forming 



FIG. 580. Inguinal hernia. Dissection showing the Internal oblique and Cremaster. 



Gimbernat's ligament. Its general direction is curved downward toward the thigh, 

 where it is continuous with the fascia lata. Its outer half is rounded and oblique 

 in direction ; its inner half gradually widens at its attachment to the os pubis, is 

 more horizontal in direction, and lies beneath the spermatic cord. 



Gimbernat's Ligament (Fig. 588) is that portion of the aponeurosis of the Ex- 

 ternal oblique muscle which is reflected upward and outward from the spine of the 

 os pubis to be inserted into the pectineal line. It is about half an inch in length, 

 larger in the male than in the female, almost horizontal in direction in the erect 

 posture, and of a triangular form, with the base directed outward. Its base or 

 outer margin is concave, thin, and sharp, and lies in contact with the femoral sheath, 

 forming the inner boundary of the crural ring (see Fig. 588). Its apex corre- 

 sponds to the spine of the os pubis. Its posterior margin is attached to the pecti- 

 neal line, and is continuous with the pubic portion of the fascia lata. Its anterior 

 margin is continuous with Poupart's ligament. 



The triangular fascia of the abdomen is a band of tendinous fibres, of a 

 triangular shape, which is attached by its apex to the pectineal line, where it is 

 continuous with Gimbernat's ligament. It passes inward beneath the spermatic 

 cord, and expands into a somewhat fan-shaped fascia, lying behind the inner pillar 



