368 Anatomy Applied to Medicine and Surge* y. 



and this corresponds to a point, a little over one inch below 

 the anterior surface of the head of the fibula, or about one 

 and a half inches below the styloid process of the fibula. 

 There are two venae comites for the artery, one lying in 

 front and the other behind, hence their lines will corre- 

 spond to the line of the artery. Long saphenous vein. 

 A line drawn from in front of the inner malleolus to the 

 inner and posterior portion of the internal condyle of the 

 femur. This line, in passing upwards, crosses the inter- 

 nal border of the tibia, in the adult, about two and a half 

 inches above the apex of the inner malleolus. 



Ligation of the Anterior Tibial in the upper third of 

 the leg. The vessel must be looked for between the tibialis 

 anticus, internally, and the extensor longus digitorum, 

 externally, when it is to be ligated in the upper part of the 

 leg, but, since the extensor, longus digitorum is a penni- 

 form muscle and overlies the artery, the incision sihould 

 be made a little internal to the line of the artery and 

 should start, above, about the level of the upper border of 

 the tubercle of the tibia. The gap between the above 

 muscles is about one inch from the anterior border of the 

 tibia, and must be sought for, though it may be difficult to 

 find. The surgeon will have to rely, to a great extent, on 

 the feel of the muscular planes, as evidenced in making 

 the tibialis anticus tense by extending and everting the 

 foot, or in putting the extensor longus digitorum on the 

 stretch by strongly flexing the phalanges of the toes. The 

 finger in the wound will recognize the individual muscle 

 brought into play by these movements and will, therefore, 

 be able to identify the interval between them. On separ- 

 ating these muscles by means of the handle of the scalpel 

 or by the finger, the external border of the tibia is the next 

 guide, and, towards it, the finger or the handle of the 

 scalpel should work, when the vessel will be found lying 



