FEMORAL HERNIA 1139 



Uses of the ^saphenous openinf/.^ — Though a weak spot, it is so on purpose to 

 transmit the saphenato the femoral vein, and the su])erticial to the deep lympliaties. 

 The depression is present in order to allow the saphena vein to he ])rotected from 

 pressure in liexion of the thi<rh. 



Site. — At the inner and njjper part of the thigh, with its centre an inch and a 

 half l)elow and outside the spine of the ])uhes. 



Diaineters. — One inch (25 mm. ) vertically, hy a half or three-quarters of an inch. 

 Shape: oval, with its hnig axis downwards and outwards. Two extremities or conuia : 

 upper Vjlending with Giml)ernat's ligament; lower, where the twf) j)artsof the fascia 

 lata meet. Tuo borders: outer also known as the ligament of Hey, or femoral ligament, 

 or falciform ])n)cess of Burns. Semilunar in shape, arching downwards and out- 

 wards from Gimhernat's ligament to the inferior cornu. This lies over the femoral 

 vessels, and is adherent to them; to it is fixed superficially the cribriform fascia 

 {vide infra). The inner border is much less prominent, owing to the weakness oi 

 the pubic })art of the fascia lata which forms it. 



(6) Femoral sheath. — This is a funnel-shaped sheath, carried out by the 

 femoral vessels under Poupart's ligament, and continuous above (in front) with the 

 transversalis fascia as it descends to the ligament, lining the inner surface of the 

 abdominal wall, and (behind) with the iliac fascia, and below continuous with the 

 proper sheath of the femoral vessels. 



It is not only funnel-shaped, but large and loose, for two reasons: (n } That there 

 be plenty of room for the femoral vein, and the slowly moving venous current in it 

 to ascend without compression; (//) to allow of all the movements of the thigh 

 taking place — flexion and extension — without undue stretching of the vessels. By 

 two coimective tissue septa the sheath is divided into three compartments — the 

 outer for the artery, the middle for the vein, and the internal one for the femoral 

 canal (vide infra). Thus one septum lies between the artery and vein, and another 

 between the vein and the femoral canal. 



(7) Femoral canal. — Definition: the innermost division of the femoral sheath. 

 The fascia transversalis and fascia iliaca meet directly on the outer side of the 

 femoral artery, but not so closely on the inner side of the femoral vein. Hence a 

 space exists here, perhaps to prevent the thin-walled vein, with its sluggish current, 

 Vicing pressed upon. Thus, a slight gap exists here — not a canal, unless so made by 

 a knife or by the dilating influence of a hernia. Length : about thrcf-quarters of an 

 inch (19 mm.). IJmits : Ijclow, saphenous opening; above, femoral ring (vide infra). 



Boundarieii. — Externally, a septum between it and the vein; internally, base of 

 Gimbernat's ligament and meeting of fascia iliaca and transversalis; behind, fascia 

 iliaca; in front, fascia transversalis. 



Content.-^. — Cellular tissue and fat, continuous with extra-peritoneal fatty layi-r. 

 A lymphatic gland, which is inconstant. Lymphatics passing from superficial 

 (groin) glands to those deep in the iliac fossa. 



(8) Femoral ring. — This is mainly an artificial product. It is the upper or 

 abdominal opening of the femoral canal. Shape : oval, with its long axis trans- 

 verse. It is larger in women. Boundaries: internally, Gimhernat's ligament; 

 externally, the femoral vein; in front, Poupart's ligament and the thickening of 

 the transversalis fascia attached to it, and called ' the deep crural arch ' ; behind, the 

 pectineus and the ilio-pectineal line. It is closed by the septum crurale. which is 

 a barrier of fatty connective tissue, continuous with the extra-i)eritoneal fatty layer, 

 perforatrd ])v Ivmpliatics passing from the superficial to the deep group. 



Position oiF vessels around the ring. — Outside, the femoral vein; above, the 

 epigastric vessels; towards the inner side there may be an unim]>ortant branch 

 between the epigastric artery aV)ove and the obturator below. 



If, instead of the above unimi>ortant branch, the ol)turator artery comes off 

 abnormally from the deep e]>igastric. it will descend, and usually does so, close to 

 the junction of the external iliac and connnon femoral vein, and thus to the outer, 

 and so the safe, side of the ring (fig. 704, A). In a very few cases it curves more 

 inwards, close to Giml)ernat's ligament, an<l thus to the inner side of the ring, and 

 is then in great danger (fig. 704, B). Sir William Lawrrncc calculated that this 

 took ]ilace once in a hundred cases. 



Course of femoral hernia. — At first this is downwards in the femoral canal. 



