Regional and surgical anatomy of the human body / A. Velpeau.

  • Alfred-Armand-Louis-Marie Velpeau
Date:
[1829?]
Catalogue details

Licence: Public Domain Mark

Credit: Regional and surgical anatomy of the human body / A. Velpeau. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    13/43 (page 12)
    This branch could mucli more readily be included in a liga- ture than the pudic itself, because it is easily found in the adipo- cellular structure about the anus. In the operation for fistula in ano by excision, its division rarely gives rise to serious hemorrhage, because it ramifies minutely, perhaps about an inch beyond the anus—the hemorrhage is either arrested spon- taneously or by slight compression. We should not forget that the hemorrhoidal artery sometimes proceeds so much forwards as to be very near the transversus perinaei; and, indeed, in such instances, it must be difficult to avoid it in the lateral opei-atione. The second is the Arteria superficialis perincei, which separates from the pudic about, half an inch behind the transversus perinaei, winding under it, and then proceeding through the superficial fascia, divides at two, three, or four lines from the rami of the ischium and pubis, and arriving in the external part of the triangular space, formed between the accelerator urinae, erector penis, and transversus perinaei, (the bulbo-ischiatic triangle,) coasts along the internal side of the erector penis and ramifies on the body of the penis, being ultimately lost in the septum scroti. Thus we find this artery deep posteriorly, and very superficial ante- riorly. Externally it gives one remarkable branch, which crosses the crus penis, to be lost on the inside of the thigh. Internally, the branches are too small to be of surgical importance; but it sometimes gives off the arteria transversalis perincei. It is easily avoided when towards the external side of the perinaeum ; but it is sometimes found near the median line. In this case we should endea- vour not to divide it. This branch is the largest of those which come from the internal pudic, and this frequently causes much hemorrhage after the operation of lithotomy. It may be wounded in this operation by approaching too near the rami of the ischium and pubis, while endeavouring to avoid the rectum, also in the transverse section, when the incision is made too far before the rectum, in which the knife is carried very much outwards. When the artery is wounded some distance posteriorly from the median line, the hemorrhage is always more considerable. This • is also true of the other arteries of the perinaeum. Arteria Transversalis perincei, often given off by the pre- ceding, but more frequently by the internal pudic, arises near the posterior and external edge of the transversus perinaii, pass- ing obliquely from without, inwards, and from above, down- wards, running superficially to its termination. This vessel: divides near the median line into three principal branches : the first is found before the anus and the rectum: the second,, between the rectum and bulb, and the third, within the bulb1 ilS(.]|'—all anastomose with those of the opposite arteries, and: thus form a very intricate and vascular net-work, placed exactly- in the site of the incision of lithotomy. More or less effusion of'