238 



FEMORAL ARTERY. 



ficial, and its pulsations can be felt during 

 life with greater or less facility according to 

 circumstances, to be explained. It has, how- 

 ever, four structures interposed between it and 

 the surface, and forming its coverings ; viz. 

 the skin, the subcutaneous cellular stratum, 

 the anterior wall of the femoral canal, and the 

 prolongation of the fascia transversalis or the 

 femoral sheath. 



The subcutaneous cellular structure pre- 

 sents a remarkable difference according to the 

 condition of the subject or certain other cir- 

 cumstances. When the body is devoid of 

 fat or emaciated, this structure appears a thin, 

 condensed, dry and lamelliform stratum, con- 

 tinued from the abdomen downward upon the 

 lower extremity, and generally denominated 

 the superficial fascia of the thigh ; but when, 

 on the contrary, the body is in good condition, 

 and the quantity of superficial adeps is con- 

 siderable, the appearance of a membranous 

 expansion is removed, and in its stead a 

 thick and uniform stratum of fat is found in- 

 terposed between the skin and the fascia lata. 

 In other cases presenting a medium condition, 

 the stratum of fat and the membranous expan- 

 sion may be both observed : in such case the 

 former is generally superficial, and the latter 

 underneath; but when the accumulation of 

 adeps in the subcutaneous structure is more 

 considerable, e. g. in the healthy infant or in 

 many adults, particularly among females, no 

 trace of superficial fascia is to be found. So 

 much for the varieties which the subcutaneous 

 cellular structure presents naturally. It is 

 also found frequently in abnormal conditions 

 deserving of attention : at times it is divisible 

 to a greater or less extent into a succession of 

 expansions, having each the appearances of 

 fasciae and being of indeterminate number : 

 this disposition, which occurs not unfrequently, 

 and is of considerable importance in a practical 

 point of view, appears due to the influence 

 of pressure exerted by tumours, e. g. that of 

 hernia. Again, in anasarca the subcutaneous 

 structure becomes greatly increased in depth, 

 and loses all appearance of membrane, seeming 

 then a deep gelatinous stratum, consisting of 

 the cellular structure and the effused serum. 



The depth, therefore, of the femoral artery 

 from the surface, and the number of coverings 

 which it may have in individual cases, must 

 be materially influenced by those several con- 

 ditions of the subcutaneous cellular structure 

 when present, and they should never be lost 

 sight of; else uncertainty and embarrassment 

 must arise in the conduct of operations. It 

 is further to be borne in mind that the account 

 of the coverings of the artery given in this 

 description has reference to the natural and 

 most simple arrangement of those structures. 

 The subcutaneous structure also encloses within 

 it the superficial vessels, nerves, and glands, 

 the relation of some of which to the artery 

 requires notice. The superficial vessels are 

 the saphena vein, the superficial femoral veins, 

 and those veins and arteries by which the 

 inguinal glands are supplied. 



The saphena vein ascends, from the inner and 



back part of the knee, along the inner and an- 

 terior aspects of the thigh to its upper extre- 

 mity, where it joins the femoral vein upon 

 its anterior and internal side, at the distance 

 of from one inch to an inch and a half below 

 Poupart's ligament. During its ascent the 

 vein passes forward and outward, and is situate 

 internal to the femoral artery: at the lower 

 extremity of the middle third of the thigh, 

 (the point at which the artery is about to pass 

 into the ham,) it is placed superficial to the 

 vessel, between it and the internal surface of 

 the limb, near to the inner, or at this part the 

 posterior margin of the sartorius muscle ; but 

 as the vein ascends, the distance between the 

 vessels increases, partly because of the greater 

 width of the thigh at its upper part, and 

 partly because the course of the vein describes 

 a curve convex inward ; and at the termination 

 of the latter it amounts to the width of the 

 femoral vein or somewhat more ; lower down 

 it is still greater in consequence of the curve 

 formed by the saphena. Hence, in operations 

 upon the superior part of the artery, the 

 saphena ought to be exempt from danger; 

 while at the lower part it must be very much 

 exposed, if the inner margin of the sartorius 

 be cut upon as the guide to the vessel. 



The superficial femoral veins next claim 

 attention: they are very irregular in their 

 course and destination, and therefore are the 

 more likely to prove a source of embarrass- 

 ment in operation. They are smaller than the 

 saphena, but yet are in many cases of con- 

 siderable size : they present, according to the 

 subject, two dispositions; either they join 

 the saphena during its ascent at variable points 

 in the course of the thigh, and in such case 

 cross the limb and the artery obliquely from 

 without inward, at different heights ; or they 

 form one or two considerable vessels, which 

 ascend external to the saphena, and open into 

 the femoral vein in front, at the same time 

 with the former vessel, passing through the 

 superficial lamina of the fascia lata in the 

 same manner as it does. When there are 

 two such veins, the inner one is generally 

 situate internal to the artery, between it and 

 the saphena, and consequently very near to 

 it ; while the external one, or the vein, if 

 there be but one, runs upward and inward, 

 and crosses the artery in its upper third, 

 between the point at which the saphena joins 

 the femoral vein and that at which the artery 

 is overlapped by the sartorius: the last-de- 

 scribed vein, when present, must obviously 

 be much endangered in exposing the femoral 

 artery at this part of its course, and perhaps 

 is the vessel which has given rise to the idea 

 that the saphena itself may be encountered in 

 cutting upon the artery in this situation. 



The superficial inguinal glands are distin- 

 guished into two sets, a superior and an in- 

 ferior : those of the former are more numerous, 

 and nearer to the integuments than the latter. 

 They are ranged immediately below Poupart's 

 ligament, having their longer diameter parallel 

 to it, and in greatest number superficial to 

 that part of the iliac portion of the fascia lata, 



