Simon Menno Yutzy.

A manual and atlas of dissection online

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Superficial perinceal vessels



Colles's fascia, turned back



Dorsal artery of penis
Artery of crus



Artery of bulb

COWPER'S GLAND

Pudic artery




Transrerse perina-n

Cut edge of triangular

ligament
.-> I TKi: I-'K'f,\ L

XKRVI-: (-[VtyiT OFF
TIL 1 SS \ 'ERSE BRA NCH
Pudic vessels

Inferior hremorrhoidal vessels
anil nerves



Dissection of the urethral region.

Dissection. Make an incision from the scrotum along the raphe to
the anal region. Reflect the skin outward onto the thigh. Just beneath
the skin is the superficial fascia common to both urethral and anal regions
and is continuous with similar structures in adjacent regions.

Beneath this superficial fascia, in the urethral region only, is a layer
of fascia known as the superficial perineal fascia, Colles's fascia, or deep
layer of the superficial perineal fascia. To avoid confusion we will call it
Colles's fascia.



176



THE PERINEUM



Colles's fascia may be demonstrated by blowing air beneath it with a
blow-pipe. It is attached on each side to the rami of the os pubis and
ischium; anteriorly it is continuous with the tunic dartos of the scrotum,
posteriorly at the base of the urethral triangle it passes around the trans-
versus perinei muscles and becomes continuous with the deep perineal
fascia or triangular ligament.

Remove Colles's fascia and expose the structures below:

Nerves (see Figs. 209, 210):
Superficial perineal.
Inferior pudendal.

FIG. 210. THE MALE PERINEUM. (Modified from Hirschfeld and Leveille.) (Morris.}

BULBO-CAVERNOSUS

Superficial triangular ligament

ISCHIO-CAVERNOSUS

Muscles of thigh




INFERIOR PUDENDAL NERVE
SUPERFICIAL PERINEAL NERVE



INFERIOR HJEMORRHOIDAL NERVE
CUTANEOUS BRANCH OF FOURTH SACRAL



Arteries (see Fig. 209):

Superficial perineal.

Transverse perineal.
Muscles (see Fig. 208) :

Bulbo-cavernosus.

Ischio-cavernosus .

Trans versus perinaei.
What is the tendinous point?



Gluteus masimus

TUBEROSITY OF ISCHIUM
Great sacro-sciatic ligament
Levutor ani
Superficial transversus perinaei



Sphincter ani



THE PERIXEUM



Xotice the arrangement of the fibres of bulbo-cavernosus muscle in the
figure beloii':

FIG. 211. DIAGRAM TO SHOW THE ACCELERATOR URIN.-E IN PROFILE. (Holden.~)




Corpus cavemosum.
Corpus spongiosum.

Upper fibres.
Middle fibres.



Lower fibres. .
Tendinous centre of
perineum.



Cut through the median line of the bulbo-cavernosus muscle and turn
the fibres outward to expose the bulb of the urethra.

Remove part of the ischio-cavernosus muscle and observe the cms of
the penis.

The triangular ligament or deep perineal fascia can be seen in the
space between the transversus perinaei, ischio-cavernosus, and bulbo-cav-
ernosus muscles. (See Figs. 209 and 210.)

Between the fascia of Colles and the triangular ligament are the fol-
lowing structures:
Muscles :

Bulbo-cavernosus.
I schio-cavernosus .
Transversus perinasi.
X erves :

Superficial perinaei.
Long pudendal.
Arteries :

Superficial perinaei.
Transversus perinaei.

The triangular ligament or deep perineal fascia stretches across the
pubic arch from the symphysis, where it is connected with the sub-
pubic ligament, back to the transverse perineal muscle, where it joins
with Colles 's fascia. It consists of two layers, superficial, or inferior,
layer, and the deep, or superior, layer. Remember, in describing the fascia,
the body is in the upright position.

The superficial layer of the triangular ligament is attached ori the
sides to the rami of the os pubis and ischium, anteriorly to the subpubic
ligament, as stated above, posteriorly it is connected with the central
13



r 7 8



THE PERINEUM



tendinous point, and is continuous with Colles's fascia, the anal and ischio-
rectal fascia.

The deep layer of the triangular ligament is a continuation of the
obturator fascia across the pubic arch. The obturator fascia is attached
to the rami of the pubis and ischium and then passes across the pubic
arch as the deep triangular ligament, joining the superficial layer of the
triangular ligament posteriorly.



