212 ABDOMEN 



Ligamentum Lacunare (Gimbernati) (Fig. 95). The lacunar 

 ligament is a triangular process of aponeurotic membrane. 

 Raise the spermatic cord, or the round ligament of the uterus, 

 place the finger behind the medial end of the inguinal 

 ligament, and press downwards. The structure upon which 

 the finger rests is the lacunar ligament, and the student should 

 note that it offers a barrier to the passage of the finger into 

 the thigh. With the handle of the knife, its shape and 

 connections can be easily defined. Its apex is fixed to the 

 pubic tubercle; by one margin it is attached to the medial 

 part of the inguinal ligament ; by its other margin it is inserted 

 for the distance of an inch into the ilio-pectineal line. Its base 

 is sharp, crescentic, and free, and is directed laterally towards 

 the femoral sheath. The dissector should thoroughly realise 

 that the lacunar ligament is not an independent structure. 

 It is merely the medial part of the folded-back margin of 

 the inguinal ligament which, in the vicinity of the pubic 

 tubercle, obtains an attachment to bone. 



The lacunar ligament occupies an oblique plane, its lower 

 or femoral surface looking distally and slightly forwards and 

 laterally, whilst its upper or abdominal surface looks upwards 

 and slightly backwards and medially. It is of importance 

 that the student should note the precise relation which this 

 ligament bears to the spermatic cord. Taken in conjunction 

 with the inguinal ligament and the aponeurosis of the external 

 oblique, it forms a groove in which the cord lies. 



Ligamentum Inguinale Reflexum (O.T. Triangular Fascia) 

 (Fig. 95). The reflex inguinal ligament is a small triangular 

 sheet of fibres which springs from the crest of the pubic 

 bone and the medial end of the ilio-pectineal line. It runs 

 upwards and medially, under cover of the superior crus 

 of the subcutaneous inguinal ring, and joins the linea 

 alba. If the fibres which compose it are followed through 

 the linea alba, they will be found to be continuous with the 

 fibres of the aponeurosis of the external oblique muscle of 

 the opposite side. It must, therefore, be considered as an 

 additional insertion of that muscle. It is, frequently, so 

 poorly developed that its true relations and connections are 

 demonstrated with difficulty, if indeed they are capable of 

 demonstration at all (Figs. 96, 98). 



Dissection. The internal oblique muscle must now be cleaned. 

 Towards its lower part it is pierced by certain nerves, and they 



