The subfascial interruption of incompetent medial calf communicating veins

          • This shows the lower leg with a group of large varicosities in the pos­teromedial aspect of the calf and an intraluminal stripper in the long saphenous vein.
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          Postoperative care of extremities after radical operation for varicose veins of the lower extremity

          Postoperative care of extremities after radical operation for varicose veins of the lower extremity
          • This shows the location of the incisions, all of which have been closed with vertical mattress sutures of silk. The long saphenous vein has been removed from distal to the malleolus to the saphenofemoral junction. A lateral trunk was stripped to the small anterior low thigh incision. Through the oblique calf incision incompetent communicating veins were interrupted beneath the deep fascia, and through the two incisions at the ankle other communicating veins were interrupted at the point of their emergence through the deep fascia.
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          The operative technique ligation and stripping of long saphenous vein

          The operative technique ligation and stripping of long saphenous vein
          • This depicts exposure of the cephalad portion of the left long saphenous vein. To avoid inadvertently lacerating it, it is exposed most safely by scissor dissection with upward traction on the skin and the subcutaneous tissues with tooth forceps. The advantage of this method is that it does not retract the vein upward with the fatty tissue surrounding it. The dissection is accomplished most satisfactorily with curved Mayo type scissors.
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          Interruption of common femoral vein with thrombectomy

          Interruption of common femoral vein with thrombectomy
          • Interruption of the common femoral vein is indicated when a thrombus is found in it, or if a patient has had a minor pulmonary embolus, irrespective of whether there are signs of venous thrombosis in the lower extremities.
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          Phlebectomy and interruption of incompetent lateral leg and foot communicating veins for large tortuous varicoseveins

          Phlebectomy and interruption of incompetent lateral leg and foot communicating veins for large tortuous varicoseveins
              • The lateral side of the right lower thigh and the lower leg are shown with large superficial varicose veins. They are so tortuous it is not possible to strip them; for that reason they must be excised through multiple, small, slightly oblique in­cisions. In addition, the location of two incompetent communicating veins should be noted at (1) and (2). These may be identified by the abrupt ending of the varices at these sites. It is important to interrupt them as they emerge from the deep fascia.
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              The operative treatment of varicose veins of the lower extremity

              The operative treatment of varicose veins of the lower extremity

              The cure of varicose veins of the lower extremity can be accomplished by their surgical removal and the interruption of the incompetent communicating veins that are so important in the etiology. The percentage of cures depends on how rad­ical these surgical procedures are. The best results cannot be accomplished unless the surgeon has personally made a thorough examination of the extremities when the patient was first seen in his office. At this time a drawing of the varices should be made, tracing in the largest ones and noting the location of the incompetent communicating veins.

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              Mobilization of the Uterus and Adnexa

              This phase of intra-abdominal surgery is difficult to illustrate pictorially, but represents an essential preliminary maneuver for any surgical procedure in the female pelvis.

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              Interruption of incompetent distal posterior tibial communicating veins of left ankle

              Interruption of incompetent distal posterior tibial communicating veins of left ankle
                          • The inner aspect of the left lower leg is shown with intraluminal strippers in the main and accessory saphenous vein trunks. The location of the incisions to in­terrupt the calf communicating veins (1) and the distal ankle communicating veins (2) and (3) are shown. Note the superficial varices in these three areas that tell the surgeon that there are incompetent communicating veins at these locations.
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                          The Perthes Test | Diagnostic tests for varicose veins

                          The Perthes Test | Diagnostic tests for varicose veins

                          This test was described by G. C. Perthes, a German surgeon, in the latter part of the 19th century. It was devised to determine the patency and competence of the deep and communicating system of veins.

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                          Retroperitoneal drainage of pelvic abscess

                          Retroperitoneal drainage of pelvic abscess

                          Despite the success achieved by intensive antibiotic therapy in the control of pelvic sepsis, abscess formation may appear in the broad ligament or cul de sac and require surgical drainage. It may occur after abdominal or surgical procedures or be the natural development of pelvic disease in the absence of any operative interference.

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