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The fossa ovalis and related blood vessels.

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THE FOSSA OVALIS, AND RELATED
BLOOD VESSELS
SIXTEEN FICL'EES
The descriptions of tlie fossa ovalis puxented herein a r e
based upon permailerit records obtained consecutively from
dissections of 200 thighs. Eight specimens xmre females,
192 males; sixteen were from one side of as many snbjects,
184 from both thighs of ninety-two subjects. The illustmtioris (figs. 1 to 16) represent the arialomy of selected fossae,
from male bodies, arranged in the order of increasing size of
the fossa. I n 100 cases tlie relationship of femoral and vein
to the fossa was recorded.
FOSSA OVALIS
?'he fossa o w l i s (O.T. saphenous opening) is regularly
described as possessing a sharp lateral edge of falciform
contour, a n ill-defined medial edge, and concave, proximal
and distal margins or comua. Its clirrierisions a r e said to
be variable, although the degree of variability is not recorded.
In the present study the occurrence of the typical form
predominates (figs. 10 t o 13). But not infreqaeiitly, in small
fossae, tho medial edge is well-defined, the inlcrior coriiu
coiitiiiued proximally t o closely approach, or actually reach,
the superior cornu (figs. 1 to 8 ) , thus forming a complete
oval ; rarely the opening resembles an enlarged hiatus rather
tliaii a trine fossa (fig. 1). When thus reduced in size, the
Contribution no. 276 from the Anatomical J,nlioratoriPs of Nortlirvestern
University Medical School.
399
400
B. J . A 9 8 0 N AKD C. B. McVAP
niedial and lateral margins arc not situated at different
dorsoventral levels ; the medial crus, spreading toward the
lateral one, covers eornpletely the cleclivitj7 between the subjacent iliopsoas and pectineus muscles, the margins of the
fascia clasping the confluens of saphenous and femoi-al veins.
I n outliiie, the fossa is occasionally almost circular (figs. 2
and 7). Usnally, Iiowevei*,it is oval (figs. 1,4, 8 t o 13) ; wheii
thus compressed laterally, the long axis may be placed vertically (figs. 8, 10 and 12), or obliquely (figs. 4, 11 and 1 5 ) ;
the narromncss may be strikingly displayed (figs. 8 aiid 10)
or poorly (ligs. 13 arid 15). Occasionally the fossa is dartshaped, with the pointed end directed downward (figs. 14
and 16).
The rclalioriship of thc superior crus t o the inguinal ligament is inconstant. It is conveiitioiially described as being
attached above to the medial half of the inguinal ligament.
When the fossa is proximally placed in the thigh, the eornii
appears as a derivative of the inguinal ligament (figs. 5,
6 and lo), the ligament itself seeming to scrve as one
boundary of the f ossa. Its independence in other instances
is equally striking, an appreciablc distance often intervening
between the ligament and the cornu (fig.2, 2 c i n ; fig. 3 and 15,
3.5 em.; figs. 14 and 16, 0.5 em.).
Within the space of the fossa proper accessory hiatuses not
infrequently occur, traiismittjng musculai~tributaries t o the
larger veins (see under Vessels hereinafter). These appear
in siniple form (figs. 9, 1 2 and 14) or as multiple orifices
(fig. 13). Auxiliary fossae occur near the major one (figs. 10
and 13).
I n size the greatest variability is expressed (table 1). The
smnllmt fossa in the 200 is 1.6 em. in length, 1.7 em. in width
(fig.2 ) ; the narro~-estmeasures 1.0 em. (fig.I), the shortest
1.6 cui. (fig. 2). The largest fossa in the group is 8.5 em.
in length, 3.5 em. in width (fig. 1 6 ) ; the widest measures
6.4 em., the longest 8.5 cm. (fig. 16). Ninety per c m t of the
specimens (i.e., 180 fossae) measure between 3.0 em. (fig. 5 )
aiid 6.4 em. iii lcngth (fig. 15) : 53.5% (I07 fossae) measure
between 3.5 em. (fig. 6 ) and 5.4 em. (fig. 11). The average
T H K F'OSSa OVALIS
401
length is 4.6 cm. In width, 87% (174 fossac) a r e between
1.5 em. and 3.9 em.; i0.576 (141 fossae) a r e between 2.0 em.
(fig. 10) and 3.9 cm. The average width is 2.8 em.
Figs. 1t o 9 Fossa ovalis, with related blood vessels one-half natural size.
