THE LOWER LIMB 



1469 



drain into the popliteal lymph-nodes . The superficial lymphatics of the buttock 

 enter the lateral, and those over the adductor muscles the most medial group of 

 the inguinal glands. 



The deep lymphatics of the lower limb, comparatively few in number, follow 

 the course of the deeper vessels. After passing through some four or five glands 

 deeply placed about the popliteal vessels (these glands also receive the lymphatics 

 along the small saphenous vein), the lymph is carried up by lymphatics along the 

 femoral artery to the deep inguinal nodes; one very often occupies the femoral 

 canal. 



Fig. 1182 shows the distribution of the superficial nerves on both aspects of the 

 limb. 



Fig. 1182. 



-Distribution of Cutaneous Nerves on the Posterior and Anterior Aspects 

 OF the Inferior Extremity. 



Last thoracic 



Lateral sural 

 cutaneous 



Sural 



Posterior 



branches 



of lumbar 



nerves 

 Posterior 



branches 



of sacral 



nerves 

 Perforating 



cutaneous of 



fourth sacral 

 Perineal 



branch of 



posterior 



cutaneous 

 Branch of 



posterior 



cutaneous 

 Obturator 



Branch of 

 femoral 

 nerve 



Medial sural 

 cutaneous 



Twigs from 

 saphenous 



Medial 

 calcaneal 



\ f Lateral 



jj \ cutaneous 



Ilio-inguinal 



Superficial 

 peroneal 



Deep 

 peroneal 



Paralysis of the nerves of the lower extremity. — The student should take this opportunity 

 of considering from the surgical anatomy the results of paralysis of the nerve chiefly affeeted, 

 viz., the great sciatic and its branches. Sciatic: The limb hangs flail-like, much in the position 

 of one affected with advanced infantile paralysis. In addition to the results of paralysis of its 

 two divisions, flexion at the knee will be lost, owing to paralysis of the hamstrings. Peroneal 

 (external popliteal) nerve: The extensors and peronei being paralysed the foot drops, it cannot be 

 dorsiflexed at the ankle nor abducted at the medio-tarsal joint. Adduction at the latter joint 

 is impaired owing to paralysis of the tibialis anterior. The arch of the foot is largely lost owing 

 to paralysis of the peroneus longus. Slight extension of the two distal phalanges of the four 

 lateral toes is still possible by means of the interossei. Sensation is impaired over the distribu- 

 tion of the medial sural cutaneous deep, and superficial peroneal nerves. Tibial (internal 

 popliteal) nerve: Here the calf muscles, the flexors, and the muscles of the sole of the foot are 

 paralysed. The ankle cannot be plantar-flexed. 



