3 o2 PRACTICAL ANATOMY. 



Locate by limitation the medio-tarsal joint, and gii'c the surgical importance 

 thereof, 



Posteriorly, it is limited by the calcaneum and astragalus ; anteriorly, by the 

 cuboid and scaphoid. It is through this articulation the knife passes in Chopart's 

 amputation at the medio-tarsal articulation. 



Locate by limitation the tarso-metatarsal articulation, and give its surgical 

 importance. 



It is limited posteriorly by the cuboid and cuneiform bones ; anteriorly, by 

 the bases of the metatarsal bones. It is through this articulation Lisfranc's 

 amputation is made. 



Locate on the cadaver : (i) The crest of the ilium ; (2) the anterior iliac spine ; 

 (3) the spine of the pubes ; (4) the symphysis pubis ; (5) the pubic crest; (6) 

 the femoral condyles, internal and external ; (7) the tuberosities of the tibia, 

 internal and external ; (8) the head, neck, and styloids of the fibula ; (9) the crest 

 of the tibia ; ( 10) the subcutaneous inner surface of the tibia ; ( 1 1) the inner and 

 outer malleoli ; (12) the os calcis ; (13) the cuboid bone ; (14) the tuberosity of 

 the scaphoid; (15) the patella and ligamentum patellae; (16) the tubercle of 

 the tibia ; (17) Poupart's ligament or crural arch. 



How to Make Skin Incisions. First cut through the skin from the 

 centre of Poupart's ligament to the centre of the second toe, the incision pass- 

 ing through the mid-line of the patella. The second cut extends along 

 Poupart's ligament, from the anterior superior spine of the ilium to the symphysis 

 pubis. The third cut extends from one femoral condyle to the other. The 

 fourth cut extends from the inner to the outer malleolus. Now remove the 

 skin. Always follow this rule in removing the skin : Cut closely enough to 

 the skin to permit light to shine through. 



THE SUPERFICIAL FASCIA. 



The superficial fascia is the second covering of the body. It contains a vari- 

 able amount of fat. When, as a result of starvation or malnutrition, this fat 

 disappears, the skin lies closely upon the deep fascia, and bony eminences are 

 numerous in other words, the individual is emaciated. This fascia always 

 'consists of two layers an upper layer, containing the fat ; a deep layer, in which 

 are found the cutaneous vessels and nerves. The immense fatty mass in the 

 superficial fascia is recorded in the surgical description of operations as the 

 panniculus adiposus. Remember that there are numerous arteries in the super- 

 ficial fascia for the nutrition of the skin, but few of them have special names. 

 Collectively they are known as superficial, dermal, or cutaneous arteries. There 

 are also numerous veins in this fascia. On account of their large size and 

 surgical importance, quite a number have received special names as long and 

 short saphenous ; still here, too, the rank and file of veins are collectively desig- 

 nated, as are the arteries viz. : superficial, dermal, or cutaneous. By common 

 consent, the word superficial is used by anatomists to designate anything in the 

 superficial fascia ; hence all arteries, veins, nerves, muscles, and lymphatics, in 

 this fascia may properly be collectively designated superficial. 



Having removed the skin, according to directions previously given, consult 

 figures 209, 210, and 21 1, and find in the deep layer of the superficial fascia the 

 following cutaneous or superficial structures : 



1. The dorsal venous arch of the foot arcus dorsalis pedis. 



2. The long saphenous vein and its tributaries. 

 \. The short saphenous vein and its tributaries. 



4. The internal and external femoral cutaneous veins. 



5. The superficial epigastric vein and its tributaries. 



