GLUTEAL REGION 285 



nerve of the thigh to the trunk of that nerve at the lower border 

 of the glutaeus maximus, and after the trunk of the nerve is 

 secured, proceed to clean the glutaeus maximus. The dissector 

 of the right inferior extremity should begin at the upper border 

 of the muscle and work downwards, the dissector of the left 

 limb should work upwards from the inferior border. On the 

 right side the dissector should cut through the deep fascia a 

 little below the upper border of the muscle, then he should 

 raise the upper portion of the divided fascia until the upper border 

 of the muscle is exposed, and the fascia superficial to it is 

 found to blend with the strong fascia covering the glutaeus 

 medius. The upper border of the muscle should now be raised 

 and drawn downwards to display the layer of deep fascia sub- 

 jacent to it. When this has been done the dissector will readily 

 realise that the strong fascia on the more anterior part of the 

 glutaeus medius splits at the upper border of the maximus into 

 a superficial layer which covers the maximus and a deep layer 

 which passes downwards over the lower part of the glutaeus 

 medius and the muscles which lie more distally at the back of 

 the hip joint. The dissector on the left side will demonstrate 

 the same facts when he reaches the upper border of the muscle, 

 for he will find the deep fascia which he has raised from the 

 surface of the glutaeus maximus blends with the strong 

 fascia on the glutaeus medius,and by lifting the upper border of 

 the maximus he will display the deeper layer of fascia. 



The glutaeus maximus is a difficult muscle to clean, as the 

 fasciculi are exceedingly coarse. It is necessary therefore not 

 only to remove the fascia which covers the muscle, but at the 

 same time to follow, for a short distance, the septa which 

 penetrate between the fasciculi and to remove them also. Do 

 not remove the thick opaque fascia which covers the insertion 

 of the muscle. 



If the work is to be done well the dissector must keep clearly 

 before him the rules which have already been laid down regard- 

 ing the cleaning of a muscle : (i) Render the fibres as tense as 

 possible by rotating the limb medially ; (2) remove the fascia 

 in one continuous layer ; (3) always cut in the direction of the 

 muscular fibres ; (4) define very carefully the borders of the 

 muscle. 



M. Glutaeus Maximus. The glutaeus maximus is a 

 powerful muscle which arises (i) from a narrow, rough 

 area on the dorsum ilii, which is included between the posterior 

 curved line and the outer lip of the crest; (2) from the sides 

 of the lower two pieces of the sacrum and the upper three 

 pieces of the coccyx ; (3) from the entire posterior surface of 

 the sacro-tuberous ligament (O.T. great sciatic); and (4), 

 slightly, from the posterior layer of the lumbo-dorsal fascia, 

 at the attachment of that fascia to the crest of the ilium. 



From this extensive origin the coarse fasciculi of the 

 muscle proceed obliquely downwards and forwards towards 

 the proximal portion of the femur ; but only a comparatively 



