400 THE INFERIOR EXTREMITY 



3. The intermediate cutaneous (L. 2, 3) is a branch of the femoral (anterior 

 crural) nerve. It supplies the skin of the front of the thigh as far as the 

 knee (Fig. 118). 



4. The medial cutaneous (L. 2, 3), also a branch of the femoral nerve, 

 supplies the antero-medial aspect of the thigh. In the distal part of its 

 course it is associated with the great saphenous vein. 



5. The ilio-inguinal (L. i) (p. 240) supplies a few branches to the skin of 

 the proximal and medial part of the thigh. 



6. The obturator nerve (L. 2, 3, 4) sends some branches through the sar- 

 torial plexus (p. 41 1), which are distributed posterior to the medial cutaneous 

 nerve. 



The Superficial Subinguinal Lymph Glands, which lie 

 on the deep fascia distal to the inguinal ligament, are subdivided 

 into two groups, (a) The proximal group consists of a chain of 

 lymph glands which lie distal to and, roughly, parallel with 

 the inguinal ligament. The lateral members of the group 

 receive afferents from the perineum, anus, buttock, and the 

 abdominal wall, below the umbilicus ; the medial glands receive 

 afferents from the anus, perineum, and external genitalia. (b) 

 The distal group lies around the proximal part of the great 

 saphenous vein and on the lateral border of the fossa ovalis 

 (saphenous opening). This group receives all the superficial 

 lymph vessels of the lower limb, except those from the buttock 

 and those from the lateral side of the foot and the postero- 

 lateral area of the leg, which enter the popliteal glands (p. 446). 



Lymphangitis from septic conditions of the toes may cul- 

 minate in suppurative adenitis of the distal subinguinal glands. 

 In these cases the thigh is usually kept in the position of flexion 

 in order to relax the overlying skin and cutaneous nerves. 



The efferents from both groups of the superficial subinguinal 

 lymph glands terminate in the deep subinguinal glands, which 

 lie behind the deep fascia around the proximal parts of the 

 femoral vessels. Abscesses in connection with this group 

 should, therefore, be opened by Hilton's method. The efferents 

 from the popliteal glands also end in the deep group, which sends 

 its own efferents to the external iliac lymph glands. The 

 most proximal member of the deep group occupies the femoral 

 ring (p. 403). 



The Deep Fascia is attached proximally to the body and 

 tubercle of the pubis, to the inguinal ligament and the anterior 

 superior iliac spine. Laterally, it encloses the tensor fasciae 

 latae and reaches the gluteal region. On the medial side it is 

 attached to the margins of the pubic arch as far as the ischial 

 tuberosity, where it becomes continuous with the deep fascia 



