224 THE INFERIOR EXTREMITY 



transverse incision must be made through the entire thickness 

 of the superficial fascia on the front of the abdomen from 

 the anterior superior spine of the ilium to the middle line of the 

 body. When the lower edge of the divided fascia is raised its 

 two layers are easily distinguished. The deeper membranous 

 stratum is known as Scarpa's fascia (Fig. 105). Insinuate 

 the fingers behind Scarpa's fascia between it and the pearly- 

 looking tendon of the external oblique muscle. Little 

 resistance will be encountered, for the fascia and the tendon 

 are only connected by some fragile areolar tissue, and the 

 fingers can be passed downwards as far as the inguinal 

 ligament. At or immediately beyond the inguinal ligament 

 the passage of the hand into the thigh is barred by the union 

 of Scarpa's fascia with the deep fascia of the thigh, which is 

 called the fascia lata. If the fingers are carried medially 

 along the line of union of the two fasciae, it will be found 

 that the line of attachment descends across the front of the 

 pubis to the rami of the pubis and ischium, that is, into the 

 region of the perineum, which is the interval between the thighs. 

 In the perineum the deep layer of the superficial fascia is no 

 longer called Scarpa's fascia ; it becomes Colics' fascia, and 

 has definite connections, which will be studied by the 

 dissector of the abdomen. 



If urine or other fluid is effused into the anterior part of 

 the perineum, it cannot get into the medial femoral region 

 because of the attachment of the deep layer of superficial 

 fascia to the rami of the pubis and ischium and to the front 

 of the pubis, but it can ascend, in the areolar tissue between 

 the deep layer of superficial fascia and the deep fascia, to 

 the wall of the abdomen. Having reached the wall of the 

 abdomen it cannot descend into the anterior femoral region 

 because of the connection between the deep layer of the 

 superficial fascia and the fascia lata at or a short distance 

 distal to the inguinal ligament. 



Dissection. The dissection of the contents of the super- 

 ficial fascia of the subinguinal and anterior femoral regions 

 is one of the most difficult dissections which fall to the 

 lot of the dissector of the inferior extremity. The structures 

 to be displayed are. (i) Four veins the great saphenous, the 

 superficial external pudendal, the superficial epigastric, and 

 the superficial circumflex iliac. (2 Three arteries the super- 

 ficial external pudendal, the superficial epigastric, and the 

 superficial circumflex iliac. (3) The proximal and distal groups 

 of subinguinal lymph glands and the lymph vessels which enter 