FIG. 212. DIAGRAM SHOWING LINES OF ATTACHMENT OF THE FASCI/E AND MUSCLES OF

THE PELVIS. (W. A.) (Morris.}



GREATER SACRO-SCIATIC
NOTCH



ISCHIAL SPINE WITH ATTACH-
MENTS OF COCCY6EUS AND
LEVATOR ANI

LESSER SCIATIC NOTCH



Course of ' white line '



Obturator fascia



Deep triangular ligament

Posterior border of
perinaeal ledge

Transversua perinaei




Obturator fascia



Levator ani



SYMPHYSIS



Subpubic ligament

Superficial triangular

ligament
Fascia of Colles

ISCHIO-CAVERNOSUS AND CR'JS



Between the superficial layer and deep layer of the triangular ligament
is a space known as the deep perineal interspace.

Remove the superficial layer of the triangular ligament, thus opening
up the deep perineal interspace and exposing the structures between the
two layers of the triangular ligament.

These structures are (see Figs. 209, 213):

Membranous urethra, Cowper's glands, internal pudic artery and vein,
artery to bulb and cms, dorsal nerve to penis, deep transverse or com-
pressor urethras (M. constrictor urethra), transverse perineal, and pro-
fundus of Henle muscles. Study each of the above structures.

Review the internal pudic artery and branches, and pudic nerve and
branches. What is Alcock's canal?



THE PERINEUM



FIG. 213. DIAGRAM TO SHOW THE TRIANGULAR LIGAMENT OF THE URETHRA OR DEEP

PERINEAL FASCIA. (Maiden.)



Crus penis.



Crus penis
with its artery
cut through.




Tuber ischii



i8o



THE PERINEUM



FIG. 214. DIAGRAM OF THE RELATIONS OF THE, COMPRESSOR URETHRA AS SEEN FROM

ABOVE. (Holden.)



Catheter.



Dorsal nerve of the

penis.
Dorsal artery of the

penis.
Dorsal vein of the ~

penis.



Anterior layer of tri-
angular ligament.
Ramus os pubis
cut through.

Posterior layer of tri-
angular ligament :
part of the pelvic
fascia.




THE PERINEUM



181



FIG. 215. SIDE VIEW OF THE PELVIC VISCERA. (Holden.}

(Taken from a Photograph.)

External sphincter. 2. Internal sphincter. 3. Levator ani cut through. 4. Accele-
rator urinae. 5. Membranous part of the urethra, surrounded by compressor muscle.
(). Prostate gland. 7. Vesicula seminalis. 8. Ureter. 9. Vas deferens. 10. Crus
penis divided, n. Triangular ligament. 12. Superficial perineal fascia. 13. Rec-
tum.




FIG. 216. DEEP DISSECTION OF MALE PERINEUM. (Roser.) (Morris.)
The bulb is slightly raised and the rectum drawn backwards, in order to make clear
the membranous urethra and prostate, which are shown incised as in the lateral opera-
tion of lithotomy.



Erector penis ^



Wilson's muscle.

URETHRA DIVIDED AS IN

THE LATERAL INCISION ,

Artery to bulb (abnormal) *

PROSTATE GLAND, WITH ITS

PLEXUS OF VESSELS
Superficial perinceal /

a rtrrii

Levantor ani, its
anterior fibres raised
to show the prostate



Gluteua maximu...




ntinuation of internal

piidic artery
, Anterior layer of

triangular ligament
-Artery to bulb

I-SJS COWPER'S GLAND



INCISION IN THE PROSTATE
_.GLAND AS IN THE LATERAL

OPERATION

Transversus perinaei
muscle



3* Trunk of internal pudie
!3f RECTUM



External sphincter



i8a



THE PERINEUM



Locate and study the following muscles:
Levator ani. (See Figs. 217, 218, 219.)

Pubo-coccygeus.

Ilio-coccygeus.
Coccygeus.
Obturator internus.



FIG. 217. MUSCLES OF THE FLOOR OF THE PELVIS. (Morris.)



SACRUM ^



Pyriformis



Levator ani (divided
below the ' white line '}



Space for obturator
interims



SYMPHYSIS




rn.txiif/e for gluieal
vessels and nerve

Pyriformis

Pasxitye fur xrialic
a inl 11 ml it' vessels
and nerve

ISCHIAL SPINE



Coceygeus
Cellular interval
Levator ani



Capsule of prostate,
and pubo-prostatic
ligaments



FIG. 2 1 8. DIAGRAM OF THE PELVIC FASCIA. (Morris.)



