This section is from the book "Anatomy Of The Arteries Of The Human Body", by John Hatch Power. Also available from Amazon: Anatomy of the Arteries of the Human Body, with the Descriptive Anatomy of the Heart.
In this situation the artery is covered by the sartorius muscle, and much discussion has arisen whether it be preferable to cut down on its internal margin and evert it, or on its outer margin, and then draw it inwards.* Both modes have their advocates: Mr. Hunter, whose operations has already been described, adopted the former plan, and the advocates for it affirm that it can be more easily done, and that a depending opening is thus gained for the exit of matter. On the other hand, Mr. Hutchinson, who has written a letter to recommend the latter plan, objects to the internal incision,—that the artery is not easily found in this way, and that the saphena vein and trunks of the lymphatics are greatly endangered. The truth is, that if we operate on the termination of the femoral artery, as Hunter did, we will find it easier to expose this vessel by cutting on the outer edge of the muscle; but if we operate immediately below Scarpa's angle, which is a simpler and better operation, we must of necessity cut on the internal edge of the sartorius, unless we choose to have a tedious and difficult operation and a valvular opening in order to reach the artery. By not attending to this distinction, many useless discussions have arisen. In this country surgeons usually operate in Scarpa's space; but in France, we are informed by Velpeau, that the operation below this point, that is, in the middle third of the thigh, is usually preferred.
* Dub. Quar. Med. Jour., vol. xviii. p. 2. 29.
If the artery be tied just before it reaches the tendon of the adductor magnus muscle (an operations which is not recommended), in order to avoid the saphena vein and come readily on the artery, the incision should be made over the external or anterior margin of the sartorius. If care be not taken to divide the strong fascia that lies beneath this muscle, it will be almost impossible to find the artery. The operator must also take care not to mistake the anastomotic for the femoral artery: this error has been committed. Lastly, he should remember how closely the artery and vein are connected in this situation; and, as the vein projects a little to the outside of the artery, the needle should be passed from without inwards, taking care not to include the saphenous or the genicular nerves.
* Dessault proposes cutting this muscle across, which can never bo necessary : though we are informed it produces no permanent injury.
If the artery be tied higher up in the middle third of the thigh, our incision should be made over the internal margin of the sartorius muscle: the fascia, which is much weaker in this situation, must be next divided, and the artery will then be exposed. The nerves are to be carefully avoided, and the needle passed from within outwards.