Henry Gray (18251861). Anatomy of the Human Body. 1918.
ones being attached close to the cartilages of the corresponding ribs, the lowest to the apex of the cartilage of the last rib, the intermediate ones to the ribs at some distance from their cartilages. The five superior serrations increase in size from above downward, and are received between corresponding processes of the Serratus anterior; the three lower ones diminish in size from above downward and receive between them corresponding processes from the Latissimus dorsi. From these attachments the fleshy fibers proceed in various directions. Those from the lowest ribs pass nearly vertically downward, and are inserted into the anterior half of the outer lip of the iliac crest; the middle and upper fibers, directed downward and forward, end in an aponeurosis, opposite a line drawn from the prominence of the ninth costal cartilage to the anterior superior iliac spine.
The aponeurosis of the Obliquus externus abdominis is a thin but strong membranous structure, the fibers of which are directed downward and medialward. It is joined with that of the opposite muscle along the middle line, and covers the whole of the front of the abdomen; above, it is covered by and gives origin to the lower fibers of the Pectoralis major; below, its fibers are closely aggregated together, and extend obliquely across from the anterior superior iliac spine to the public tubercle and the pectineal line. In the middle line, it interlaces with the aponeurosis of the opposite muscle, forming the linea alba, which extends from the xiphoid process to the symphysis pubis.
That portion of the aponeurosis which extends between the anterior superior iliac spine and the pubic tubercle is a thick band, folded inward, and continuous below with the fascia lata; it is called the inguinal ligament. The portion which is reflected from the inguinal ligament at the pubic tubercle is attached to the pectineal line and is called the lacunar ligament. From the point of attachment of the latter to the pectineal line, a few fibers pass upward and medialward, behind the medial crus of the subcutaneous inguinal ring, to the linea alba; they diverge as they ascend, and form a thin triangular fibrous band which is called the reflected inguinal ligament.
In the aponeurosis of the Obliquus externus, immediately above the crest of the pubis, is a triangular opening, the subcutaneous inguinal ring, formed by a separation of the fibers of the aponeurosis in this situation.
The following structures require further description, viz., the subcutaneous inguinal ring, the intercrural fibers and fascia, and the inguinal, lacunar, and reflected inguinal ligaments.
The Subcutaneous Inguinal Ring (annulus inguinalis subcutaneus; external abdominal ring) (Fig. 393).The subcutaneous inguinal ring is an interval in the aponeurosis of the Obliquus externus, just above and lateral to the crest of the pubis. The aperture is oblique in direction, somewhat triangular in form, and corresponds with the course of the fibers of the aponeurosis. It usually measures from base to apex about 2.5 cm., and transversely about 1.25 cm. It is bounded below by the crest of the pubis; on either side by the margins of the opening in the aponeurosis, which are called the crura of the ring; and above, by a series of curved intercrural fibers. The inferior crus (external pillar) is the stronger and is formed by that portion of the inguinal ligament which is inserted into the pubic tubercle; it is curved so as to form a kind of groove, upon which, in the male, the spermatic cord rests. The superior crus (internal pillar) is a broad, thin, flat band, attached to the front of the symphysis pubis and interlacing with its fellow of the opposite side.
The subcutaneous inguinal ring gives passage to the spermatic cord and ilioinguinal nerve in the male, and to the round ligament of the uterus and the ilioinguinal nerve in the female; it is much larger in men than in women, on account of the large size of the spermatic cord.
The Intercrural Fibers (fibræ intercrurales; intercolumnar fibers).The intercrural fibers are a series of curved tendinous fibers, which arch across the lower part of