202 



ABDOMEN 



with the fatty superficial fascia on the front of the thigh. 

 The relations of the fascia of Scarpa are very different. In 

 the region of the pubes it is carried continuously downwards 

 over the spermatic cords, the penis and scrotum, into the 

 perineum, where it becomes continuous with the fascia of 

 Colles (see p. 152), which is attached, on each side, to the 

 corresponding body of the pubis. On the lateral side of the 

 spermatic cord, in the region of the groin, Scarpa's fascia 

 ends, immediately distal to the inguinal ligament, by blending 

 with the fascia lata of the thigh. 



Dissection. The connections of the fascia of Scarpa are so 

 important that it is necessary to undertake a special dissection, 

 in order that they may be demonstrated. As this dissection 

 encroaches somewhat upon the region of the thigh, it must be 

 done in conjunction with the dissector of the lower extremity. A 

 transverse incision should 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 median line of the 

 abdomen. When the inferior edge of the divided fascia is raised 

 the two layers can be easily distinguished. Insinuate the fingers 

 between the fascia of Scarpa and the subjacent pearly-looking 

 tendon of the external oblique muscle. Little resistance will be 

 met, as the fascia of Scarpa is bound down to the deeper structures 

 only by some lax areolar tissue. As the superficial fascia is 

 raised from the aponeurosis of the external oblique, the anterior 

 cutaneous branch of the ilio-hypogastric nerve will be seen 

 piercing the aponeurosis and entering the deep surface of the 

 superficial fascia, a little way above the subcutaneous inguinal 

 ring. The fingers can be readily passed downwards behind the 

 fascia of Scarpa as far as the inguinal ligament. There it will 

 be found that they can force their way no farther. The passage 

 of the hand into the thigh is barred by the blending of the fascia 

 of Scarpa with the fascia lata of the thigh. At that level the 

 fascia of Scarpa ceases to exist ; it loses its identity by becoming 

 fused with the deep fascia of the thigh along the line of, and 

 immediately distal to, the inguinal ligament. Towards the pubes 

 the finger can be pushed downwards behind the fascia of Scarpa 

 and along the spermatic cord into the perineum. No barrier 

 opposes the passage of the finger in that direction. The con- 

 tinuity of the fascia of Scarpa and the fascia of Colles is thus 

 demonstrated. 



If the dissector now recalls the fact that, in the urethral 

 triangle of the perineum, the fascia of Colles is attached 

 laterally to the margins of the pubic arch and to the anterior 

 surfaces of the bodies of the pubic bones, and posteriorly to 

 the base of the urogenital diaphragm, whilst above the level of 

 the pubic crests it is continuous with the fascia of Scarpa on 

 the front of the abdominal wall, he will have little difficulty in 

 understanding the course which urine takes when extrava- 