Transversalis fascia



Obturator fascia

White line '

Hecto-vesieal fascia



Obturator fascia

Isehio-rectal fascia



Alcock'a canal with
pudic vessels




Abdominal muscle*
ILIAC CREST



Psoas

BORDER Of ACETABULUM



Apex of ischio-rectal
fossa

Levator ani

ISCHIAL TUBEROSITY
Sphincter ani



PELVIC FASCIA



183



FIG. 219. MUSCLES OF THE FLOOR OF THE PELVIS. (W. A.) (Morris.)
(A portion of the ischial and pubic bones sawn away.)



Aperture for

ior gluteal
vessels and litres




Aperture for
sciatic anil pudic
vessels and nerve



Coecygeal fibres of
levator ani



Fibres of leva-
tor ani



Sphincter ani
RECTUM



' White line ' of
obturator fascia



Pubic attachment
of levator ani



PROSTATE



Tendinous centre
of periuasum



PELVIC FASCIA.

To expose the pelvic fascia remove the peritoneum. Note the loose
connective tissue between the peritoneum and fascia about the bladder.

Study a description of the pelvic fascia. Notice, first, to what parts
of the pelvis the fascia is attached, and then, second, the manner in which
it is reflected on the pelvic viscera.

Trace the fascia, beginning with the iliac fascia, with which the pelvic
fascia is continuous, into the pelvis, notice its division into recto-vesical,
obturator, and anal, or ischio-rectal, fasciae.



1 84



PELVIC FASCIA



FIG. 220. TRANSVERSE SECTION OF THE PELVIS, TO SHOW THE REFLECTIONS OF THE
PELVIC FASCIA. (After Gray.) (H olden.}




Pelvic fascia
dividing.

Obturator
fascia cover-
ing obturator
internus.

Recto-vesical
layer cover-
ing levator
am.



Anal fascia.



FIG. 221. VERTICAL FRONTAL SECTION OF THE PELVIS, SHOWING FASCI/E. (Morris.}

(Modified from Braune.)



PROSTATE
VERUMONTANUM



Levator ani



MEMBRANOUS URETHRA

Pudie vessels

PUBIC ARCH

Fascia of ischio-

cavernosus

CRUS PENIS

BULB

BULBO-CAVERNOSUS

WITH ITS FASCIA

Integument of

perinaeum




White line



Subperitoneal fat

Obturator internus

Ischio-reetal fascia

OS INNOMINATUM

Keeto-vesical fascia,
parietal and visce-
ral layers

Obturator fascia

Obturator mem-
brane

ISCHIO-RECTAL FOSSA

Deep triangular lig,
Deep transversus

perinaei

Superficial triangu-
lar ligament

Muscles of thigh
Isehio-cavernosus



Muscles of thigh



FEMALE PERINEUM



185



FEMALE PERINEUM.



Follow the same general order and directions as those given for the
dissection of the male perineum, noting the differences in the organs and
the provisions made for their accommodations.
Study the external organs of generation:
Mons veneris.
Vulva.

Labia majora.
Labia minora.
Clitoris. .
Vestibule.
Fourchette.
Glands of Bartholin.
Vagina.
Hymen.
Bulbi vestibuli.
Study urethra, position, size, and plexus of veins.



FIG. 222. THE EXTERNAL GENITALS OF THE FEMALE. (Morris.}



MONS VENERIS



GLANS CLITORIOIS %



MEATUS URINARIUS IN
VESTIBULAR SPACE




CORPUS CL1TORIDIS



LABIUM KAJUS
LABIUM !;,INUS




Examine the osseous and ligamentous boundaries of the lower aperture
of the pelvis. What difference exists between the male and female pelvis?



i86



PELVIC VISCERA



Distend the rectum moderately with tow and sew the edge's of the
anus together; also sew the edges of the labia majora together.

Dissection: Proceed on the same plan as in the dissection of the
male perineum, following the same directions, looking up the same fig-
ures, noting the differences, where they exist.



FIG. 223. DIAGRAMMATIC REPRESENTATION OF THE PERINEAL STRUCTURES IN THE FE-
MALE. (Morris.)



