. Abdominal hernia : its diagnosis and treatment. ficial epigastric artery. Both are in deep layer of superficialfascia and are divided in hernia operations. 3, Circumflex iliac artery. Not usually divided. of the patient. In operating it will happen many times thatthe dividing line between the two layers is not discovered, butoccasionally it is so well defined as to mislead the operatorinto the belief that he has already reached the aponeurosis ofthe external oblique muscle. The only surgical importanceconnected with this fascia is that the deep layer contains twosets of vessels that are usua
. Abdominal hernia : its diagnosis and treatment. ficial epigastric artery. Both are in deep layer of superficialfascia and are divided in hernia operations. 3, Circumflex iliac artery. Not usually divided. of the patient. In operating it will happen many times thatthe dividing line between the two layers is not discovered, butoccasionally it is so well defined as to mislead the operatorinto the belief that he has already reached the aponeurosis ofthe external oblique muscle. The only surgical importanceconnected with this fascia is that the deep layer contains twosets of vessels that are usually cut in the first incision in herniaoperations (fig. i). 22 ABDOMINAL HERNIA. These arteries both come from the femoral space and arefirst, the superficial epigastric, crossing Pouparts ligament atits middle third and passing on upwards over the internal ringtowards the umbilicus. Second, a superficial branch of theexternal piidic, leaving the femoral space and passing up di-rectly over the external abdominal ring, and arching over to Fig. Aponeurosis of external oblique muscle, in which is shown the external ring co\ered bythe intercolumnar fascia. the root of tlie penis. These vessels are not important in sizebut may require ligation at time of operation. Beneath this fascia we find the aponeurosis of the externaloblique muscle which is easily distinguished by its glisteningsurface and from the fact that its fibres run obliquely down-ward towards the public bone (fig. 2). In operations forhernia the fleshy part of the external oblique muscle is seldom SURGICAL ANATOMY. 23 seen. The fit)res of the aponeurosis are bound together by theoverlying iiitcrcoluinnar fascia, which is tendonous in char-acter and furnishes strong protection to tiie upper angle of theexternal abdominal ring, by arching across from one pillar toanother. In opening down to the external abdominal ring, itfrequently obscures the upper angle of that aperture and pre-vents the easy passage of the direct
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