222 THE INFERIOR EXTREMITY 



To reflect the skin take hold of the most convenient angle 

 of the flap the upper or the lower medial angle in the present 

 dissection with the forceps, and with the edge of the scalpel 

 detach it from the soft fat beneath. 



As soon as the angle selected is sufficiently detached discard 

 the forceps, seize the detached angle between the thumb and 

 forefinger of the left hand, and pull it away from the fat, keeping 

 it stretched and tense ; then draw the edge of the scalpel across 

 the skin, at its junction with the fat, from one edge of the flap 

 to the other, always keeping the edge of the knife against the 

 skin. If the work is done properly the leathery-looking deep 

 surface of the skin will be entirely freed from fat, as the flap 

 is reflected, and the superficial nerves and vessels which lie in 

 the fat will not be injured. When the skin is reflected the 

 superficial fascia is exposed. 



Superficial Fascia (Panniculus Adiposus). The superficial 

 fascia is found over the whole surface of the body. It varies 

 in structure in different parts, but in all parts, with the 

 exception of the region of the scrotum, it contains a greater 

 or a smaller amount of yellowish fat, the amount varying not 

 only with the part under consideration but also with the 

 general obesity or thinness of the subject In some regions, 

 such as the anterior part of the neck and the adjacent part of 

 the chest, reddish muscle fibres are present in the deeper part 

 of the fat ; in the scrotum the muscle fibres entirely replace 

 the fat. The fat is interspersed and divided into lobules by 

 lamellae of denser tissue called fibrous tissue, and in the deeper 

 part of the superficial fascia the fibrous tissue becomes more 

 predominant, forming a membrane which is the deeper or 

 membranous layer of the superficial fascia. In the superficial 

 fascia lie the cutaneous vessels and nerves and the deeper 

 parts of the hair follicles and skin glands and the superficial 

 lymph glands. Under the superficial fascia is a more firm 

 membranous layer, the deep fascia, surrounding the muscles 

 and deeper parts. 



The superficial fascia intervenes therefore between the 

 skin and the deep fascia, and it is attached to both by fibrous 

 strands which pass through the fat. As it lies between the 

 skin and the deep fascia it provides a soft elastic cushion upon 

 which the skin rests, and which, by its elasticity, allows the 

 skin to be moved over the deeper parts. It rounds off the 

 angularities of the deeper parts and forms a bed in which 

 the cutaneous vessels and nerves ramify before they enter 

 the skin. 



In most parts of the body the laxity of the superficial 



