1138 SURGICAL AXD TOPOGRAPHICAL ANATOMY 



blending with Ponpart's ligament, will be affected l)y movements of the thigh, 

 much as is the external abdominal ring, being tightened and stretched when the 

 hmb is extended and abducted, relaxed when it is adducted and Hexed. 



The parts beneath the ligament which block up the gap between it and the 

 innominate bone are of the utmost importance in preventing the escape of a femoral 

 hernia. 



The different structures are arranged in three compartments, named from with- 

 out inwards — A. Outer, or iliac ; B. Central, or vascular ; and C. Inner, or 

 pectineal. Of these, the tirst is the largest; the second or central one lies on a 

 j)lane slightlv more superficial, or nearer to Ponpart's ligament, than the other two; 

 wliile the innermost compartment differs from the other two by not communicating 

 with the pelvis, being closed above by fascia (vide infra). (A) The outer, or 

 iliac, compartment is bounded in front by Ponpart's ligament and the iliqc fascia, 

 whicli is here blending with it, behind bv the ilium, externally by this bone and 

 the sartorius, and internally by the ilio-pectineal septum, which, descending from 

 the Ijlending of the iliac fascia and Ponpart's ligament alcove, passes down to the 

 ilio-pectineal eminence, and thence to the inner aspect of the front of the capsule 

 of the hip-joint. This compartment transmits the ilio-psoas and anterior crural 

 and external cutaneous nerves. (B) The central, or vascular, compartment is 

 bounded, in front, by Ponpart's ligament and the transversalis fascia, which here 

 blends with it, forming the so-called deep crural arch, and at the same time 

 descends on to the front of the femoral sheath. The posterior boundary is formed 

 by the meeting of the ilio-pectineal sejitum externally and the pectineal fascia oi 

 sheath from within — internally Gimbernat's ligament, and externally the ilio- 

 pectineal septum. This central compartment transmits the external iliac vessels 

 and crural branch of the genito-crural nerve. This lies to the outer side of the 

 artery, the vein internally. Between the vein and the base of Gimbernat's 

 ligament is the femoral canal (vide infra). (C) The innermost, or pectineal, 

 compartment is bounded by the pectineal fascia continuous Avith the pubic part 

 of the fascia lata, and behind by the pubic ramus. It lodges the upper end of the 

 peetineus muscle, and the handle of a scalpel passed upwards along the muscle 

 would be prevented from passing into the pelvis by Gimbernat's ligament and the 

 blending of the pectineal fascia with the upper border of the pubic ramus. 



(3) Gimbernat's ligament. — This is merely the triangular internal attach- 

 ment of Ponpart's ligament. Its apex is attached to the pubic spine; of its three 

 borders, the base is free towards the vein and the femoral canal. Its upper border 

 is continuous with Ponpart's ligament, its lower is attached to the ilio-pectineal 

 line. 



(4) Fascia lata. — Two portions are described over the upper part of the 

 thigh: — (a) An iliac, external and stronger, attached to Ponpart's ligament in it? 

 whole extent and lying over the sartorius, ilio-psoas, and rectus, (b) A pubic, 

 internal, weaker, and much less well defined, is attached above to the ilio-pectinea 

 line and the spine of the pubes. The upper cornu of the ' saphenous opening ' is 

 at Gimbernat's ligament, and at the loAver cornu the two portions of the fasci 

 blend. 



Their relation to the femoral vessels. — The iliac jiortion, being attached alon 

 Poupart's ligament, passes over these. Tlie pubic portion, fastened down over the 

 peetineus, which slopes down on to a deeper plane than the adjacent muscles, passes 

 behind the femoral vessels to end on the capsule of the hip-joint. 



(5) Saphenous opening. — This is doubly a misnomer. It is not an opening, 

 but an oval depression, situated at the spot where the two parts of the fascia lata 

 diverge on different levels. As without dissection it is not an opening, but an oval 

 depression, fossa ovalis would have been a better term, were it not otherwise 

 employed. Though the fascia lata is wanting here, there is no real opening, as the 

 deficiency is made up by the deep layer of superficial fascia, or cribriform fascia, 

 which fills up the opening. The term 'saphenous' is also misapplied: etymologi- 

 cally, it means ' very evident.' Now, it is notorious that in very many subjects this 

 opening only becomes plain when rendered an artificial one by dissection; and that 

 thus, with the limited op])ortunities of one or two subjects, it is by no means ea.sy 

 to verifv the details about it which have been described as constant. 



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