ISCHIO-PUBIG ARCH



CRUS CLITORIDIS WITH
ISCHIO-CAVERNOSUS




BULBO-CAVERNOSU3
COVERING BULBU3
VESTIBULI



Superficial trian-
gular ligament



GLANS CLITORIDIS
WITH PREPUCE

PARS INTERMEDIALIS
Mucous membrane
of vestibule

MEATUS URINARIUS



BULBUS VESTIBULI



GLAND OF BARTHOLIN



Sphincter ani



DEMONSTRATION IX.



PELVIC VISCERA.



Remove the pelvic viscera.

Draw down the penis and separate it from the pudic arch. Divide the
transversus perinaei and levator ani close to their insertions, detach the
sphincter ani from its attachment to the coccyx. Remove the organs
of generation, rectum, and bladder with the remaining kidney and ureter
attached.

In the female separate the clitoris from the pubic arch; then proceed
the same as in removing the male organs.

Dissect the rectum from the rest of the organs.

Rectum:

Clean and study the rectum, position and relation to surrounding
parts, peritoneum, recto-vesical or recto-vaginal pouch, anus, internal
sphincter muscle, mucous membrane, and rectal or Houston's valves.



PELVIC VISCERA
Describe the blood- and nerve-supply.



187



Male Reproductive Organs.
Prostate gland: -

Expose the prostate gland and vesiculae seminales by following down
the vas deferens, dissecting away the tissue about the neck of the bladder
* and the posterior inferior surface of the bladder.

FIG. 224. POSTERIOR VIEW OF THE BLADDER. (Holden.)
i. Ureter. 2. Vas deferens. 3. Vesicula seminalis. 4. Trigone. 5. Prostate.




FIG. 225. DIAGRAM OF THE RELATIVE POSITION OF THE PELVIC VISCERA. (Holden.)



Symphysis pubis.



Corpus cavernosum
penis.

Glans penis.



Corpus spongiosum
urethrse.



Bulb of corp. spon-
giosum.
Cowper's gland with

duct.

Membranous part of
urethra surrounded
by compressor
muscle.

Prostate gland.




Peritoneum in
dotted outline.



Ureter.



Vas deferens.



Vesicula semi-
nalis.



Describe the prostate gland, vesiculae seminales, vas deferens, and
ejaculatory duct, position, function, blood- and nerve-supply of each.



8 PELVIC VISCERA

FIG. 226. VASA DEFERENTIA AND VESICUL^E SEMINALES. (After Sappey.) (Morris.)



EJACULATORY DUCT -
SINUS POCULARIS



VERUMONTANUM
ORIFICE OF EJACULATORY DUCT



AMPULLA OF VAS DEFERENS



UNION OF VESICULA WITH VAS



EJACULATORY DUCT ENTERING
PROSTATIC FISSURE



PROSTATE



MEMBRANOUS URETHRA




VAS DEFERENS



ORIFICE OF SINUS POCULARIS
LOWER END OF VERUMONTANUM



VESICULA SEMINALIS



FIG. 227. VAS DEFERENS AND VESICULA SEMINALIS DISSECTED. " (After Sappey )

(Morris.)



DIVERTICULA



DIVERTICULA



SACCULUS




SACCULI OF AMPULLA OF VAS



JUNCTION OF VAS AND VESICULA
EJACULATORY DUCT



PELVIC VISCERA



189



Testes and their coverings.

General description of the testes. Position in foetal life and their
descent.

Describe the coverings of the testes.

FIG. 228. HORIZONTAL SECTION OF THE SCROTUM AND TESTICLE. (Diagrammatic.)

(Morris.)



Skin

Dartos

External spermatic fascia

Cre mast eric fascia

Parietal layer of tunica vaginalis



Septum scroll



MEDIASTINUM TESTIS




Internal spermatic fascia and
Bubperitoneal fascia

Cavity of tunica vaginalis
Visceral layer of tnnica vaginahg
Tunica albuginea
Digital fcssa



Open the scrotum and examine the testes, epididymis, and the begin-
ning of the vas deferens. Describe each; also describe the spermatic
cord.

FIG. 229. DIAGRAM OF THE TESTICULAR TUBULES. (Morris.)



TUNICA ALBUGINEA RECEIVING ATTACH-
MENT OF TRABECUL/t



VAS RECTUM




COLLECTING TUBE
CONI VASCULOSI



VASA EFFERENTIA



RETE TESTIS IN MEDIASTINUM TES1IS
TUBE OF EPIDIDYMIS



VAS ABERRANS
VAS DEFERENS



Penis:

Root, body, and glans penis. Study each part. What is the blood -
and nerve-supply?

