1016 



SURGICAL ANATOMY OF THE ARTERIES. 



sionally this muscle crosses the thigh so directly, that it must be drawn con- 

 siderably outwards in order to reach the artery [plate 74, fig. 4]. To the 

 exact point at which the sheath of the vessels, and even the fascia should be 



Fig. 702. Fig. 702. SUPERFICIAL DISSECTION OP THE 



FEMORAL VESSELS, WITH THEIR SMALLER 

 BRANCHES IN THE RiaHT GROIN (from 

 R. Quain). i 



a, the integument of the abdomen ; 6, the 

 superficial abdominal fascia ; &', the part 

 descending on the spermatic cord ; c, c, the 

 aponeurosis of the external oblique muscle ; 

 c', the same near the external abdominal 

 ring ; c", the inner pillar of the ring ; d, the 

 iliac part of the fascia lata ; d\ the pubic 

 part, e, e, the sheath, of the femoral vessels 

 laid open, the upper letter is immediately 

 over the crural aperture; e', placed on the 

 sartorius muscle partially exposed, points to 

 the margin of the saphenic opening ; 1, 

 femoral artery, having the femoral vein 2, 

 to its inner side, and the septum of the 

 sheath shown between the two vessels ; 3, the 

 principal saphenous vein ; 3', its anterior 

 branch ; 4, the superficial circumflex iliac 

 vein and arterial branches to the glands of 

 the groin ; 5, the superficial epigastric vein ; 

 6, the external pudic arteries and veins ; 7 

 to 8, some of the lower inguinal glands re- 

 ceiving twigs from the vessels ; 9, internal, 

 10, middle, and 11, external cutaneous 

 nerves. 



cut through, the pulsation of the artery 

 will guide the operator. A small 



nerve may present itself in this part of the operation. The immediate invest- 

 ment of the artery should be opened to the smallest possible extent, and the 

 knife or other instrument should be sparingly used at this stage of the ope- 

 ration : the object being to disturb the artery from its connections, including 

 its nutrient vessels (vasa vasorum), as little as possible, and likewise to avoid 

 wounding any of the small muscular branches which spring from most 

 arteries at irregular intervals. The division of an artery of the size of those 

 last referred to at a distance from the source from which it springs is of 

 little importance. It contracts, and soon ceases to bleed. But when it is 

 divided close to the trunk, blood issues from it as it would if an opening 

 equal in size to the calibre of the little branch were made in the trunk 

 itself. 



In order to avoid injuring the vein, which is separated from the artery 

 only by a thin partition of areolar tissue, the point of the aneurism-needle, 

 which conveys the ligature, is to be kept close to the artery. 



Other veins of occasional occurrence may render increased care necessary, 

 for example, those small branches which cross the artery or course along 

 its surface ; or it may be a larger vein a division of the femoral vein when 

 it is double, or the deep femoral vein when the ligature is applied a little 

 higher than usual [plate 75]. 



To reach the femoral artery in the middle of the thigh, the depth of the 

 vessel being considerable, the incision through the integuments must be pro- 

 portionally long. As the sartorius is directly over the vessel, the opera- 



