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.

  • Henry Gray
Date:
1883
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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. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

    944/998 (page 776)
    The pubic portion of the fascia lata is situated at the inner side of the saphenous opening : at the lower margin of this aperture it is continuous with the iliac portion : traced upwards, it covers the surface of the Pectineus, Adductor longus, and Gracilis muscles; and passing behind the sheath of the femoral vessels, to which it is closely united, is continuous with the sheath of the Psoas and Iliacus muscles, and is finally lost in the fibrous capsule of the hip-joint. This fascia is attached above to the pec- tineal line, and internally to the margin of the pubic arch. It may be observed from this description that the iliac portion of the fascia lata passes in front of the femoral vessels, the pubic portion behind them ; an apparent aperture consequently exists between the two, through which the internal saphenous joins the femoral vein. The Saphenous Opening is an oval-shaped aperture, measuring about an inch and a half in length, and half an inch in width. It is situated at the upper and inner part of the thigh, below Poupart's ligament, towards the inner side, and is directed obliquely downwards and outwards. Its outer margin is of a semilunar form, thin, strong, sharply defined, and lies on a plane considerably anterior to the inner margin. If this edge is traced upwards, it will be seen to form a, curved elongated process or cornu (the superior cornu), or falciform ])rocess of Burns, which ascends in front of the femoral vessels, and curving inwards, is attached to Poupart's ligament and to the spine of the pubes and pecti- neal line, where it is continuous with the pubic portion.* If traced downwards, it is found continuous with another curved margin, the concavity of which is directed upwards and inwards : this is the inferior cornu of the saphenous opening, and is blended with the pubic portion of the fascia lata covering the Pectineus muscle. The inner boundary of the opening is on a plane posterior to the outer margin and behind the level of the femoral vessels ; it is much less prominent and defined than the outer, from being stretched over the subjacent Pectineus muscle. It is through the saphenous opening that a femoral hernia passes after descending along the crural canal. If the finger is introduced into the saphenous opening while the limb is moved in different directions, the aperture will be found to be greatly constricted on extending the limb, or rotating it outwards, and to be relaxed on flexing the limb and inverting it : hence the necessity for placing the limb in the latter position in employing the taxis for the reduction of a femoral hernia. The iliac portion of the fascia lata, hut not its falciform process, should now be he removed by detaching it from the lo»ver margin of Poupart's ligament, carefully dissecting it from the Subjacent structures, and turning it inwards, when the sheath of the femoral vessels is exposed descending beneath Poupart's ligament (tig. 444). The Crural Arch, or Poupart's Ligament, is the lower border of the aponeurosis of the External oblique muscle, which stretches across from the anterior superior spine of the ilium, to the spine of the os pubis and pectineal line : the portion corresponding to the latter insertion is called Gintbernat's Ligament. The direction behind the crural arch, and named the deep crural arch, which Mr. Gay identifies with Hey's ligament. * It is difficult to perceive in the recognised description of these ligaments (Hey's and Burns's) any difference between the two; nor is it clear what structure Mr. Hey really intended to describe. Mr. Gay (on Femoral Rupture, p. 16) gives very cogent reasons for thinking that the ' deep crural arch' was the structure which Hey had in view. The most recent writer on Femoral Hernia speaks thus while treating of these parts:—'The whole upper edge of the iliac fascia lata is commonly called the falciform process, whilst its deeper fibres receive the name of Burns's ligament. Hey's femoral ligament would appear to consist of distinct fibres connected with the inner fold of the iliac fascia, which extend immediately beneath the tendon of the external oblique to the subperitoneal fascia.' (Callender, On the Anatomy of the Parts concerned in Femoral Rupture, p. 19, note.) This description of Hey's ligament accords closely with that of the deep crural arch, for the subperitoneal fascia is Mr. Callender's name for the fascia transversalis. Mr. Callender goes on to say, ' The upper border of this (saphenous) opening thus receives, by an unfortunate complication, the names of Falciform process, Femoral ligament, Burns's or Hey's ligament. The various divisions of the iliac fascia lata depend in great measure upon the skill of the dissector, and are, in my opinion, artificial.