Ligation Of The Gluteal, Sciatic, And Internal Pudic Arteries

To ligate the gluteal artery incise the skin and part the fibres of the gluteus maximus in the upper two-thirds of a line joining the posterior superior spine and the top of the great trochanter (Fig. 508). Pull the lower edge of the gluteus medius up and the artery and superior gluteal nerve will be seen coming out between it and the pyri-formis. To ligate the sciatic and internal pudic arteries an incision parallel to the one just described but about 7.5 cm. (3 in.) lower is made through the gluteus maximus, and just below the edge of the pyriformis from without inward will be found the great sciatic nerve, lesser sciatic nerve, sciatic artery, and the internal pudic nerve and internal pudic artery crossing the spine of the ischium.

Fig. 507.   View of the outer surface of the bones of the hip showing Roser Nelaton line (a d). Bryant's triangle (a b c), iliotrochanteric line, (a c) and the iliotrochanteric angle (b a c).

Fig. 507. - View of the outer surface of the bones of the hip showing Roser-Nelaton line (a-d). Bryant's triangle (a b c), iliotrochanteric line, (a c) and the iliotrochanteric angle (b a c).

Bursae

Covering the tuberosity of the ischium is a bursa which sometimes suppurates and forms a sinus. It can readily be excised. These sinuses are often bilateral.

Fig. 508.   Ligation of the gluteal, internal pudic, and sciatic arteries.

Fig. 508. - Ligation of the gluteal, internal pudic, and sciatic arteries.