GLUTEAL REGION. 1079 



cutaneous nerves in this region. Of these he will find, descending over the 

 crest of the ilium, in order from before backwards, the lateral branches of 

 the last dorsal and ilio-hypcgastric nerves (pp. 658 and 660), with several 

 branches of the lumbar nerves (p. 634) ; aud, piercing the gluteus maximus 

 muscle near its posterior attachment, some small cutaneous twigs from the 

 posterior divisions of the upper sacral nerves (p. 635) ; lastly, turning 

 round its inferior border, branches from the small sciatic nerve (p. 675). 

 It will be observed that the fascia lata, which is strongly developed over 

 that part of the gluteus medius which lies in front of the gluteus maximus 

 muscle, on reaching the upper border of the gluteus maximus, divides into 

 two lamina, of which one is continued on the superficial, and the other on 

 the deep aspect of that muscle (p. 292). Care is to be taken to lay bare 

 the inferior border of the gluteus maximus in its whole extent ; and a 

 synovial bursa over the tuberosity of the ischium is to be sought for. The 

 muscle is then to be divided close to its iliac and sacral attachment, and in 

 turning it forward, the sciatic artery and the superficial branch of the 

 gluteal artery will come into view. The branches of these arteries and of 

 the small sciatic nerve which enter the muscle are to be followed out to 

 some extent, and they may then be divided to permit the complete reflec- 

 tion of the muscle. While this is being done, a large synovial bursa will be 

 found between the trochanter major and the insertion of the gluteus maxi- 

 mus into the fascia lata. 



The fascia lata is to be removed from the upper part of the gluteus 

 medius muscle, and the parts exposed by the removal of the gluteus maxi- 

 mus are to be cleaned in their order from above downwards, viz. : the back 

 part of the gluteus medius muscle, the gluteal vessels (p. 429), the pyriformis 

 muscle, the sciatic vessels and the great and small sciatic nerves (p. 674), the 

 gemelli muscles, superior and inferior, with the tendon of the obturator inter- 

 nus muscle between them (p. 268). The tendon of this muscle may now be 

 dissected from between the gemelli, divided and turned back, to show the 

 synovial cavity in which it plays upon the smooth trochlear surface of the 

 ischium. The quadratus femoris, the tendon of the obturator externus muscle 

 situated more deeply, the upper part of the adductor magnus muscle, and the 

 origin of the hamstring muscles are then to be exposed. From the small 

 sciatic nerve the inferior puclendal branches will be seen given off, in addition 

 to those already mentioned, and from the sciatic artery, besides muscular 

 branches, the coccygeal branch, the branch to the great sciatic nerve, and 

 that by which it anastomoses with the internal circumflex artery may be 

 traced. On the spine of the ischium also will be seen the pudic vessels and 

 nerve, and the nerve to the obturator internus muscle (pp. 425 and 670) ; 

 and descending under cover of the tendon of the obturator internus and the 

 gemelli is the small nerve to the quadratus femoris. 



The gluteus maximus muscle having been entirely removed from its upper 

 attachment, and the tendon of insertion being left, the gluteus medius is to 

 be raised from the ileum in three-fourths of its extent ; its anterior border 

 and that of the gluteus minimus muscle being left for dissection from the 

 front. The attachments of the gluteus medius muscle are to be observed, 

 as also the superior and inferior deep branches of the gluteal artery, and the 

 distribution of the gluteal nerve (pp. 429 and 667). The posterior part of 

 the gluteus minimus may then be raised from the ileum to show the extent 

 of its attachment to that bone, and its relation to the capsule of the hip- 

 joint. 



2. The Popliteal Space. It is advisable to dissect this space before the 