Bladder:

Insert a blow-pipe through the urethra and distend with air, and dry
the bladder.



IQO



PELVIC VISCERA



Study its external surface, walls, and structures, ligaments, form
when distended and when empty.

Open the bladder by making an incision through the anterior wall
along the median line ; extend the incision along the superior wall of the
penis, thus laying open the bladder and urethra.



FIG. 230. THE MALE URETHRA, CLEFT DORSALLY TO SHOW VENTRAL Mucous WALL.

(M orris.)



URETER -\

Plica uretica

SECTION OF BLADDER



INTERNAL URINARY MEATUS



PROSTATIC SINUS WITH OPENING OF
PROSTATIC GLANDS

SINUS POCULARIS

FOLLICULAR GLANDS OF DORSAL WALL



SEPTUM PECTINIFORME



THIN LAYER OF CORPUS SPONGIOSUM
ORIFICE OF COWPER'S GLAND

Albuginea of corpora cavernosa




SECTION OF PROSTATE
VERUMONTANUM
EJACULATORY DUCT
PROSTATIC GLANDS



MEMBRANOUS URETHRA



SECTION OF CORPUS CAVERNOSUH



BULBOUS PORTION OF URETHRA



Mucous membrane



FOSSA NAVICULARIS



EXTERNAL URINARY MEAVJS;



PREPUCE
GLANS PENIS



Examine and study the inner surface of the bladder.
What difference between male and female bladder?



PELVIC VISCERA



191



FIG. 231. THE POSTERIOR WALL OF THE BLADDER. (After Henle.) (Morris.}



VAS DEFERENS



MRETER PIERCING VESICAL
WALL



PLICA URETERICA
VESICAL APERTURE OF
URETER

MUSCULARIS

MUCOSA
JVULA OF LIEUTAUD




PROSTATE
VERUMONTANUM
OPENING OF EJACULATORY DUCT

SINUS POCULARIS -
PROSTATIC SINUS



Examine and study the urethra. (See Fig. 230.)
What difference between male and female urethra?

Female reproductive organs.

Review the external organs.
Vagina:

Open the vagina by a posterior incision through its wall. Note its
mucous membrane and the intra-vaginal cervix. Describe the vagina.

FIG. 232. THE FEMALE ORGANS OF GENERATION. (Modified from Sappey.) (Morris.}
(Vagina divided and laid open behind.)



POSTERIOR SURFACE OF BODY OF UTERUS



Utero-ovarian ligament
OVARY

FALLOPIAN TUBE

Broad ligament




FIMBRIATED EXTREMITY

OF TUBE
FIMBRIA OVARICA

Lower
part of broad ligament

OS UTERI

OS EXTERNUM

VAGINAL WALL, DIVIDED AND REFLECTED



VAGINA, ANTERIOR WALL



iQ 2 PELVIC VISCERA

Uterus:

Examine the uterus with its broad ligaments, Fallopian tubes, round
ligaments and ovaries attached.

Open the uterus by a posterior median incision.
Study uterus and ligaments; and ovaries.



F IG - 233. FRONTAL SECTION OF THE VIRGIN UTERUS. (After Sappey.) (Morris.}



UTERINE WALL
CAVITY OF BODY



UTERINE WALL
CAVITY OF CERVIX WITH ARBOR VIT/E



OS EXTERNUM
VAGINAL WALL




FIG. 234. THE BROAD LIGAMENT AND ITS CONTENTS, SEEN FROM THE FRONT. (Morris.)

(After Sappey.)
Also see Fig. 232.



PAROVARIUM



AMPULLA OF FALLOPIAN TUBE



FALLOPIAN TUBE

EXTERNAL ANGLE OF UTERUS



FIMBRIATEO EXTREMITY OF TUBE

FIMBRIA OVARICA



Round ligament
Ligament of ovary





Anterior peritoneal lamina



What is the blood- and nerve-supply of the uterus, vagina, ovaries,
and broad ligaments? (Figs. 205, 235.)

Study the lymphatics of the pelvic and abdominal viscera.



'93



FIG. 235. DIAGRAM OF THE ARTERIES AND LYMPHATICS OF THE FEMALE GENERATIVE

ORGANS. (Mcrris.)



