GLUTIEAL REGION, (Surgical Anatomy.) (Fr. region fessiere.) The glutaml region may be defined with tolerable precision to be all that space external to the pelvis which is covered by the gluttei muscles of each side. Its boun daries geem naturally to be the crista of the ilium above; behind, the mesian line as low down as the point of the coccyx ; before, a line drawn from the anterior superior spinous pro cess of the ilium to the trochanter major; and below, a line drawn from the point of the coccyx to the insertion of the glutaus maximus; in fact, the inferior margin of this muscle forms the boundary line. These limits, better defined than those of most of the anatomical regions, separate this tract from the lumbar and iliac regions above, from the superior anterior region of the thigh in front, from the perineal and posterior regions of the thigh below, and from the corresponding part of the opposite side at the posterior mesian line. This space, which does not comprise many points of importance in surgical anatomy, is yet not without interest. Ilere are the glutwal and ischiadie arteries, also the commencement of the course of the great sciatic nerve. The internal pudic artery also skirts along the inferior edge of the gluttval region, but this will be best considered as part of the region of the perineum.
The first thing that strikes DS in the exami nation of this region is the great density and thickness of the integuments; they are inferior in this respect only to the sole of the foot. This density is, however, found greater pro portionally in the true skin than in the cuticle, which retains much of the softness and pliabi lity of the same covering in other parts of the body, and the end of this is evident, since whatever the pressure may be upon the glut:I:al parts, a dense state of the cuticle in any degree similar to the sole of the foot would, in the varied positions and movements of the trunk, be quite incompatible with comfort. On the other hand, the true skin, though pliant, is remarkably dense and strong, As fibres almost tendinous in structure, interlacing each other in every direction, and united underneath to a strong but rather loose cellular tissue which connects it to the glutmus muscle. It is to the laxity of this cellular connexion that the inte guments of this part are partly indebted for that pliability which enables us to rest with ease and comfort upon surfaces of various degrees of hardness and inequality. It contains
a considerable quantity of fat, which adds to the softness and elasticity of this cushion, and is very different from the granular hard fat found in the plantar region. The density of the integumental covering of the glatmal region varies somewhat in different parts. It is greatest where it covers the tuber ischii, and gradually diminishes on all sides except on the side next the perineum, where the change is very abrupt from its characteristic density to the extreme thinness and delicacy of the perineal covering. The peculiarity of structure of the integument covering the glutai should be borne in mind by the surgeon in the treatment of diseases of this part. Abscesses should on this account be earlier opened from the obstacle thus pre sented to their pointing. It is on this account also, probably, that we so generally find abscesses here accompanied with sloughing of the cellular tissue, which is best obviated by an early opening.
The fleshy fibres of the glutaus maximus are covered by a somewhat denser stratum of cellular tissue, forming an aponeurosis distinct from the fascia lata of the thigh, though conti nuous with it at the anterior edge of the muscle, where the fascia lata lies upon the anterior half of the Outwits medius. The great Outwits is composed of coarse and loosely connected fasciculi, running in a direction downwards and forwards. It commences by a somewhat semicircular line of origin from the posterior two-thirds of the crista ilii, from the side of the sacrum and of the coccyx. From this origin the fibres run somewhat converging towards the great trochanter and upper part of the Linea aspens. This direction of the fibres should be borne in mind in connexion with all remedial manipulations on this part, that the position in which the limb should be placed may be chosen most favourably for the relaxing of the muscle. The other muscles which are in this neighbourhood, and all of which move the thigh-bone, are so much smaller than this great muscle that the relaxing of this is of the first importance, and the position must be chosen with reference almost entirely to this.