246 THE INFERIOR EXTREMITY 



lateral femoral circumflex artery, which passes laterally either 

 behind or between the nerves. After the nerves mentioned 

 have been cleaned pull the trunk of the femoral nerve laterally 

 and secure the nerve to the pectineus, which springs from the 

 medial border of the femoral nerve and passes medially behind 

 the femoral sheath. Follow it as far as possible behind the 

 sheath and keep it in mind during the next stage of the dis- 

 section, which includes the removal of the femoral sheath and 

 the cleaning of the femoral artery and its branches and the 

 femoral vein and its tributaries. As many of the branches 

 of the artery as possible should be retained, but small branches 

 to the muscles may be removed if they obstruct the cleaning 

 of the larger vessels. The main trunks of the veins must also 

 be kept and cleaned, but the venae comites of the smaller arteries 

 should be removed. 



Commence with the femoral artery. Trace the superficial 

 branches already displayed back to their origin from the trunk 

 as it lies in the femoral sheath, then raise the trunk of the artery 

 from the sheath, and completely remove that portion of the 

 sheath which surrounded the artery, but do not forget the nerve 

 to the pectineus which lies immediately behind the sheath. As 

 the arterial part of the femoral sheath is removed, find the deep 

 external pudendal artery, which springs from the proximal part 

 of the trunk ; then clean the distal part of the femoral artery as 

 far as the apex of the trigone. First clean the medial side, from 

 which no important branches arise. Then clean along the lateral 

 side, from above downwards, and about 50 mm. distal to the 

 inguinal ligament find the large profunda femoris branch, which 

 springs from the postero - lateral aspect of the parent trunk. 

 Follow the profunda artery distally and medially behind the 

 femoral and profunda veins and secure its first two branches, 

 the medial and the lateral femoral circumflex arteries. The 

 medial femoral circumflex artery passes backwards into the 

 deep part of the trigone ; the lateral femoral circumflex artery 

 runs laterally, behind or between the muscular branches of the 

 femoral nerve, to the lateral border of the femoral trigone, where 

 it breaks up into ascending, transverse and descending branches. 

 Not uncommonly one or both the femoral circumflex arteries 

 spring from the trunk of the femoral artery, and the dissector 

 must be prepared to meet with such variations. 



After the arteries are displayed, clean the femoral and pro- 

 funda veins, both of which lie posterior to the femoral artery 

 in the distal part of the trigone. As the posterior aspect of the 

 proximal part of the femoral vein is cleaned the nerve to the 

 pectineus must be followed to its termination in the pectineus 

 muscle ; then the remaining parts of the pectineal fascia must 

 be removed from the pectineus and adductor longus. As that 

 is done, an interval will come into view between the lower 

 border of the pectineus and the upper border of the adductor 

 longus, in which the superficial division of the obturator nerve 

 should be found. Lastly, the iliac fascia must be cleaned from 

 the surfaces of the iliacus and psoas, and the fat in the angle 

 between the psoas and pectineus must be removed. 



Trigonum Femorale. The femoral triangle is the name 

 given to the triangular hollow which lies in the proximal 



