FEMOKAL ARTERY. LIGATURE. 



1017 



tion may be performed by turning the muscle either towards the outer or 

 the inner side of the limb ; and the incision would be made according to 

 the plan adopted, at the inner or the outer margin of the muscle. The 



Fig. 703. 



Fig. 703. DEEP VIEW OP THE FEMO- 

 RAL ARTERY AND ITS BRANCHES ON 

 THE LEFT SIDE (from R. Quain). 5 



The sartorius muscle has been re- 

 moved in part, so as to expose _ the 

 artery in the middle third of the thigh ; 

 a, the anterior superior iliac spine ; b, 

 the aponeurosis of the external oblique 

 muscle near the outer abdominal ring, 

 from which the spermatic cord is seen 

 descending towards the scrotum ; c, 

 the upper part of the rectus femoris 

 muscle ; d, abductor longus ; e t fibrous 

 sheath of Hunter's canal covering the 

 artery ; 1, femoral artery ; 1', femoral 

 vein divided and tied close below Pou- 

 part's ligament ; 2, profunda femoris 

 artery ; 3, anterior crural nerves ; 4> 

 internal circumflex branch; 5, super- 

 ficial pudic branches ; 6, external cir- 

 cumflex branch, with its ascending 

 transverse and descending branches 

 separating from it ; 6', twigs to the 

 rectus muscle ; 7, branches to the 

 vastus internus muscle ; 8, and 9, 

 some of the muscular branches of the 

 femoral. 



preferable mode appears to be 

 to divide the integument on or 

 over the muscle, near its inner 

 margin, so as to arrive directly 

 upon the muscle and draw it 

 outwards, after cutting freely 

 through the investing fascia. 

 The fibrous structure stretched 

 over the vessels from the adduc- 

 tors to the vastus internus muscle 

 being divided, the position of the 

 femoral vein and saphenous nerve 

 are to be kept in view in com- 

 pleting the operation. In the 

 first steps of the operation in this 

 part of the thigh, injury to the 

 long saphenous vein is to be guarded against. 



Before concluding the observations on the femoral artery, a very small 

 class of cases claims a word of notice. It has happened (in Sir Charles Bell's 

 case) that the application of a ligature to a femoral artery has not been fol- 

 lowed by the usual consequence of cessation of the pulsation in the aneurism ; 

 and the uninterrupted continuance of the circulation was found, on exami- 

 nation after death, to be attributable to the circumstance of the artery being 

 double where the ligature was applied, while the two parts became re-united 

 above the tumour. If such a case should again be met with in an opera- 



