1400 CLINICAL AND TOPOGRAPHICAL ANATOMY 



descends on to the front of the femoral sheath. The posterior boundary, Cooper's ligament, is 

 formed bj^ the meeting of the ilio-pectineal septum laterally and the pectineal fascia or sheath — 

 medially the lacunar (Gimbernat's) ligament, and laterally the ilio-pectineal septum. This 

 intermediate compartment transmits the ex ernal iliac vessels and the lumbo-inguinal nerve. 

 This lies to the lateral side of the artery, the vein medially. Between the vein and the base of 

 the lacunar ligament is the femoral canal (vide infra). (C) The medial or pectineal compart- 

 ment is bounded by the pectineal fascia, continuous with the pubic part of the fascia lata, and 

 behind by the pubic ramus. It lodges the upper end of the pectineus muscle, and the handle of 

 a scalpel passed upward along the muscle would be prevented from passing into the pelvis by the 

 lacunar ligament and the blending of the pectineal fascia with the upper border of the pubic 

 ramus. 



(3) Lacunar (Gimbernat's) ligament. — This is merely the triangular medial 

 attachment of Poupart's ligament. Its apex is attached to the pubic tubercle; 

 of its three borders, the base is free toward the vein and the femoral canal. 

 Its upper border is continuous with Poupart's ligament; its lower is attached to 

 the terminal (ilio-pectineal) line. 



(4) Fascia lata. — Two portions are described over the upper part of the thigh : 

 — (a) An iliac, lateral and stronger, attached to the inguinal ligament in its whole 

 extent and lying over the sartorius, ilio-psoas, and rectus, (h) A pubic, medial, 

 weaker, and much less well defined, is attached above to the terminal line and 

 the tubercle of the pubes. The upper cornu of the fossa ovalis is at the lacunar 

 ligament, and at the lower cornu the two portions of the fascia blend. 



Their relation to the femoral vessels. — The iliac portion, being attached along 

 Poupart's ligament, passes over these. The pubic portion, fastened down over 

 the pectineus, which slopes down on to a deeper plane than the adjacent muscles, 

 passes behind the femoral vessels to end on the capsule of the hip-joint. 



(5) Fossa ovalis (saphenous opening). — This is not an opening, but an oval 

 depression, situated at the spot where the two parts of the fascia lata diverge on 

 different levels. Though the fascia lata is wanting here, there is no real opening, 

 as the deficiency is made up by the deep layer of superficial fascia, or cribriform 

 fascia, which fills up the opening. 



Uses of the fossa ovalis {saphenous opening). — Though a weak spot, it is so on purpose to 

 transmit the saphenous to the femoral vein, and the superficial to the deep lymphatics. The 

 depression is present in order to allow the saphenous vein to be protected from pressure in 

 flexion of the thigh. 



Site. — At the medial and upper part of the thigh, with its centre 3.7 cm. (1| in.) below and 

 lateral to the tubercle of the pubis. 



Diameters.— Vertically, 2.5 cm. (1 in.), by 1.2 or 1.8 cm. (| or | in.). Shape: oval, with 

 its long axis downward and laterally. Two extremities or cornua: upper blending with the 

 lacunar ligament; lower, where the two parts of the fascia lata meet. Two borders: lateral or falci- 

 form, also known as the ligament of Hey, or femoral ligament. Semilunar in shape, arching 

 downward and laterally from the lacunar 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 medial border is much less prominent, owing to the weakness of the pubic part 

 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 hgament, and continuous above (in front) with 

 the transversahs 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: — (a) That there be plenty 

 of room for the femoral vein and the slowly moving venous (MUTCiit in it to ascend without com- 

 pression; (b) to allow all the movements of the thigh taking jilace — flexion and extension — 

 without undue stretching of the vessels. By two connective-tissue septa the sheath is divided 

 into three compartments — the lateral for the artery, the intermediate for the vein, and the 

 medial 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 medial division of the femoral sheath. 

 The fascia transversahs and fascia iliaca meet (hrectly on the lateral side of the 

 femoral artery, but not so closely on tlic medial side of the femoral vein. Hence 

 a space exists here, perhaps to prevent tiie thin-walled vein, with its sluggish 

 current, being pressed upon, but it is merely a slight gap — not a canal, unless so 

 made by a knife or by the dilating influence of a hernia. 



Length: about 1.9 cm. (J in.). Limits: below, fossa ovalis; above, femoral ring {vide 

 infra) . 



