A manual of operative surgery . ock is consider-ably above the level of the lower border ofthe gluteus maximus, with which thereforeit does not correspond. When the hip isfully extended, as in the erect posture,the buttocks are round and prominent, thegluteal fold is transverse and verydistinct. When the hip is a little flexedthe buttocks become flattened, thegluteal fold becomes oblique and almostdisappears. Operation.—The nerve is most accessi-ble for stretching if exposed at the lower border of the gluteusmaximus muscle, just as it is leaving the hollow between thetuber ischii and the great
A manual of operative surgery . ock is consider-ably above the level of the lower border ofthe gluteus maximus, with which thereforeit does not correspond. When the hip isfully extended, as in the erect posture,the buttocks are round and prominent, thegluteal fold is transverse and verydistinct. When the hip is a little flexedthe buttocks become flattened, thegluteal fold becomes oblique and almostdisappears. Operation.—The nerve is most accessi-ble for stretching if exposed at the lower border of the gluteusmaximus muscle, just as it is leaving the hollow between thetuber ischii and the great trochanter. This corresponds to itsmost superficial part. The patient should be turned sufficiently over upon theface to enable the buttock to be exposed and the thigh to beextended. A vertical incision, four inches in length, is then madein the course of the nerve. The incision should commence overthe gluteal fold, and should be exactly opposite to the middleof the interval between the tuber ischii and the great FIG. 350.—RELATIONS OFTHE SCIATIC NERVE. G., Gluteus maximus ; N.,Great Sciatic ; b. , Biceps ;E., Adductor magnus. 456 OPERATIONS ON NERVES [part v If the wound be made nearer to the tuber there is an increaseddifficulty in displacing the hamstring muscles. The centreof the incision will about correspond to the free lower marginof the gluteus maximus. The skin and fascia having beendivided, the small sciatic nerve and a few cutaneous arterieswill be encountered. The quantity of the subcutaneous fat maybe considerable. The lower border of the gluteus maximus should be clearlyexposed as it runs obliquely downwards and outwards. Theedge of this muscle must be drawn upwards by means of a strongand broad retractor. The finger introduced into the wound willnow encounter the hamstring muscles a little below their originfrom the tuber ischii. These muscles should all be drawninwards, their fibres having been first relaxed by bending theknee. They are retaine
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