A Manual of the Operations of Surgery: For the Use of Senior Students, House Surgeons, and Junior PractitionersBell, Joseph
Science
A Manual of the Operations of Surgery: For the Use of Senior Students, House Surgeons, and Junior Practitioners
Bell, Joseph
Surgery, Operative
LIGATURE OF FEMORAL.--Under this head we practically mean cases of
ligature of the superficial femoral, for the common femoral, or (as
called by some anatomists) the femoral, before the profunda is given
off, very rarely requires to be tied. If it is wounded, of course the
bleeding point must be sought, and the artery tied above and below it,
but if an aneurism on the superficial femoral renders ligature of that
trunk impossible, experience teaches that ligature of the external iliac
gives better results than ligature of the common femoral. Erichsen
asserts that out of twelve cases in which the common femoral has been
tied, only three have succeeded, the others dying from secondary
hæmorrhage. The experience of the Dublin surgeons, Porter, Smyly, and
Macnamara, has been more satisfactory, as in eight cases of this
operation six were successful.[8] A ninth case was unsuccessful. Reasons
to explain the danger are not far to seek, for the numerous small
muscular branches, along with the superficial epigastric, circumflex,
and pudic trunks, reduce the chances of a good coagulum in the common
femoral to a minimum, even without taking into consideration the
shortness of the trunk before the great profunda femoris is given off.
For the common femoral artery is only from one to two inches in length,
and if there are some rare cases in which it is a little later in its
bifurcation, there are others in which it divides nearer to Poupart's
ligament.
The superficial femoral is the name given to the main trunk between the
origin of the profunda, and the point at which, passing through the
tendon of the adductor magnus, it receives the name of popliteal. During
this long course it gives off no branch large enough or regular enough
to receive a name, except one, the anastomotica magna, which rises in
Hunter's canal, close to the end of the vessel, so in that respect it is
peculiarly suitable for the application of a ligature. Again, in the
upper part of its course, it is superficial, being covered only by skin
and fascia. A short notice of its most important anatomical relations is
necessary.
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