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.
              • Note that the proximal incision (1) is oblique and the distal ones (2) and (3) are a little more longitudinal. The reason for this is that it is not possible to ascer­tain the exact location of the communicating veins, so it is necessary to utilize incisions that permit exploration of them from a longitudinal aspect. It has been found that these oblique incisions heal with a much better cosmetic type of scar. Note that a large communicating vein is shown in incision (1) coming out through the deep fascia. There are two in incision (2), the proximal one coming out through the deep fascia; the distal one, after incision of the deep fascia, can be seen to be arising from the posterior tibial vein. The saphenous vein trunks have also been removed by stripping.
              • This shows the double ligation and division of the communicating veins. This is done just at the level of the deep fascia for the two proximal veins. The distal one is ligated beneath the deep fascia since in this case it was necessary to incise the deep fascia to expose the posterior tibial vein to make sure it was a com­municating vein. It is obvious that at this level of the ankle it is not possible to do the extensive subfascial finger exploration that is carried out in the calf region.
              • This shows the skin closure with interrupted vertical mattress sutures of silk. The only subcutaneous closure is by interrupted sutures of 3-0 plain catgut to the deep fascia.


Interruption of incompetent distal posterior tibial communicating veins of left ankle



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