A system of practical surgery / By William Fergusson ; with illustrations by Bagg.

  • William Fergusson
Date:
1846
Catalogue details

Licence: Public Domain Mark

Credit: A system of practical surgery / By William Fergusson ; with illustrations by Bagg. Source: Wellcome Collection.

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    ■278 towards the inner side, to join the anterior tihial between the meta- tar.sjd lioncs of tlie two innermost toes ; the internal plantar will he observed to pass along the fissure between the flexor brevis eominiinis and the niiiseles of the great toe, and will in general be found to give oil, in addition to small twigs in its eoiirse, branches to supply the lower surface of the great toe, and the inner margin of the second. The external plantar artery gives otf numerous bninches in its course, and, from the convexity of its arch, those arise which form the digital twigs of the small toes. When the foot is minutely injected the arteries in the sole appear very numerous, and of considendde magnitude ; many branches can be dis.sected in the dense granular substance between the skin and ajioneurosis; these anastomose freely with each other, — with some from the uiiper part of the foot, as well as with others deep in the sole, and if care be taken to preserve a number of them, this part of the body may be made to appear as if covered with a mesh- work of arteries of a somewhat formidable-looking character. With the exception, however, of the posterior tihial and its two plantar branches, the vessids in this situation are of little i>r no surgical import- ance. The further examination of the foot may be postiioncd until the dissection of the posterior surface of the leg is comiileted. An incision should next be made ,'dong the mesial line of the poste- rior surface of the thigh and leg, from opposite the middle of the femur as low as that alreadj' made over the tendo Achillis, and the skin with the subcutaneous cellular membrane should be turned to each side, so as to expose a portion of the a[)oncurosis of the thigh and that of the leg. In raising the skin from the latter part, the posterior sajdiena vein will be remarked extending from below the malleolus externus as high as the popliteal space ; in the lower end of its course a small nerve (coramunicans tibialis) will be discovered near it, which may readily be traced, with the branches of the vein, below the outer ankle upon the back of the foot. In elevating the inner flap small veins may be noticed passing to join the internal saphena, and this vein it- self may now perhaps be more comjiletely seen than hitherto, as it courses along the inner and upper part of the tibia. The aponeurosis of the leg will be remarked to be continuous with that of the thigh ; and both will be observed to be of considerable strength, more parti- cularly the latter. An incision should next be made through these sheaths to the same extent as that originally made through the skin, to allow their being turned to each side with that texture. Attention should first be directed to the popliteal space, which, when the aponeurosis is raised, will be more distinct than it has hitherto ap- peared. 'J'lie tendon of the bicejis, which has been in some degree ob- scured by a very strong portion of the aponeurosis, will be observed on the outer side of this space; the tendon of the semi-tendinosus, part of the semi-meiubranosus, of the gracilis, and of the sartorius muscles, will be seen to form its inner margin : above, the space is bounded by the a|)position of the bicejis, semi-tendinosus, and semi membranosus, and below by the junction of the two heads of the gastrocnemius ex-
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