250 INFERIOR EXTREMITY 



must be detached from its origin and turned distally. The posterior 

 surface of the adductor magnus will then he fully exposed, and its 

 attachment to the femur and its relations to the perforating arteries can 

 be studied. 



Arteriae Perforantes (Perforating Arteries). Four per- 

 forating arteries, branches of the profunda femoris, will be 

 found emerging from the surface of the adductor magnus muscle 

 close to the linea aspera of the femur. They are called first, 

 second, third, and fourth, according to the level at which they 

 appear from above downwards. The fourth is the terminal 

 branch of the profunda, and makes its appearance about 

 an inch proximal to the opening in the adductor magnus 

 muscle through which the popliteal artery enters the fossa 

 poplitea. The perforating arteries and their branches must 

 be thoroughly cleaned, together with the apertures in the 

 adductor magnus through which they pass. It will then be 

 seen that they do not pierce the fleshy substance of the 

 muscle. Prepared for each is a tendinous archway, and they 

 reach the posterior region of the thigh by passing between 

 these and the linea aspera, to which the piers of the various 

 arches are attached. 



The openings are in the same line with, and are in all 

 respects analogous to the large opening in the adductor 

 magnus muscle for the popliteal artery. The result obtained 

 is the same in each case. When the muscle contracts, the 

 vessels are protected from pressure. 



Emerging from the tendinous arches the perforating 

 arteries wind round the posterior border of the femur to 

 gain its lateral aspect and reach the vastus lateralis in 

 which they end. In this part of their course they pierce the 

 short head of the biceps femoris. The highest member of 

 the series, which lies proximal to the level of the femoral 

 attachment of the biceps, pierces, as we have already seen, 

 the insertion of the glutaeus maximus. 



Anastomosis on the Posterior Aspect of the Thigh. In a 

 well-injected subject a chain of arterial anastomosis can be 

 traced from the glutseal region to the popliteal fossa, and 

 the present is the best time to examine it. Commencing 

 proximally, in the glutaeal region, the superior gluteeal artery 

 is found anastomosing with the inferior glutseal, and the 

 inferior glut^eal with the terminal branches of the medial 

 circumflex artery. In the posterior part of the thigh the 



