364 THE INFERIOR EXTREMITY 



superficial dissection of the anterior part of the thigh (see p. 228). They 

 form two groups, a proximal and a distal. The proximal group was found 

 lying parallel with and close to the inguinal ligament, and the distal 

 group at the sides of the proximal part of the great saphenous vein 

 (Figs. 1 06, 159). 



All the lymph from the skin and the subcutaneous structures of the 

 inferior extremity, except that derived from the lateral side of the foot, 

 the back of the heel, and the back of the leg, passes through one or other of 

 the two groups of superficial subinguinal glands, and from them it is 

 carried to the deep subinguinal glands by efferent vessels which pierce the 

 cribriform fascia and the anterior wall of the femoral sheath. The lymph 

 from the dorsum and medial side of the foot, the front and medial side of 

 the leg, the medial side and the greater part of the front of the thigh, is 

 conveyed to larger lymph vessels which accompany the great saphenous 

 vein and end in the distal subinguinal glands. The lymph from the 

 buttock and back of the thigh flows to the proximal subinguinal glands. 

 The lymph from the lateral side of the foot, the back of the heel and 

 the leg, passes into lymph vessels which accompany the small saphenous 

 vein and terminate in the popliteal lymph glands. 



It follows, from what has already been stated, that all the lymph of the 

 inferior extremity, except that from the deep parts of the buttock and back 

 of the thigh, passes through the deep subinguinal glands. From the deep 

 subinguinal glands the lymph passes into the external iliac glands, which lie 

 in the lower and anterior part of the abdomen close to the inferior end of 

 the external iliac artery and immediately above the inguinal ligament, and 

 from them it is conveyed through the common iliac glands, which lie at a 

 higher level, to the lumbar glands. The lumbar glands are situated still 

 higher in the abdomen opposite the lumbar vertebrae at the sides of the 

 aorta, and they are the last glands through which the lymph of the inferior 

 extremities passes before it enters the thoracic duct (Figs. 159, 160). 



Nervi Cutanei. Before proceeding to display the deep 

 fascia of the back of the leg the dissector should revise the 

 numerous cutaneous nerves. 



N. Saphenus. The saphenous nerve is the most medial 

 of the deeper group of branches of the femoral nerve. 

 It commences therefore in the femoral triangle, where it 

 descends along the lateral border of the femoral artery ; it 

 accompanies the artery through the adductor canal, lying 

 first on its lateral side, then in front of it, and finally in the 

 distal part of the canal on its medial side. It does not 

 accompany the artery through the opening in the adductor 

 magnus, but, at the distal end of the adductor canal it 

 passes between the sartorius and gracilis muscles accompanied 

 by the saphenous branch of the arteria genu suprema. At 

 the medial side of the knee it pierces the deep fascia, enters 

 the superficial fascia, and then it accompanies the great 

 saphenous vein to the medial border of the foot. In the 

 adductor canal it gives twigs to the subsartorial plexus. 

 After it leaves the canal, and before it emerges between the 



