GLUT^AL REGION 233 



inches in a distal direction. This will bring very conspicuously into 

 view the upper part of the vastus lateralis. Next, grasp the cut edge of 

 the fascia lata from which the glutaeus maximus has been separated, and, 

 dragging it forcibly laterally, dissect in the interval between it and the 

 glutaeus medius. The tensor fasciae latae, which is intimately associated 

 with this portion of the fascia lata, is pulled laterally with it, and the deep 

 surface of that muscle, clothed by a strong deep lamella of fascia, comes into 

 view. Very little dissection is required to expose its nerve of supply a 

 branch from the superior glutaeal which emerges from the anterior border 

 of the glutaeus minimus, and sinks into its deep surface. An artery will 

 also be noticed ramifying on the deep surface of the tensor fasciae latae ; 

 this is the ascending branch of the lateral circumflex artery. Seeing that the 

 anterior borders of the glutaeus medius and glutaeus minimus are adherent, 

 it is well to separate them from behind forward by introducing the ringers 

 between their posterior borders. When the glutaeus medius is completely 

 isolated, it may be divided about two inches above the greater trochanter of 

 the femur, and the two portions thrown respectively proximally and distally. 

 A small bursa, between the muscle and the upper part of the greater 

 trochanter, will thus be brought into view, and the exact insertion of the 

 tendon will be rendered evident. As the proximal part of the muscle is 

 raised, a number of vessels and nerves between it and the glutaeus minimus 

 will be exposed. These must be carefully cleaned and followed to their 

 destinations. They are derived from the superior glutaeal artery and nerve. 



Arteria Glutsea Superior (O.T. Glutseal Artery). This is a 

 large vessel which springs from the hypogastric artery and 

 escapes from the pelvis, through the upper part of the great 

 sciatic foramen, above the level of the piriformis. 



Immediately after its exit, it divides into a superficial and 

 a deep division. The superficial division has been already 

 seen during the reflection of the glutaeus maximus. It is 

 distributed to the deep surface of that muscle, and is placed 

 between it and the glutaeus medius. 



The deep division bifurcates close to its origin into a 

 superior and an inferior branch ; both of these lie between 

 the glutaeus medius and minimus. The superior branch follows 

 accurately the anterior curved line on the dorsum ilii, and, at 

 the anterior superior spine, terminates by anastomosing with 

 the superficial and deep circumflex iliac arteries, and with 

 the ascending branch of the lateral circumflex artery. The 

 latter has already been noticed passing proximally under 

 cover of the tensor fasciae latae. The inferior branch runs 

 distally and anteriorly towards the greater trochanter. It gives 

 twigs to the two glutaeal muscles between which it lies, and 

 some terminal offsets to the hip-joint. 



Nervus Glutseus Superior (O.T. Superior Glutseal Nerve). 

 The superior glutaeal nerve emerges from the pelvis in company 

 with the superior glutaeal artery, and passing anteriorly, between 



