Anatomy, Surgical and topographical -- Atlases; Surgery -- Atlases; Surgery, Operative -- Atlases
The structure which is named Poupart's ligament in connexion with
inguinal herniae, is named the femoral or crural arch (Gimbernat) in
relation to femoral hernia. The simple line, therefore, described by
this ligament explains the narrow interval which separates both
varieties of the complaint. So small is the line of separation described
between these herniae by the ligament, that this (so to express the
idea) stands in the character of an arch, which, at the same time,
supports an aqueduct (the inguinal canal) and spans a road (the femoral
sheath.) The femoral arch, A I, Fig. 1, Plate 43, extends between the
anterior superior iliac spinous process and the pubic spine. It connects
the aponeurosis of the external oblique muscle, D d, Fig. 2, Plate 44,
with F, the fascia lata. Immediately above and below its pubic extremity
appear the external ring and the saphenous opening. On cutting through
the falciform process, F, Fig. 1, Plate 44, we find Gimbernat's
ligament, R, a structure well known in connexion with femoral hernia.
Gimbernat's ligament consists of tendinous fibres which connect the
inner end of the femoral arch with the pectineal ridge of the os pubis.
The shape of the ligament is acutely triangular, corresponding to the
form of the space which it occupies. Its apex is internal, and close to
the pubic spine; its base is external, sharp and concave, and in
apposition with the sheath of the femoral vessels. It measures an inch,
more or less, in width, and it is broader in the male than in the
female--a fact which is said to account for the greater frequency of
femoral hernia in the latter sex than in the former, (Monro.) Its
strength and density also vary in different individuals. It is covered
anteriorly by, P, Fig. 1, Plate 44, the upper cornu of the falciform
process; and behind, it is in connexion with, k, the conjoined tendon.
This tendon is inserted with the ligament into the pectineal ridge. The
falciform process also blends with the ligament; and thus it is that the
femoral hernia, when constricted by either of these three structures,
may well be supposed to suffer pressure from the three together.
A second or deep femoral arch is occasionally met with. This structure
consists of tendinous fibres, lying deeper than, but parallel with,
those of the superficial arch. The deep arch spans the femoral sheath
more closely than the superficial arch, and occupies the interval left
between the latter and the sheath of the vessels. When the deep arch
exists, its inner end blends with the conjoined tendon and Gimbernat's
ligament, and with these may also constrict the femoral hernia.
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