4QO The Leg 



the solcus, and that important second layer of deep fascia beneath it, 

 are divided in turn, and the artery is looked for at a considerable' dis- 

 tance outwards, where it lies upon the tibialis posticus or flexor longus 

 digitorum. The nerve is crossing it from the inner to the outer side, 

 so the needle had better be passed from the inner side. 



A good deal of fibrous tissue may be met with on the deep aspect 

 of the soleus, which has to be traversed before that second layer of the 

 dT|) fascia is seen. The division of the solcus should not be made too 

 close to the border of the tibia, or the operator will be apt to lose him- 

 self amongst the fibres arising from the periosteum ; thus he may 

 possibly detach the flexor longus digitorum from the tibia and work 

 outwards beneath it- -even into the substance of the tibialis posticus. 



In the lower third of tne legr the artery may be tied by making 

 the incision midway between the inner border of the tendo Achillis 

 and the posterior border of the tibia, care being taken not to wound 

 the internal saphenous vein, which is, or ought to be, a good deal to the 

 front of the incision. Two layers of deep fascia again require division ; 

 the artery is found to the outer side of the tendons of the tibialis pos- 

 ticus and flexor longus digitorum, between its veins, the nerve being on 

 its outer side, as before. Still farther out is the tendon of the flexor 

 longus hallucis. The artery and its vena? comites, the nerve, and the 

 tendons are here spread out flat on the surface of the tibia. The needle 

 had better be passed from the outer side. 



At the ankle the artery maybe reached through a two-inch in- 

 cision which curves round the inner malleolus, halfway between it and 

 the inner tuberosity of the os calcis. There is no fear of damaging the 

 internal saphenous vein. The layers of the deep fascia have here 

 joined to form the internal annular ligament, which has to be divided 

 on a director, when the artery is found laced in by fibres which form a 

 sort of sheath. It lies between its venae comites, with the large nerve 

 external to it. The needle had better be passed from the outer side. 



Branches. The peroneul is given off an inch below the border of 

 the popliteus ; resting at first on the tibialis posticus, it descends along 

 the inner border of the fibula, in the substance of the flexor longus 

 hillucis. It is covered, in addition, by the gastrocnemius, soleus, and 

 sub-soleus fascia. At about two inches above the ankle it divides into an 

 anterior and a posterior branch. The anterior peroneal reaches the front 

 of the leg through the interosseous membrane, and anastomoses with 

 the external malleolar and tarsal arteries. The posterior division 

 descends behind the outer ankle, and anastomoses with the branches 

 just enumerated, and also with the external plantar. Other branches 

 of the peroneal are muscular, nutrient to the fibula, and a transverse 

 communicating branch to join a similar vessel from the posterior 

 tibia!, which crosses about two inches above the ankle, under the flexor 

 s hallucis. 



Irregularity. Sometimes the peroneal is as large as the posterior 



