Anatomy, descriptive and surgical / by Henry Gray ; with an introduction on general anatomy and development by T. Holmes ; the drawings by H.V. Carter ; with additional drawings in later editions ; ed. by T. Pickering Pick.

  • Henry Gray
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: Anatomy, descriptive and surgical / by Henry Gray ; with an introduction on general anatomy and development by T. Holmes ; the drawings by H.V. Carter ; with additional drawings in later editions ; ed. by T. Pickering Pick. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    984/1036 (page 980)
    fibula, and here lies close to this bone. Its subsequent course is defined by a line drawn from the front of the head of the fibula to the middle of the front of the ankle. This line corresponds pretty nearly with the outer border of the tibialis anticus all the way doAvn. If this muscle be put in action, its outer border (the intermuscular line) is plainly seen, and the incision for the ligature of the artery in any part of its course may be defined with the greatest pre- cision. The artery can be felt beating and can be compressed where it crosses the front of the tibia and ankle. 122. Posterior Tibial Artery.—The posterior tibial commences about one inch and a quarter below the head of the fibula. Its subsequent course corre- sponds with a line drawn from the middle of the upper part of the calf to the hollow behind the inner ankle, where it can be felt beating distinctly about half an inch behind the edge of the tibia. A vertical incision down the mid- dle of the calf would reach the artery under cover of the gastrocnemius and soleus. A vertical incision along the middle third of the leg, about half an inch from the inner edge of the tibia, would enable the operator to reach the artery sideways, by detaching from the bone the tibial origin of the soleus. [The posterior tibial artery, behind the malleolus, lies midway between the tendo Achillis, or the heel, and the malleolus. It is the middle of five struc- tures : in front of it are, (1) the tibialis posticus tendon, (2) the flexor longus digitorum tendon; behind it are (4) the posterior tibial nerve and (5) the flexor longus pollicis tendon. It is important to observe that, as Wyeth has shown, it bifurcates into the two plantar arteries at a line drawn from the point of the malleolus to the middle of the heel.] 123. Saphena Veins.—The subcutaneous veins on the dorsum of the foot form an arch convex towards the toes (as on the back of the hand), from which issue the two main subcutaneous trunks of the lower limb, the internal and external saphena veins. The internal vein can be always plainly seen over the front of the inner ankle. Its further course up the inner side of the leg, knee, and thigh to its termination in the femoral is not in all persons manifest. [It lies about half an inch behind the internal border of the tibia, skirts the knee postero-internally, and, passing up the inside of the thigh, empties at the saphenous opening into the femoral. A thrombus not uncommonly may form in it, or in the femoral, or may extend from it into the femoral. The careful investigation of both veins then becomes very important, and is not generally difl&cult, especially if we remember the course of the saphena and the relation of the femoral to its artery.] The external saphena vein runs behind the outer ankle and up the middle of the calf to empty itself (generally) into the popliteal vein. THE FOOT. What are the bony landmarks which guide us in the surgery of the foot ? 124. Points of Bone.—Along the inner side of the foot, beginning from behind, we can feel—1, the tuberosity of the os calcis; 2, the projection of the internal malleolus; 3, the projection of the os calcis, termed sustentaculum tali, about one full inch below the malleolus; 4, about one inch in front of the malleolus internus, and a little lower, is the tubercle of the scaphoid bone; the gap between it and the sustentaculum tali being filled by the calcaneo-scaphoid ligament and the tendon of the tibialis posticus, in which there is often a sesa- moid bone; 5, the internal cuneiform bone; 6, the projection of the first metatarsal bone; 7, the sesamoid bones of the great toe. [On a line nearly midway from the scaphoid to the inner malleolus the head of the astragalus can be felt. In front, with the foot in extension, we can feel also the upper and lateral articular surfaces of the astragalus, and especially the ridges between them.]