Abbreviations : V.s.m., r e n a saplicna ningna j V.e.s., rena epigastrica superficialis;
V.c.i.s., vena circunnflex ilium superficialis ; V.p.c., v m a pudenda externa. Asterisk
indicates acressnry saphenous tributary.
402
B. J . AXSON AND C. B. McVtzP
Without exception fossne are capacious for the vessels
which they transmit: in only one case does tlie circumference
of the sapheiious vein approach that of the fossa through
which it passes (fig. 1): regularly a very considerable space,
unoccupied by vessels, is included between the cornua of the
fossa (eg., figs. 10 to 16), tlie size of contents in no way
affecting the proportions of the orifice. So aniple, in fact,
is the space of the fossa, that the contained femoral vein
is almost invariably exposed throughout its width. Moreover,
in 83% of 100 consecutive cases the femoral artery, also, is
TABJJE 1
Di?nerrsions of fossu ovalis
Length in
cp.ntim eters
specimens
centmeters
Number of
specimens
1.6
2.0-2.4
3.5-2.9
3 .O-3.4
3.5-3.9
1
4
6
19
21
38
33
34
21
12
4
3
1
1
1.0-1.4
1.5-1.9
11
19
5.0-2.4
48
47
4.0-4.4
4.54.9
5.0-5.4
5.5-5.9
6.04.4
G.5-G.9
7.0-7.4
7.5
8.5
Z'umber of
Width i n
2.5-2.9
3.0-3.4
3.6-3.9
4.0-4.4
4.5-4.9
5.0-5.4
5.5-5.9
6.0-G.4
46
14
7
3
3
0
2
I
200
200
wholly o r partially exposed. More specificially, in 3670,
three-fourths t o all of its breadth i s in view (figs. 7 and 16) :
in SO%, one-half to one-fourth; in 1770, not only is tlie artery
entirely in view, hut space occurs laterally, unoccupied by
vessel (fig. 5).
There is apparently no constant relationship betwwn the
size of the body and the caliber of the fossa. I n specimens
of the same height the fossae may be of widely different proportions, fossae of great size (fig. 16) and small (fig. 1) occurring in specimens of the same height (69 inches), others
THE FOSSA OT’ALIS
403
Q S
Figs. 10 to 16 Fossa ovalis and vessels, continued. Onc-half natural size.
Figure 10 is of t h e right side (as :ire figs. 1, 4, 7 t o 9 ) ; all others are from
thc l e f t side.
404
B. J. ANSOX AND C. B. McVAY
of similar proportions (figs. 9 and 10) appearing in cadavers
of differing heights (64 and 70 inches, respectively).
BLOOD VESSELS
The veins of the scrotal, inguinal, and anterior femoral
regions are usually received by the great saphenous tributary
of the femoral vein, in the immediate neighborhood of the
fossa ovalis. I n many of the cases, the superficial epigastric
and superficial iliac circumflex veins enter the saphenous
vein as independent channels (figs. 10, 14). Any of the three
major vessels may be doubled (figs. 4 and 5, Vv.p.e.; fig. 6,
Vv.e.s.) ; two adjacent tributaries may be confluent (figs. 2, 9,
3 1 and 12, V.e.s. and V.c.i.s.; fig. 3, TT.e.s. and V.p.e.). Not
infrequently veins are received from the femoral muscles
through accessory hiatuses in the deep fascia (figs.12 to 14),
and from lymphatic glands lodged in the superficial fascia
(figs. 2 and 7 ) . I n some instances the arrangement of superficial veins from the area proximal to the fossa ovaljs is
excessively simple (figs. 1 and 7), while, in other cases the
venous pattern is compl~s. I n one instance (fig. 3) seven
channels, in two groups (medial and lateral) converge upon
a,short vessel tributary t o the femoral vein: a saphcnous
vein joins a superficial external pudendal to form the common
medial channel, the latter receiving, sup.eriorly, one of three
superficial epigastric veins ; the most laterally placed of the
superficial epigastric veins, joining the superficial iliac circumflex, forms the lateral venous channel, which near the
confluens vvitli the medial channel, receives a third superficial
epigastric vein superiorly, a second saphenous vejn inferiorly.
,4 vein may be bifid throngh part of its course (fig. 12) ; accessory saphenous veins are common (figs. 3, 4, 6, 12 to 16),
occasionally as many as three occurring within the territory
of the femoral triangle (fig. 7 ) .
Only those cases which are illustrated will br ronsidcred here. A detailed
study of the vessels of the lower abdominal wall and of the thigh is now in
progress; the results of this study nil1 he reported in a suhsequeiit paper.
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