—The femoral artery is usually tied either at the base of Scarpa’s triangle, just below Poupart’s ligament, or in Hunter’s canal. In the first location its pulsation can be easily felt before dividing the skin, and will serve as the best guide. It requires an incision made downward over the course of the vessel, from the middle of Poupart’s ligament. In approaching it here a number of lymph nodes may be encountered, some of which may be considerably enlarged. They should be disturbed as little as possible, unless involved in cancerous or serious septic disease. The anterior crural nerve lies to the outer side of the vessel and the vein to its inner side. Between these it may easily be found and tied ([Figs. 176] and [177]).
In Hunter’s canal the femoral artery may be found nearly beneath the long saphenous vein, and near the outer edge of the sartorius. If the leg be abducted, and the adductor magnus thus stretched, the position of the canal, between the latter and the vastus internus, is easily recognized. The canal itself is partly formed by fascia which should be divided, while the artery will be found within.
Fig. 178
Fig. 179
Surgical anatomy and ligation of the posterior tibial artery. (Bernard and Huette).
The lower part of the femoral artery, or practically the popliteal artery, may be found, if necessary, by an incision in the middle of the popliteal space, the operator gradually working down by blunt dissection to the location of the vessel, which is easily recognized by its pulsation.
The Posterior Tibial Artery.
—The posterior tibial artery nearly underlies a line from the centre of the popliteal space to a point between the inner malleolus and the heel. To expose it easily the limb, somewhat flexed, should lie upon its outer side, the patient lying nearly on his face, and incision made in the calf of the leg, beginning at the head of the fibula, after which one may expose the junction of the two heads of the gastrocnemius. Through this the tendon of the plantaris is to be sought, after which it may be necessary to divide a portion of the soleus. Here the vessel should be sought by the sense of touch, the operator seeking for its pulsation. Lower down, and in the lower part of the leg, it may be found by incision along the imaginary line which it underlies, lying on the flexor longus digitorum, with its accompanying nerve on its outer side. Still lower, at the ankle, it may be easily found, just behind the malleolus. (See [Figs. 178] and [179].)
Fig. 180