172 INFERIOR EXTREMITY 



wards the fossa ovalis and join the great saphenous vein before 

 it pierces the fascia. 



Lymph Glands and Vessels. The disposition of the super- 

 ficial lymph glands into two groups will now be evident a 

 proximal inguinal group along the line of the inguinal ligament, 

 immediately distal to the attachment of Scarpa's fascia to the 

 fascia lata, and a distal group, the superficial subinguinal 

 glands, which extends for a short way down the thigh along 

 the line of the great saphenous vein. 



In a spare subject, or, better still, in a dropsical subject, the 

 general arrangement of the lymph vessels may also be made 

 out. To the subinguinal group of glands proceed the vessels 

 of the lower extremity ; to the inguinal group of glands go 

 the lymph vessels from the genitals, perineum, and the surface 

 of the abdomen. These are termed the afferent vessels. In 

 addition to these, numerous vessels pass between the various 

 glands and connect them with each other. The lymph 

 vessels which lead the lymph away from the glands are 

 called the efferent vessels. A large number of these pass 

 through the fossa ovalis, others pierce the fascia lata. They 

 join the deep subinguinal glands and the external iliac glands 

 which lie in relation to the femoral and external iliac arteries. 



Dissection. It has already been noted that an opening in the fascia 

 lata called the fossa ovalis (O.T. saphenous opening] is situated at the 

 proximal and medial angle of the anterior part of the thigh. It is bounded 

 proximally, laterally, and distally by a sharp crescentic margin, the margo 

 falciformis, and through it pass the great saphenous vein, on its way to 

 join the femoral vein, and the efferent lymph vessels which connect the 

 inguinal lymph glands and the superficial subinguinal lymph glands with 

 the deep subinguinal lymph glands. The deep fascia on the lateral side 

 of the fossa ovalis is called the iliac portion of the fascia lata, and that on 

 its medial side is the fascia pectinea. It is difficult to display the opening 

 satisfactorily but the difficulty may be overcome by the exercise of a little 

 care. The dissector should commence by raising the proximal part of the 

 great saphenous vein from the fatty bed in which it lies ; he should then 

 carry the handle of his scalpel upwards behind the vein till he feels it dip 

 backwards over a sharp free margin, the cornu inferius of the opening. 

 This cornu is always clearly defined. It blends medially with the fascia 

 pectinea, which lies superficial to the pectineus and adductor longus 

 muscles. Laterally it is continued upwards into the lateral part of the 

 margo falciformis, and the proximal end of the latter, turning medially, 

 becomes the cornu superius which gains attachment to the distal and medial 

 part of the lig. lacunare (O.T. Gimbernat's ligament). The margo falci- 

 formis and the cornu superius are not always easy to define, but if the 

 dissector, after he has displayed the cornu inferius, will carefully remove 

 the superficial fat from the surface of the fascia, on the lateral side of the 

 great saphenous vein, he will find that at a short distance from the vein 

 the iliac portion of the fascia lata suddenly becomes thinner. The sudden 



