In the anterior region of the leg, the form is considerably flatter than in the posterior, and narrows as we proceed downwards, at the lower part becoming almost round. During extension of the foot, this region is marked by longitudinal elevations and depressions, indi cative of the situations of the, muscles, and of the connecting portions of aponeurosis. An examination of these points will assist us in cutting down upon the arteries here, as the depressions mark the exact boundaries of the muscles, being produced by the aponeurotic processes, which dip between them.
The integument of the anterior region, gene rally covered with hair in man, and of a some what dense structure, enjoys sufficient mobility to admit of wounds being united by the first intention, provided the loss of substance be not great. Not being very extensible, abscesses, tumours, &c., have great difficulty in projecting externally in front of the limb, and consequently for the most part remain more or less flattened. The posterior part of the leg has an integument more soft and elastic, and possessing fewer hairs than the anterior, particularly on the inner side. The position of the skin, with relation to the parts which it covers, occasions a marked difference in the mode of repairing the ravages of extensive ulcerations or sloughings. On the front and outer part of the leg, where the skin is somewhat stretched over the tibia and fibula, the process of cicatrization can only draw together the sound parts to 'a small de gree. In consequence the healing process is slower in completion, and the cicatrix less de pressed in proportion than when it is situated posteriorly. On the contrary, in this latter situation, the skin being stretched only over soft parts, when a considerable portion of it has been destroyed, the contractile force of the new skin has full opportunity to exert itself, and this it does sometimes to a degree that is re markable, acting as a sort of ligature upon the back part of the leg. NVe have seen a case where, by the cicatrization of an old and very extensive ulcer, the lower part of the calf of the leg, viewed in profile, had an appearance as if more than half the entire leg had been cut away" The most dense and strong part of the integument of the leg is over the inner side of the tibia where this forms the only covering of the bone, while at the upper and back part of the leg the skin is exceedingly thin and deli cate, and devoid of hairs. We may here re
mark, in illustration of the properties of the integuments of the leg, important in relation to surgery, that the contractile property of the skin is usefully exemplified in amputation, when, should the flap of the integument be more extensive than we desire, even to a great de gree, we always find that in the progress of the case it contracts so much as to exhibit no re dundance in the end; in filet that a large quantity of integument, however unsightly, is far less to be dreaded than the opposite defect. It is not our intention here to enter minutely upon the diseases of the parts we are now de scribing, but we cannot refrain from alluding to a state of disease of the integuments which we have never seen but in the leg, and of which we have met with no account in books. It consists in a soft elastic swelling, generally occupying the entire circumference of the leg, for the lower third or fourth of its length, though often much less. The skin over it is considerably redder than natural, and of a somewhat dark colour. It is not at all tender to the touch, but is exceedingly painful when the foot is down and in exercise ; on pressing the finger firmly upon it no pit is left, but the skin is very white until the capillaries fill again, which they do slowly. Should the skin ulce rate, the sore is very slow in healing, and gene rally has a brownish unhealthy look, but the state in question often lasts for years without any ulceration occurring. The disease is very indolent, neither increasing nor diminishing in extent for many years. We have not been able to trace it satisfactorily to any cause more than too much standing. All the cases observed by us have occurred in females between the ages of twenty and forty, whose employment kept them very much on foot. It appears to us to consist in a varicose state of the capillaries of the cellular tissue and inner side of the cutis. No treatment that we have employed has had anything more than a temporary effect. Pres sure, as long as it is continued, relieves it ; but all the morbid symptoms return upon the remedy being omitted.