Lymphatics of broad ligament
(to lumbar glands)



OVARY



FALLOPIAN TUBE




Funicular lymphatics
(to inguinal glands)



Uterine and vaginal lymphatics
(topeli-ic glands)



Vnlvar li/mptiafics
(to inguinal glands)



Ovarian
artery



Funicular
artery



Vaginal arteriet



Transverse perinceal artery



194



PELVIC CAVITY



DEMONSTRATION X.

CAVITY OF THE PELVIS.

Examine the pelvis on an articulated skeleton. True pelvis; false
pelvis. Note the important ligaments of the pelvis.



FIG. 236. VERTICAL AXTERO-POSTERIOR SECTION OF THE PELVIS. (Morris.}



Superior sacro-iliac
ligament



Anterior sacro-iliac
ligament

Inferior sacro-iliac
ligament



Small sacro-sciatio
ligament



Great sacro-sciatic
ligament




Review the pelvic fascia.

Divide the body transversely in the lumbar region just above the crest of
the ilium, and then through the middle line of the sacrum and symphysis of
pub-is.

Now expose the internal iliac artery and its branches, and internal
iliac vein and its tributaries.



PELVIC CAVITY 195

F IG 237 . SIDE VIEW OF PELVIS AND UPPER. THIRD OF THIGH, WITH THE EXTERNAL

ILIAC, INTERNAL ILIAC, AND FEMORAL ARTERIES AND THEIR BRANCHES, LEFT SIDE.

(From a dissection by W. J. Walsham in the Museum of St. Bartholomew's Hospital.)

The bladder is hooked over to expose back of pelvis.

Common iliac artery
S YMPA THETIC SER \ ~E
Middle sacral artery



Common iliac vein
URETER

Internal iliac artery
External iliac vein

External iliac artery

Potterivr Iranch of internal iliac dividing into
gluteal and ilio-lumbar arteries

Lateral sacral artery

SACRAL PLEXUS
OBTURATOR SERVE-

Obturator ar t
Obliterated hypogastric
Superior vesical artery
Edge of levator aiii

Pudic artery

BLADDER
Middle vesical artery

Deep epigastric artery
Pubic branch of epi-

artery
Common femoral artery

Long sripfienotts rein
Pectineus muscle



Obturator artery

Adductor magnus

Internal circumflex artery

Adductor brevis

OBTURA TOR SERVE (ant. branch)

Profunda artery

Adductor longus, hooked aside

Superficial femoral artery and rein



Gracilis muscle
Lower part of sartorius




Psoas muscle
Ilio-lumbar artery

EXTERSAL CUTA-
SEOUS SERVE

Iliacus muscle

GESITO-CRURAL
SER VE

ASTERIOR CRU-
RAL SERVE

Deep circumflex iliac

artery
Superficial circumflex

iliac artery

ANTERIOR CRURAL tf.
Gluteal artery and



"



uteali



Tensor facias iemoris

(hooked aside)
Glutens medius and

minimus
Sartorius muscle
MIDDLE CUTA-
SEOl'SSERVE

SERVE TO RECTUS

KERYE TO VASTUS
EXTERXUS

External circumflex ar.

NERVE TO CRUREl'S
Rectus, hooked aside
Profunda rein

LOSfi SAPHESOUS
SERVE AND
SERVE TO VAS-
TUS ISTERSUX



Vastus internus
muscle



Fio. 238. PLAN OF THE BRANCHES OF THE INTERNAL ILIAC ARTERY. (Holden.}




SAC. MED



PELVIC CAVITY



Sacral plexus.

Plan of formation of pelvic plexus.



FIG. 239. DIAGRAM OF THE LUMBAR AND SACRAL PLEXUSES. (Modified from Paterson.)

(Mom?.)



