. Modern surgery, general and operative. the incision shown in Fig. the skin, fat, fascia, andthe glutaeus maximus the artery at the lowerborder of the pyriformis muscleand trace it to its point ofemergence from the the ligature from withoutinward. There is practically nomortality from this operation. Internal Pudic Artery.—This artery is one of the terminalbranches of the anterior trunkof the internal iliac. It passesto the lower margin of the greatsacrosciatic foramen, and leavesthe pelvis between the pjTiformisand coccygeus muscles, crossesthe ischial spin
. Modern surgery, general and operative. the incision shown in Fig. the skin, fat, fascia, andthe glutaeus maximus the artery at the lowerborder of the pyriformis muscleand trace it to its point ofemergence from the the ligature from withoutinward. There is practically nomortality from this operation. Internal Pudic Artery.—This artery is one of the terminalbranches of the anterior trunkof the internal iliac. It passesto the lower margin of the greatsacrosciatic foramen, and leavesthe pelvis between the pjTiformisand coccygeus muscles, crossesthe ischial spine, and againenters the pelvis by the lessersacrosciatic foramen. Thevessel is accompanied by the internal pudic nerve (Fig. 285). Ligation.—The position of the patient and the incision are the same asfor ligation of the sciatic artery (Fig. 286). The artery is found below theischial spine. Pass the needle from below upward to avoid the nerve. Thereis practically no mortality from this operation. Kochers Operative Surgery, by Fig. 286.—Position and direction of the superficialincisions which must be made in order to secure thegluteal artery and the sciatic and pudic arteries: A,Posterior superior iliac spine; B, great trochanter; C,tuberosity of the ischium; D, anterior-superior iliacspine; A-B, iliotrochanteric line, divided into line corresponds in direction with the fibers of thegluteus maximus muscle. The incision to reach thegluteal artery is indicated by the darker portion ofthe line. Its center is at the junction of the upperand middle thirds of the iliotrochanteric line, andexactly corresponds with the point of emergence ofthe gluteal artery from the great sciatic notch. A-C,ilio-ischiatic line. The incision to reach the sciaticartery and internal pudic is indicated by the lowerdark line. It is also to be made in the direction ofthe fibers of the gluteus maximus muscle. The centerof the wound corresponds to the junction of the lowerwith the mid
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