Operative surgery . withinoutward. The Fallacies.—The tendon ofthe semitendinosus may be mis-taken for the tendon of the semi-membranosus muscle. The semimembranosus has a large fleshy belly, whichextends much nearer to the median line of the popliteal space than does thesemitendinosus. Sometimes there are two popliteal veins, one on eitherside of the vessel, and rarely two popliteal arteries. The Results.—The popliteal is seldom ligatured unless ruptured. Of 9cases ligatured, 3 died. Of 5 tied before asepsis, the 2 for aneurism recov-ered; 3 for hsemorrhage died. Of four aseptically, 3 for ha
Operative surgery . withinoutward. The Fallacies.—The tendon ofthe semitendinosus may be mis-taken for the tendon of the semi-membranosus muscle. The semimembranosus has a large fleshy belly, whichextends much nearer to the median line of the popliteal space than does thesemitendinosus. Sometimes there are two popliteal veins, one on eitherside of the vessel, and rarely two popliteal arteries. The Results.—The popliteal is seldom ligatured unless ruptured. Of 9cases ligatured, 3 died. Of 5 tied before asepsis, the 2 for aneurism recov-ered; 3 for hsemorrhage died. Of four aseptically, 3 for haemorrhage, 1for aneurism, and 1 for elephantiasis, all recovered. Ligature of the Anterior Tibial Artery.—This artery is often injuredin fracture of the leg. The Anatomical Points.—It arises from the popliteal just below thepopliteus muscle, passes forward between the bones above the interosseousmembrane downward on the anterior surface of this membrane to the anklejoint, becoming the dorsalis pedis Fig. 197.—Ligature of popliteal artery at thelower third. THE LIGATURE OP ARTERIES. 151 The linear guide to thevessel is drawu on the an-terior surface of the legfrom the inner border ofthe head of the fibula (*)to midway between themalleoli (Fig. 198). The muscular guide isthe outer border of thetibialis anticus vessel can be tied atthree situations — at itsupper, middle, and lowerthirds ; but two—the mid-dle and lower thirds—aremore than sufficient for allpractical purposes. The Operation. UpperThird (Fig. 198, a) .—Liga-ture at this situation is te-dious and difficult, on ac-count of the great depthof the vessel, and shouldnot be attempted unlesscircumstances demand 193 shows the deeprelations of the vessel. The Middle Third {, J).—The artery in thissituation lies quite deeply,and a good light must behad to see the entire ex-tent of the operation-wound (Fig. 200). The Operation.—Placethe patient on the backwith the thighs
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