132 
anastomoses form an important part of that 
system of collateral circulation by which the 
Stream of blood is continued to the leg and 
foot, after the obliteration of the popliteal 
aie 
he anterior tibial artery may require to be 
tied in case of wound or aneurism. In wounds 
of the dorsal artery of the foot, it may be advi- 
sable to put a ligature at the lower third of the 
leg, when the anterior tibial is running between 
the tendons. Its course may be here ascer- 
tained by feeling its pulsation, or by observing 
the liue of the tendon of the extensor proprius 
gai on the fibular side of which it here lies. 
hen about to tie it higher up, the incision in 
the integuments and fascia must be the more 
free in proportion as it is nearer the knee; and 
it may sometimes be advisable even to divide 
some of the fibres of the fascia transversely, to 
rmit more freely the retraction of the muscu- 
far sides of the cut. In dissection, we so easily 
separate the muscles and expose the artery, 
that we may underrate the difficulty attending 
the operation of tying it. The depth at which 
it lies in this part, the constant contraction of 
the muscles, and the difficulty of retracting the 
sides of the incision, occasioned by the strong 
aponeuroses, all constitute considerable obsta- 
cles to the operation. This artery was subcu- 
taneous in a case related by Pelletan, and is 
occasionally very small indeed, or even abso- 
lutely wanting. The first anomaly we have se- 
veral times seen in dissection, and an instance 
of the latter is related by Huguier.* In these 
cases a large branch of the peroneal, which had 
passed through the interosseous ligament a 
little above the ankle-joint, supplied the place 
of the lower part of the artery. In a case 
which was met with by Velpeau, he found this 
artery not perforating the interosseous ligament 
at all, but winding round the fibula just below 
the head of this bone, and in company with the 
musculo-cutaneous nerve.t 
The artery is accompanied by two veins, one 
laced on each side, throughout its course. 
e anterior tibial nerve, which is a branch 
from the peroneal, runs on the fibular side of 
the artery first, and then obliquely crosses it, 
sometimes again passing outwards, towards the 
lower part of the leg. The deep-seated lym- 
phatics following the course of the vessels, 
deep-seated disease of the front of the leg may 
produce alteration of the glands of the ham. 
A lymphatic gland is found in front of the an- 
terior tibial vessels, a little below the opening 
of the interosseous ligament through which 
the vessels pass. 
In the posterior region of the leg the mus- 
cles are arranged in two distinct layers, the 
superficial, composed of the gastrocnemius, 
soleus, and plantaris; the deep, of the popli- 
teus, the tibialis posticus, the flexor communis 
digitorum, and flexor longus pollicis. The 
gastrocnemius becomes tendinous, considerably 
higher in the calf than the soleus, sending off 
* See Velpeau’s Anatomy of Regions, p. 474. 
- Sce Velpeau’s Médécine Operatoire, tom. iii. 
137. 
REGIONS OF THE LEG. 
its broad thin tendon about the middle of th 
leg, to unite with that of the soleus, about @ 
junction of its middle and lower thirds. 
soleus, beginning its origin lower than ~ 
last muscle, from the bones of the leg, ¢ 
tinues its muscular fibres lower in proport 
in this respect varying considerably in di 
subjects. 
ese two muscles, arising above 
distinct heads, and having but one msé 
below, form in fact but one muscle, 4 
Meckel has named the triceps ‘ 
common tendon is of a strength propor 
to that of the muscles themselves, ai 
therefore exceedingly powerful. Ne 
ing, the combined action of the muscles is 
sionally too much for the tendon, and in 
ing, dancing, or other similar move 8, 
sometimes ruptured. After this ace 
difficulty of cure results, not so much 
injury done to the tendon itself, as from 
difficulty of bringing the two ends into a 
tion. In fact, complete union neve 
the utmost extension of the foot never bri 
the lower portion so high as the upper 
tracted by the muscles. The union, hi 
which is of a cellular structure, becomes 
ciently strong to be perfectly servic 
Boyer speaks of a partial rupture of the 
Achillis, and describes with precision the s 
toms, but we apprehend this form of the” 
dent is very rare.* The pathol of 
foot, which has only of late years 
understood, shows that permanent retr 
the muscles of the calf, either prima 
condary, is its most frequent cause, 
division of the tendo Achillis and the 
tendons of this has in co uer 
resorted to with ere success. iain Pp 
operating which our experience leads 1 
prefer, is to insert a sharp-pointed 
through the skin, and pass it behind the te 
with its flat side towards it, till having re: 
its farther side, the edge is turned, at 
tendon is divided in the withdrawal, w 
more division of the skin than the me 
ture. If the tendon is kept tense durin 
operation by the forcible flexion of th 
and is not quite divided at one c 
undivided tendinous fibres are pu 
stretched, and partially torn from their 
attachments, which occasions a sort of 
noise, which is not heard when the foree 
applied, till after the entire division 6 
tendon. The union here takes place i 
same manner as in rupture of the tendon 
the treatment proceeds upon a somewhat 
rent principle, since it is in this latter ¢ 
intention to keep the divided ends apart 
the foot is therefore placed at ight a 
while, in the ruptured tendon, the i 
tended, in order to approximate the @ 
much as possible. The extreme contrac 
the muscle, in club-foot, leaves no poss 
of further retraction of the upper part 
er 
oe 
— Boyer’s Maladies Chirurgicales, tom. 
p. 95. “ 
+ See Liston’s Practical Surgery, p. 16 
‘ 
