Regional and surgical anatomy of the human body / A. Velpeau.

  • Velpeau, A. (Alfred), 1795-1867.
Date:
[1829?]
Catalogue details

Licence: Public Domain Mark

Credit: Regional and surgical anatomy of the human body / A. Velpeau. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    12/43 (page 11)
    ARTERIES. The internal pudic artery proceeds along the internal surface of the tuberosity and ramus of the ischium; merely applied upon the external surface of the obturator fascia, it becomes gradually included in its layers so completely, that before it approaches the posterior edge of the transversus perineei, it is already enclosed in a complete fibrous canal. It proceeds above this muscular plane and the crus penis, always making towards the arch of the pubis. The vessel becomes more super- ficial as it advances, but is, however, covered by the deep fascia up to its ultimate division into the artery of the corpus caver- nosum and the dorsal branch of the penis. Thus the trunk of the pudic artery is firmly bound down in its whole extent. Hence it is immoveably fixed and perfectly uninfluenced by any force or change of position operating upon the perinseum. This artery, while within the ischium, is about one inch and half distant from the anus. It so coasts along the rami of the ischium and pubis, that there is no possible danger of wounding it in lithotomy, unless you neglect all the rules which have been laid down. In tracing it inferiorly, we find it one inch above the ischium; but superiorly, it is merely half an inch above the plane of the crus penis: so that in the living body it is far removed from the integument, and placed out of the reach, as it were, of the knife during the incision of the soft parts. Its relation with the aponeurosis renders it very difficult, if not impossible, to tie this artery, should it be unfortunately wounded. Perhaps the actual cautery presents the only rational means of success; for compression does not prevent effusion of the blood between the obturator internus muscle, or levator ani and aponeurosis. The pudic artery furnishes three principal branches. The first is the Artei'ia hcemorrhoidalis externa, which comes off from the trunk, and perforates the obturator fascia twelve or fifteen lines behind the transverse muscle, and consequently some lines before the pudic is applied upon the internal surface of the tuberosity of the ischium. On entering the cavity between the tuberosity of the ischium and the rectum, this branch proceeds transversely towards the anus, and divides into small branches which pass into the cellular mass which fills this space. As it passes from the aponeurosis, its size is suffi- ciently considerable for us to fear a hemorrhage from its division, which certainly should not occur in the several forms of the lateral operation of lithotomy, unless the incision is earned into the false perimcum, which is not generally approved of. How- ever, as its position is not very deep, and as its direction is somewhat obliquely forwards, we may divide the artery should the incision be made too near the rectum, more especially should we extend it three or four inches, having commenced about ten t or twelve lines before the anus, as S. Cooper, Hey, and others 11 have recommended.