FROM LAST THORACIC



GEN1TO-CRURAL

ILIO-HYPOGASTRIC

INGUINAL



EXTERNAL
CUTANEOUS



OBTURATOR



ACCESSORY
OBTURA TOR



BRANCH TO ILIAC US
ANTERIOR CRURAL



SUPERIOR GLUTEAL



INFERIOR GLUTEAL



GREAT SCIATIC

NERVE TO

Q.UADRATUS

FEMORIS

EXTERNAL

POPLITEAL

SECTION

INTERNA L

POPLITEAL

SECTION

TO HAMSTRINGS




FIRST LUMBAR



SECOND LUMBAR



THIRD LUMBAR



- FOURTH L UMBA R



FIFTH LUMBAR



FIRST SACRAL



SECOND SACRAL



THIRD SACRAL

VISCERA L
FOURTH SACRAL

PERFORATING
CUTANEOUS



FIFTH SACRAL

KERVE TO COCCYGEUS

NER VETO LEI 'A TOR

ANI

FIRST COCCYGEAL



SMA LL SCIA TIC PUDIC
NER VE TO OBTURA TOR INTERNUS



VISCERAL



PELVIC CAVITY



197



Expose the sacral plexus by removing from its anterior surface pelvic
fascia. The sciatic and internal pudic arteries also lie anterior to the
sacral plexus, pelvic fascia lying between the arteries and the plexus of
nerves.

Trace the branches of the sacral plexus to where they pass out of
the pelvis.



FIG. 240. BRANCHES OF THE LUMBAR AND SACRAL PLEXUS VIEWED FROM BEFORE.
(After Hirschfeld and Leveill.) (Morris.)



GANGLIATED CORD OF SYMPATHETIC
LAST THORACIC SERVE



FIRST L UMBAR



ILIO-

HYPOGASTRIC
ING I" IX A L

SECOND
LUMBAR



FOURTH

LUMBAR

DfQUINAL

EXTERNAL

CUTANEOUS

GKX1TO-CRURAI.
LU.VBO-SACRAL

CORD

ANTERIOR CRURAL
OBTURATOR

GEXITAL BRAXCB
OF GEXITO-CRURAL

CRURAL BRA\rrr OF

GKXITO- CRURAL

INGUINAL

IHXTRIBU- \

TI<>\ /il'
EXTEHXA L 1

CRURAL
BRANCH

OF G EX I TO-
CRURAL




AORTIC PLEXUS

LAST THORACIC NERVE



ILIO-HYPO-
GASTRIC



INGUINAL

THIRD
LUMBAR

XERVE



GENITO-
CRURAL



EXTERNAL
CUTANEOUS

GENITAL
BRANCH
OF

GENITO-
CRURAL

CRURAL
BRANCH OP
GBK1TO-
CRURAL

OBTU-
RATOR



SACRAL
PLEXUS



Also expose the:

Fifth sacral nerve.
Coccygeal nerve.
Sacro-coccygeal plexus.



198



PELVIC CAVITY



FIG. 241. A DISSECTION OF THE LUMBAR AND SACRAL PLEXUSES, FROM BEHIND.

(Morris.}

(The anterior crural nerve is placed between the external cutaneous and obturator nerves. )

Also see Fig. 240.



TWELFTH RIB



LAST THORA CIC NER VE



ILIO-
HYPOGASTRIC



INGUINAL



ILIAC BRANCH

OF ILIO-
HYPOGASTRIC



Glutens medius

Gluteal artery
SUPERIOR
GLUTEAL NERVE



GREA T-SCIA TIC NER VE

INFERIOR GLUTEAL
NERVE

SMA LL SCIA TIC NER VE




Dura mater of cord



- POSTERIOR PRIMARY
DIVISION



- GENITO-CRURAL



- CAUDA EQUINA



Filura terminate



EXTERNAL
CUTANEOUS



OBTURATOR

LUMBO-SACRAL CORD



*f ' FIRST SACRAL
NERVE



FIFTH SACRAL
NERVE



VISCERAL BHAXCHES
Sciatic artery
Small sacro-seiatic

ligament
PUDIC NER VE

NERVE TO

OI1TURA TOR
INTERNUS

PERFORA TING
CUTANEOUS OF
SECOND AND
THIRD SACRAL
NERVES



Sympathetic nerves:

Trace down into the pelvis the gangliated cord.
Pelvic plexus:

Offsets of the pelvic plexus.
Hemorrhoidal.
Vesical.

Prostatic in male.
Vaginal in female.
Uterine in female.
Muscles:

Examine the pyriformis, coccygeus, obturator internus, and origin
of levator ani. (See Figs. 217, 218.)

Locate the white line. (See Fig. 219.)



GLUTEAL REGION



199



DEMONSTRATION XL

GLUTEAL REGION.

Dissection: Make an incision through the skin from the tip of the


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Online LibrarySimon Menno YutzyA manual and atlas of dissection → online text (page 8 of 11)