ABDOMINAL WALL 389 



On the left side of the body the parts, below the horizontal line drawn 

 from the anterior superior iliac spine to the lateral border of the rectus, 

 along which the aponeurosis of the external oblique muscle has been 

 divided, should be preserved intact for the special study of the structures 

 associated with inguinal hernia. On the right side of the body divide the 

 lower part of the aponeurosis along the lateral border of the rectus to the 

 pubes. This incision should pass to the medial side of the medial crus of 

 the subcutaneous inguinal ring, so that this opening may be preserved. 

 The triangular flap of aponeurosis may now be thrown downwards and 

 laterally. By this proceeding the inguinal ligament, the entire extent of the 

 internal oblique muscle, and the cremaster muscle are displayed for study. 



Ligamentum Inguinale (O.T. Poupart's Ligament). The 



inguinal ligament is merely the thickened lower border of the 

 aponeurosis of the external oblique folded backwards upon 

 itself. It thus presents a rounded surface towards the thigh 

 and a grooved surface towards the abdominal cavity. The 

 manner in which it is attached by its lateral and medial 

 extremities deserves the close study of the dissector. Laterally 

 it is fixed to the anterior superior spine of the ilium ; medially 

 it has a double attachment viz. (i) to the pubic tubercle, 

 which may be considered as its attachment proper; (2) 

 through the medium of the lacunar ligament (Gimbernaf s] to 

 the pecten pubis (O.T. ilio-pectineal line). 



The inguinal ligament does not pursue a straight course 

 between its iliac and pubic attachments. It describes a 

 curve, the convexity of which is directed downwards and 

 laterally towards the thigh. By its inferior border it gives 

 attachment to the fascia lata. When this is divided, the 

 inguinal ligament at once loses its curved direction. 



Ligamentum Lacunare (O.T. Gimbernat's Ligament) (Fig. 

 145). This is a triangular process of aponeurotic fascia. 

 Raise the spermatic cord, place the finger behind the 

 medial end of the inguinal ligament, and press downwards. 

 The structure upon which the finger rests is the ligament 

 in question, and the student should note that at this point it 

 offers a barrier to the passage of the finger into the thigh. 

 With the handle of the knife its shape and connections can 

 be easily defined. Its apex is fixed to the pubic tubercle ; 

 by one margin it is attached to the medial part of the 

 inguinal ligament ; by its other margin it is inserted for the 

 distance of an inch into the pecten pubis. Its base is 

 sharp, crescentic, and free, and is directed laterally towards 

 the femoral sheath. The dissector should thoroughly realise 

 that the lacunar ligament is not an independent structure. 

 i25 b 



